Employees struggling with the trials and expenses of infertility may be entitled to insurance coverage for that treatment. The New Jersey Family Building Act, N.J.S.A. 17:48E-35.22, provides certain employees with the right to insurance coverage that covers services relating to infertility, such as medications, surgery, in vitro fertilization, and certain other services. More specifically, the law requires “health service corporation contracts” between insurance companies and certain employers to include coverage for “medically necessary expenses incurred in the diagnosis and treatment of infertility….”
When determining whether this law applies to you, you must first determine whether there are more than 50 persons covered by the contract. If there are more than 50 persons under the contract (and generally there are for most public employees and employees of larger companies), then you must determine if an exception applies.
If the employer is covered under the law, you must then determine if your condition falls within the definition of “infertility” under the statute and the governing regulations. There are 8 categories of scenarios defined as “infertility,” which include women under the age of 35 who have been unable to become pregnant after 12 months of unprotected sex, women age 35 and over who have been unable to become pregnant after six months of unprotected sex, and partners who are unable to conceive as a result of involuntary medical sterility. Regarding the latter scenario, it is important to note that the regulations explicitly exclude any person who has been voluntarily sterilized, regardless of any attempts to reverse that sterilization.
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