NJ Mandate

I live and work in NJ - this is what it says:

New Jersey:
New Jersey law requires that group policies covering 50 or more people, and covering pregnancy-related expenses, need to cover the cost of the diagnosis and treatment of infertility. This includes surgery, IVF, GIFT, ZIFT, ICSI, embryo transfer, and IUI. Up to a maximum of four egg retrievals can also be performed.

ANOTHER SITE:
New Jersey:

A group health insurance policy issued to a group of more than 50 persons that includes pregnancy-related benefits must provide coverage for medically necessary expenses arising from the diagnosis and treatment of infertility. Infertility coverage must include diagnosis and diagnostic tests, medications, surgery, IVF, embryo transfer, artificial insemination, GIFT, ZIFT, intracytoplasmic sperm injection, and four completed egg retrievals per lifetime of the covered person. Coverage for IVF, GIFT, and ZIFT may be limited to a covered person who (1) has used all reasonable, less expensive and medically appropriate treatments and is still unable to become pregnant or carry a pregnancy; (2) has not reached the limit of four completed egg retrievals; and (3) is 45 years old or younger. A religious employer may exclude coverage for IVF, embryo transfer, artificial insemination, ZIFT, and intracytoplasmic sperm injection, if they are contrary to its bona fide religious tenets.

“Infertility” is the disease or condition that results in the abnormal function of the reproductive system such that a person cannot (1) impregnate another; (2) conceive after two years of unprotected intercourse if the female is under 35 years old, or one year of unprotected intercourse if she is 35 or older or one of the partners is medically sterile; or (3) carry a pregnancy to live birth. Benefits must be provided to the same extent as for pregnancy-related procedures, except that services must be performed at facilities that conform to ACOG or the American Society for Reproductive Medicine standards. Copayments, deductibles, and benefit limits that apply to other medical or surgical benefits also apply to infertility diagnosis and treatment (N. J. Stat. Ann. § 17B: 27-46. 1x).

My insurance (UHC) covers diagnostic procedures and medications for infertility. It states this is excludes IUI, IVF, ICSI etc.

My employer has almost 6000 employees worldwide. Approx. 1000 in NJ alone. Reading the statement above, doesn't that lead you to believe it should cover the cost? I have an appt. on Tuesday with the financial counselor at my RE, but - am I reading this wrong??

Message edited 6/13/2008 8:23:05 PM.

Re: NJ Mandate

I think though it depends which state is your company headquarters, because that is probably the state mandate that counts

Re: NJ Mandate

Re: NJ Mandate

squeak wheel...squeak!!!

Re: NJ Mandate

Jen - Call your insurance and ask why they are not following the state mandate!

I just re-read part of your post. My husband has UHC, and I work for a HUGE company as well (we work for the same company). His insurance does cover IVF - 3 lifetime attempts. Although, I am going to call both mine and his and ask why 3 when the NJ mandate says 4.

Message edited 6/14/2008 8:42:42 AM.

Re: NJ Mandate

Re: NJ Mandate

What "type" of company do you work for?

A lot of companies can be excluded from the mandate.

I worked in insurance.

Some companies are called ASO accounts.

BAsically they pay more to get excluded from things liek mandates. Its suppossed to be better for the insured, but sometimes ends up worse.

Unions are always excluded, many school districts, state and local and fed government positions are excluded and large large corporations.

HTH

Re: NJ Mandate

My company is headquartered in Milwaukee, however our insurance is from Illinoise. This might be the case with you as well.

Re: NJ Mandate

Found out today we are "self-insured" and therefore not included.

SO UNFAIR!!!!!!!!!!!!

Re: NJ Mandate

Posted by CaseyGirl

Found out today we are "self-insured" and therefore not included.

SO UNFAIR!!!!!!!!!!!!