Mandated Insurance Coverage of Infertility Treatment
An Analysis of Age Requirements for New Jersey
Mandated Insurance Coverage of Assisted Reproductive Technology Over the past decade, advances in assisted reproductive technology (ART) including such procedures as in vitro fertilization (IVF) have reduced the obstacles to conception for women with infertility issues, particularly for women of advanced maternal age. Each state is now facing the dilemma of whether or not to mandate coverage of ART for their constituents. Furthermore, the state must decide what the qualifications for coverage should be if a mandate is to be enacted. RESOLVE, the National Infertility Association, a non-profit consumer-advocacy and patient –support organization, maintains a website with an up to date listing of mandated infertility coverage for each state (www.resolve.org). Currently, thirteen states have made the decision to mandate infertility coverage, New Jersey is one of two states, the other being Connecticut, who have chosen to apply an age requirement. On February 28, 2000, the state of New Jersey enacted a mandate to regulate coverage for ART services. The New Jersey State legislature is now concerned that the state may be perceived to be discriminating based upon age. Legislators have requested an analysis to answer the question: Is there a more appropriate age cutoff for mandated insurance coverage for infertility? In the past there have been minor amendments to the New Jersey fertility mandate informally known as the Family Building Act. It is the intention of this analysis to help New Jersey legislators determine whether the current coverage limitation is fair and reasonable and/or if the age requirement should be modified to make it so. As the mandate currently stands, health insurance policies covering more than 50 people are required to offer services for the diagnosis and treatment of infertility to individuals over 35 years of age who have been unable to conceive for two years, and to those between the ages of 35 and 45 who have been unable to conceive for one year. No coverage is mandated for those over 45 years of age (Martin, 2001). Furthermore, groups that are self-funded, or employed under a religious organization for which fertility treatment is contrary to their ideology, are not required to follow the mandate. Recently, legislators have reviewed the requirement of 50 or more persons to be on one policy, as this excludes employees of small businesses from infertility benefits; however, a decision has not yet been made on whether or not to make amendment in this regard (Karcher, 2006). Legislators are now requesting a review and analysis of sections 1a, 2a, 3a, 4a, and 5a, which state that covered persons must be “45 years of age or younger” (Martin, 2001). Analysis is required to determine if the aforementioned limitation/exclusion should be expanded to include infertile persons 50 years of age or younger, reduced to include only those 42 years of age or younger, or eliminated completely. The population most impacted by a change in the infertility policy would be women between the ages of 42 and 50. Women in this age group may find themselves faced with a change in their health insurance coverage for infertility services. As an amendment in the age requirement has not previously been considered nor has it been publicly announced there is a need to scrutinize the possible amendment before announcing any such change which could cause unrest in the community. Possible Actions
Expansion of Age Requirement. The first possible reformation to the current age requirement would be to increase infertility coverage to include women 50 years of age and under. The social and financial impacts must be examined in order to properly determine the feasibility of such a change. An extension of women covered could have both positive and negative...