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Basic Infertility Coverage
Plans that offer basic coverage will generally cover diagnostic testing before and after a diagnosis of infertility have been established. Services that are usually covered under basic coverage are:
| • Office visits |
• Hysterosonogram |
| • Blood tests |
• Semen analysis |
| • Ultrasounds |
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*Please Note: If you are covered with under an Aetna Managed Care product (HMO or POS) you will not be covered to have any necessary diagnostic blood tests and/or ultrasounds done in the office. Unfortunately, at this benefits level Aetna requires you to have such services performed at a participating laboratory (i.e. Quest or Lapcorp) or at a participating imaging facility. If you choose to have these services at URA you will be financially responsible for any costs incurred at the time of service.
Comprehensive Infertility Coverage
Generally comprehensive coverage is offered to small group policies. These plans will cover diagnostic testing and Artificial Insemination (IUI) only. Services generally covered under this benefit level are:
| • Office visits |
• Hysterosalpingogram(HSG) |
| • Blood tests |
• Semen analysis |
| • Ultrasounds |
• Diagnostic ART prep |
| • Hysterosonogram |
• Artificial insemination (IUI) |
Advanced/ART Infertility Coverage
This is the highest level of infertility coverage offered. Plans that offer Advanced/ART coverage will generally cover services such as:
| • Office visits |
• Hysterosalpingogram (HSG) |
| • Blood tests |
• Semen analysis |
| • Ultrasounds |
• Diagnostic ART prep |
| • Hysterosonogram |
• Artificial insemination (IUI) |
| • In Vitro Fertilization(IVF) |
• Infertility medications |
NJ Infertility Mandate
In November 2001, the State of NJ implemented the “The Family Building Act Law”, otherwise known as the NJ State Infertility Mandate. This law requires that NJ health insurance policies provide infertility benefits to large employer groups (>50 employees). Unfortunately, this law exempts self-insured companies, federal employees, religious groups, & small groups .
This law will cover anyone who meets the following criteria:
• A male is unable to impregnate a female.
• A female under 35 years of age is unable to conceive after two years of unprotected intercourse.
• A female 35 years of age and over is unable to conceive after one year of unprotected intercourse.
• The male or female is medically sterile.
• The female is unable to carry a pregnancy to live birth.
Services covered under this law:
• Diagnosis & diagnostic testing.
• Artificial insemination (IUI) with an unlimited number of cycles.
• In-vitro fertilization (IVF), including the use of donor eggs and/or a gestational carrier (if medically indicated) limited to 4 egg retrievals per lifetime.
• Assisted Hatching (AZH) & Intracytoplasmic Sperm Injection (ICSI).
• Fresh & frozen embryo transfer.
• Infertility medications, including injectables, even if the contract does not provide prescription benefits.
• Ovulation Induction
• Surgery
Exclusions Under the Law:
Cryopreservation & storage charges
• A person who has undergone voluntary sterilization and/or one who has reversed his/her sterilization is no longer ineligible for coverage under the law.
• In-vitro Fertilization (IVF) can be denied only when one or more of the following applies:
• Covered person failed to use all reasonable less expensive & medically appropriate treatments first.
• The covered person has reached the limit of 4 egg retrievals.
The covered person is 46 years of age or older.
In November 2001, the State of New Jersey implemented the “The Family Building Act Law”, otherwise known as the NJ State Infertility Mandate. This law requires that NJ health insurance policies provide infertility benefits to large employer groups (>50 employees). Unfortunately, this law exempts self-insured companies, federal employees, religious groups, & small groups .
This law will cover anyone who meets the following criteria:
• A male is unable to impregnate a female.
• A female under 35 years of age is unable to conceive after two years of unprotected intercourse.
• A female 35 years of age and over is unable to conceive after one year of unprotected intercourse.
• The male or female is medically sterile.
• The female is unable to carry a pregnancy to live birth.
Services covered under this law:
• Diagnosis & diagnostic testing.
• Artificial insemination (IUI) with an unlimited number of cycles.
• In-vitro fertilization (IVF), including the use of donor eggs and/or a gestational carrier (if medically indicated) limited to 4 egg retrievals per lifetime.
• Assisted Hatching (AZH) & Intracytoplasmic Sperm Injection (ICSI)Fresh & frozen embryo transfer.
• Infertility medications, including injectables, even if the contract does not provide prescription benefits.
• Ovulation Induction
• Surgery
Exclusions Under the Law:
• Cryopreservation & storage charges
• A person who has undergone voluntary sterilization and/or one who has reversed his/her sterilization is no longer ineligible for coverage under the law.
• In-vitro Fertilization (IVF) can be denied only when one or more of the following applies:
• Covered person failed to use all reasonable less expensive & medically appropriate treatments first.
• The covered person has reached the limit of 4 egg retrievals.
• The covered person is 46 years of age or older. | 
