About New Jersey Infertility Treatment

Infertility is defined as the failure to conceive after one year of unprotected sexual intercourse.

In the United States approximately 15-20 percent of married couples will experience some degree of infertility. This means that 1 in 6 couples will need professional assistance. Traditionally, human infertility has been referred to as the “woman’s problem,” ignoring the male contribution. More recent studies have revealed that in a population of infertile couples, about 40 percent of infertility cases are due to male factors, 40 percent are due to female factors and the other 20 percent are due to female and male factors together.

But a diagnosis of infertility does not mean that becoming pregnant is impossible. Nearly 90 percent of infertility cases are treatable with medical therapies ranging from drug treatment and surgery to advanced reproductive technologies such as in vitro fertilization (IVF).

To completely evaluate the reproductive potential of a couple, the physician must see the couple together to facilitate treatment. Infertility can be a multi-factor problem, where several conditions when presented alone are not so important but when added together could markedly influence the reproductive potential of a couple. Therefore, a systematic, simultaneous basic evaluation should be implemented on both spouses.

New Jersey mandate for infertility coverage

A select few states in the U.S. have laws requiring health insurance companies to provide coverage for infertility treatment, and New Jersey is one of them. The insurance mandate states that any insurance provider who provides pregnancy-related benefits must also cover infertility treatment and IVF costs.

If you meet the following criteria and definition of infertility, you may be able to receive health insurance coverage for infertility treatment in the state of New Jersey.

  • A male is unable to impregnate a female
  • A female under 35 years of age is unable to conceive after two years of unprotected sexual intercourse
  • A female 35 years of age or over is unable to conceive after one year of unprotected sexual intercourse
  • The male or female is medically sterile
  • The female is unable to carry a pregnancy to live birth
  • Patients must be less than 46 years of age
  • Patients have been unable to obtain successful pregnancy through any less costly infertility treatments covered by insurance.

The New Jersey infertility insurance mandate (officially known as the New Jersey Family Building Act) will cover the costs of the following treatments for eligible patients:

  • In vitro fertilization (IVF)
  • Intracytoplasmic sperm injection (ICSI)
  • Artificial insemination
  • Assisted hatching
  • Fresh and frozen embryo transfers
  • Fertility medications
  • Fertility surgery
  • Gamete intrafallopian transfer (GIFT)
  • Zygote intrafallopian transfer (ZIFT)
  • Fertility testing and diagnostics
  • Four completed egg retrievals per lifetime
  • Ovulation induction.

Read Full Benefit Standards for Infertility Coverage