N.J. Admin. Code § 11:4-54.5

Current through Register Vol. 56, No. 19, October 7, 2024

Section 11:4-54.5 - Permissible benefit exclusions

(a) Following are the only permissible exclusions from the infertility benefit requirements of this subchapter:

1. Reversal of voluntary sterilization.

i. Coverage for infertility services provided to partners of persons who have successfully reversed sterilization may not be excluded provided that the partner is infertile as defined by P.L. 2001, c. 236 and this subchapter;

2. Payment for medical services rendered to a surrogate for purposes of childbearing where the surrogate is not covered by the carrier's policy or contract;

3. Costs associated with cryopreservation and storage of sperm, eggs and embryos;

4. Nonmedical costs of an egg or sperm donor. Medical costs of donors, including office visits, medications, laboratory and radiological procedures and retrieval, shall be covered until the donor is released from treatment by the reproductive endocrinologist;

5. Infertility treatments that are experimental or investigational in nature;

6. Ovulation kits and sperm testing kits and supplies;

7. In vitro fertilization, gamete intrafallopian tube transfer, and zygote intrafallopian tube transfer for persons who have not used all reasonable less expensive and medically appropriate treatments for infertility, who have exceeded the limit of four covered completed egg retrievals, or who are 46 years of age or older; and

8. Group policies, contracts, riders and endorsements that provide hospital or medical benefits, other than policies or contracts that provide prescription drug benefits only, may provide that infertility medication benefits are excluded if infertility medication benefits are provided under another group health insurance policy or contract issued to the same policyholder or contractholder.

N.J. Admin. Code § 11:4-54.5