New York requires fully insured large-group plans (more than 100 employees) to cover 3 IVF cycles and prescription drugs for IVF, and requires every fully insured plan to cover fertility preservation before fertility-damaging medical treatment.
Your plan
What the law does
Fully insured, employers with more than 100 employees
Likely required to cover IVF — 3 egg retrievals, unlimited transfers. Applies when the plan renews on or after 2020-01-01.
Fully insured, smaller employer
Not covered by the law. Any benefit is voluntary plan design.
Individual / marketplace plan
Not covered by the law.
Self-funded employer plan (card says "administered by")
Exempt from state law (ERISA). Coverage, if any, is your employer's choice — check the Summary Plan Description for a fertility rider or lifetime maximum.
Medicaid
Covers some fertility medications only, not IVF procedures.
Free, 5 steps, nothing saved unless you choose to.
The one thing to check first: is your plan self-funded?
State fertility laws only reach fully insured plans. Most workers at large employers are in self-funded plans, which are governed by federal ERISA law and exempt from every state mandate — 67% of covered workers nationally, and about 80% at firms with 200+ employees (KFF 2025).
Look at your insurance card. If it says "administered by" (an insurer's name as the third-party administrator), your plan is probably self-funded. If it says "insured by" or "underwritten by," it is probably fully insured. The card is a strong hint, not proof — the only definitive answer comes from HR: "Is our medical plan self-funded or fully insured?"
This also decides where a denied claim goes: fully insured plans appeal to the state insurance regulator; self-funded plans appeal under ERISA rules to the U.S. Department of Labor.
What the law requires
Cycle cap: 3 completed egg retrievals with unlimited embryo transfers — 3 IVF cycles per lifetime. DFS defines a cycle as all treatment starting when medications are administered for ovarian stimulation with intent of a fresh transfer, OR when medications are administered for endometrial preparation with intent of a frozen embryo transfer. A retrieval + embryo freezing + first FET counts as one cycle; each later FET-only cycle also counts as a cycle. A cycle that began but was not completed still counts..
Who qualifies: the definition of infertility is inclusive — single people and LGBTQ+ patients qualify without a heteronormative 'unprotected intercourse' requirement.
Step therapy: the law allows plans to require IUI before IVF except: DFS: insurers may consider whether basic treatments such as IUI are medically appropriate first, but may not require patients to pay out of pocket for therapeutic donor insemination to prove infertility when inability to conceive is due to sexual orientation or gender identity.
Medications: covered.
PGT-A genetic testing: not addressed by the law — plan-specific.
Embryo storage: covered.
Donor eggs/sperm: not addressed by the law — plan-specific.
Surrogacy: not covered.
Fertility preservation before cancer treatment: required.
Where people get surprised
Self-funded employer plans are exempt under ERISA even if the employer is in New York — the card usually says 'administered by'.
Small-group (100 or fewer employees) and individual/Marketplace plans do not have to cover IVF — only diagnosis, basic treatment and fertility preservation.
A frozen embryo transfer done as its own cycle counts against the 3-cycle limit; a cycle you start but cancel also counts.
NY Medicaid covers only ovulation-enhancing drugs (clomiphene, letrozole, etc.) and related monitoring for ages 21–44, up to 3 cycles per lifetime — no IVF.
IVF is not required as a fertility preservation service; freezing embryos before cancer treatment may be handled differently from freezing eggs or sperm.
What may change
S.2619-A (Scarcella-Spanton) — Would remove the 3-cycle limit on IVF coverage and extend IVF coverage to individual and small-group policies. Status: Amended and recommitted to Senate Insurance Committee 2026-05-26.
S.8866 (Salazar) — Equity in Fertility Treatment Act — Would require coverage of 3 completed donor egg retrievals with unlimited embryo transfers, bar denials based on prior fertility preservation, and codify IVF coverage for same-sex couples. Status: Passed Senate 2026-01-27; in Assembly committee.
S.3155 (Cooney) — Would prohibit insurers from requiring women 35+ to transfer all embryos from a prior cycle before covering another cycle. Status: Passed Senate 2026-01-27; in Assembly committee.
S.4497 (Hinchey) — Would broaden required coverage of fertility preservation services (egg freezing and storage). Status: Passed Senate 2026-01-27; in Assembly committee.
How to appeal a denial
Internal appeal — you have 180 days from the denial to file. The plan must decide within 30 days (before service) or 60 days (after service); 72 hours if urgent.
External review — available for at least 4 months after the final internal denial, for medical-necessity and "experimental" denials (PGT-A, ICSI, step therapy). An independent reviewer decides within 45 days. Contractual exclusions are not eligible for external review — those go to the regulator as a complaint.
Regulator — New York State Department of Financial Services (DFS). DFS External Appeal program (independent external review of medical-necessity, experimental/investigational and out-of-network denials after internal appeal) File a complaint. Copy the regulator on every appeal letter; clinics report it speeds things up.
If your plan is self-funded, skip the state regulator: your appeal runs under ERISA and complaints go to the U.S. Department of Labor's Employee Benefits Security Administration.
Frequently asked
Is IVF covered by insurance in New York?
New York requires fully insured large-group plans (more than 100 employees) to cover 3 IVF cycles and prescription drugs for IVF, and requires every fully insured plan to cover fertility preservation before fertility-damaging medical treatment.
My employer is large but my card says 'administered by' — does the state law apply?
Probably not. 'Administered by' usually means a self-funded plan, which federal ERISA law exempts from state insurance mandates. Confirm with HR.
The law took effect but my plan doesn't cover IVF yet — why?
The requirement applies to plan years beginning on or after 2020-01-01. If your plan year renews mid-year, coverage starts at that renewal.
What if my claim is denied?
File an internal appeal within 180 days, request the exact policy language relied on, and copy the regulator. Medical-necessity and 'experimental' denials can go to external review.
This page explains public coverage rules and typical prices as of the dates shown. It is an estimate and an interpretation, not a coverage decision by your plan, and not legal, medical, tax, or insurance advice. Your plan documents control. We never store what you enter here unless you choose to save a plan.