Weinberg, Gill Legislation Expanding Fertility Treatment Coverage Goes to Governor

State Seal

TRENTON – Legislation sponsored by Senate Majority Leader Loretta Weinberg and Senator Nia H. Gill to update state law and increase fertility coverage for New Jersey women received final approval today in the Senate. It now goes to the governor’s desk.

“New Jersey’s current laws are discriminatory when it comes to coverage for fertility treatments,” said Senator Weinberg. “It’s critical that we update coverage guidelines to ensure that women are covered, including those with same-sex partners. This bill will establish that coverage eligibility may be based on a doctor’s determination of infertility. This is about updating the law, but it’s also an issue of women’s rights.”

“Current guidelines unfairly restrict health insurance coverage of fertility treatments for some women,” said Senator Gill. “Clarifying the law will better ensure that women are not denied coverage based on their relationship status or sexual orientation. This is an important change that will better ensure that women can get the treatment they need.”

The bill (S1398) expands the availability of insurance coverage for infertility-related health benefits to certain women that are currently denied coverage for those benefits under certain health insurance plans. The legislation would amend the current definition of infertility to provide that infertility can be demonstrated through a determination of infertility by a licensed physician. It would also provide additional clarification to the law to remove barriers to coverage.

Under current law, hospital, medical and health service corporations, commercial group insurers and health maintenance organizations are required, in certain circumstances, to provide coverage under group policies for medically necessary expenses incurred in the diagnosis and treatment of infertility.

Current law defines “infertility” as the disease or condition that results in the abnormal function of the reproductive system such that a female partner under 35 years of age has been unable to conceive after two years of unprotected intercourse, or a female partner over 35 has been unable to conceive after one year of unprotected intercourse or one of the partners is considered medically sterile.

Because the definition of infertility requires the female partner to have unprotected intercourse, certain females, such those with same-sex partners, women without partners, or women with partners who have protected intercourse, may not be qualified to receive coverage for these benefits.  This bill defines “infertility” as: a disease or condition that results in the abnormal function of the reproductive system, as determined pursuant to American Society for Reproductive Medicine (ASRM) Guidelines by a physician who is board certified or board eligible in Reproductive Endocrinology and Infertility or in Obstetrics and Gynecology or as meeting certain conditions laid out in the legislation.

The legislation includes the State Health Benefits Plan and the School Employees Health Benefits Plan among the health benefits plans that must provide expanded availability of insurance coverage for infertility-related health benefits under the bill.

The Senate approved the bill by a vote of 34-1. The Assembly approved it 58-6-3.