Employees covered under large group insurance plans in New York State will be delighted to learn that beginning in 2020, in-vitro fertilization (IVF) will be a mandated covered benefit on their healthcare plans. New York became the 10th state to mandate coverage for IVF, requiring employers with 100 or greater employees to provide coverage for three IVF cycles. Each IVF cycle can run around $10,000 to $20,000, so this additional coverage will be a welcome benefit for individuals facing infertility challenges. Additionally, the legislation that’s taking effect on January 1, 2020, will mandate egg freezing for certain patients facing health risks. More information on the bill and what’s included, along with estimated costs, can be found here.
The New York State Department of Financial Services (NYDFS) hired Wakely Consulting to analyze the incremental cost to premiums for this additional benefit, and the estimated impact on insured plans will be 0.5% to 1.1%. So essentially, the entire employer group will be subsidizing this costly but invaluable benefit utilized by a small percentage of the population. But as we blogged about before, yesterday’s luxuries are today’s necessities – and though NY already mandated certain advanced infertility services like artificial insemination, IVF needs are now being recognized as fundamental benefits of every large plan.
One important caveat. As with all state mandates, if an employer is self-funded, they can elect NOT to provide the IVF coverage since self-funded programs are regulated at the Federal level by ERISA, not at the state level by NYDFS. Therefore, NY-based, self-funded employers should give some long, hard thought as to whether they’d like to cover IVF services. There is no doubt it will add cost to their programs, but many employees will likely come asking.