N.J. Admin. Code § 11:4-54.4

Current through Register Vol. 56, No. 24, December 18, 2024

Section 11:4-54.4 - Required benefits

(a) Infertility coverage shall include, but is not limited to, payment of benefits for the following services and procedures recognized by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists:

1. Artificial insemination with no limit as to the number of cycles;

2. Assisted hatching;

3. Diagnosis and diagnostic tests;

4. Fresh and frozen embryo transfer;

5. Four completed egg retrievals per lifetime of the covered person;

i. Where a live donor is used in the egg retrieval, the medical costs of the donor shall be covered until the donor is released from treatment by the reproductive endocrinologist;

ii. Egg retrievals where the cost was not covered by any carrier shall not count in determining whether the four completed egg retrieval limit has been met;

6. Gamete intrafallopian transfer and zygote intrafallopian transfer;

7. Intracytoplasmic sperm injections;

8. In vitro fertilization, including in vitro fertilization using donor eggs and in vitro fertilization where the embryo is transferred to a gestational carrier or surrogate;

9. Medications, including injectible infertility medications, even if the contract or policy does not provide prescription drug benefits. Where a contract or policy provides both prescription drug and medical and hospital benefits, infertility drugs shall be covered under the prescription drug coverage;

10. Ovulation induction; and

11. Surgery, including microsurgical sperm aspiration.

N.J. Admin. Code § 11:4-54.4