BILL NUMBER: S5545
SPONSOR: HOYLMAN-SIGAL
 
TITLE OF BILL:
An act to amend the insurance law, in relation to the definition of
infertility and health insurance coverage for in-vitro fertilization
 
PURPOSE:
To ensure that all those wish to become parents through in-vitro ferti-
lization (IVF) may have the coverage to do so by requiring insurance
coverage for donor cycle.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 sets out the title of this act.
Section 2 amends section 3221 of the insurance law to expand IVF cover-
age to include donor cycles.
Section 3 amends section 4303 of the insurance law to expand IVF cover-
age to include donor cycles.
Section 4 provides the effective date.
 
JUSTIFICATION:
The 2019 enacted budget established a requirement for insurance compa-
nies to cover three IVF cycles. The intent was to make the language
non-discriminatory for the LGBTQ+ community. However, key groups were
inadvertently excluded. While the law affords coverage to couples where
one of the partners is using IVF, coverage is unavailable to gay men, as
donor cycles, a key element necessary to obtain an egg, are not covered.
Coverage is therefore also not available for lesbian couples where
neither partner will undergo IVF.
The original 2019 legislation intended to cover three completed cycles
of IVF where one complete cycle begins with either hormone treatment and
retrieval, depending on the needs of the parents, and ends with trans-
fer. However, currently, insurance companies have interpreted a complete
cycle of IVF to only be one phase of the process. For example, insurers
have interpreted retrieval as one completed cycle and transfer as anoth-
er completed cycle. As a result, some couples are left to pay out of
pocket, even when transferring embryos from a covered cycle, or when
additional cycles of IVF are needed, and others must stop their IVF
journey entirely as they cannot afford the care. Further, when transfers
are not properly covered, it serves as an incentive to transfer too many
embryos in one transfer, which is risky and leads to bad medical
outcomes for all involved.
This legislation will ensure that the 2019 law is implemented as
intended by requiring coverage of donor cycles and explicitly stating
that coverage will be provided for three full rounds of IVF, each
including a completed oocyte retrieval and the process of in-vitro
fertilization with unlimited embryo transfers from the covered
retrieval. This legislation will ensure that those who wish to become
parents through IVF, and have the insurance coverage afforded by the
2019 legislation, are able to do so.
 
LEGISLATIVE HISTORY:
S.6118 of 2023-2024 (Hoylman-Sigal): Died in Rules
A.6177 of 2023-2024 (Paulin): Died in Insurance
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
Immediately.