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New York State’s New Health Insurance Directive — What It Is, and How Will It Expand Fertility Treatment For Couples?

Through their new insurance directive, New York State is taking steps to ensure that all couples and individuals, regardless of their sexual orientation or gender identity, do not have to deal with discriminatory policies and costs when it comes to fertility treatments.

March 26, 2021
Annabeth Collis

For LGBTQ+ couples, in vitro fertilization and other fertility treatment options can be helpful and important avenues for starting a family. Although these couples benefit from access to these services, without direct legal protection, these couples must sometimes pay more out-of-pocket expenses than heterosexual couples for infertility treatments. 

Fortunately, this past Tuesday, New York State Governor Andrew Cuomo and The Department of Financial Services announced new health insurance guidance for the state. 

Here’s what this new guidance means for same-sex couples in New York State. 

a baby's crib with an elephant blanket hanging over the side
There are many fertility treatment options for both males and females, and same-sex couples can do research to figure out which method will be best for starting their families. 

LGBTQ+ Couples and Access to Fertility Treatments

When trying to conceive and start a family, same-sex couples face different steps and challenges from heterosexual couples. Because this pathway to parenthood is different, same-sex couples often turn to IVF and other fertility treatments when they are ready to become parents. 

Female Fertility Options

The fertility process for female same-sex couples usually begins with the couple deciding which person will carry the baby. Although this decision can be directly made by the couple, it is often also informed by the medical histories of both partners. Typically, a physician will obtain the full medical and gynecologic records of both partners and make a decision about which partner has the least chance of experiencing medical complications that will make it more difficult or more dangerous to carry a baby. 

After these things are considered, female couples can decide which specific fertility treatment option they would like to pursue. These treatment options can include:

  • Intrauterine Insemination (IUI) - The simplest and least expensive method of conceiving for female same-sex couples, IUI can be done without medication. Even though this option is the simplest, starting treatment does involve testing, and IUI has approximately a 20% pregnancy rate per month. 
  • In Vitro Fertilization (IVF) - IVF has the highest chance of success per month, and it is typically one of the fastest options. However, IVF often costs more than other treatments, so it is important for couples to factor in their financial situation before committing to this option. 
  • Co-maternity - If couples opt to pursue co-maternity, one woman in the couple donates her eggs for the other woman to carry.

When selecting one of these options, female couples also need to consider if they would like to use anonymous or known-donor sperm. If a couple decides to use known-donor sperm, legal and psychiatric clearance is required and a six-month quarantine of the sperm is recommended.

Male Fertility Options

When deciding who will carry the baby, male same-sex couples have two primary options:

  • Gestational Carrier - For this option, a woman is chosen to be both the source of the egg and the uterus. 
  • Surrogate Carrier - This option involves one woman being either a known or anonymous egg donor and a different woman carrying the baby. 

After an option is selected, medical evaluations are conducted for the sperm-contributing partner and the egg-contributing female. In addition to conducting a routine evaluation of the female carrier’s uterus, doctors will also look at the female carrier's previous obstetric history. An ideal gestational carrier should have:

  • No previous cesarean deliveries — this places all subsequent pregnancies at a higher risk of complications. 
  • Prior full-term vaginal deliveries (this should be a prerequisite)
  • No toxic or unhealthy habits (including smoking) 

Once these details regarding the female carrier are decided, the male couple chooses which partner’s sperm is going to be used. The sperm from the selected sperm provider will be screened for disease, and a routine semen analysis will also be used to determine the most effective type of fertilization. 

Because same-sex couples often need access to these medical resources and procedures to start their families, it can be crucial that they are not burdened by extra and unnecessary medical expenses. 

a man signing a document
In an attempt to prevent discriminatory policies and excessive fertility treatment costs, New York State has issued a new health insurance directive. 

New York State: Expanding Health Insurance

As of February 23, 2021, the New York State Department of Financial Services was given guidance requiring New York health insurers to cover fertility services for all New Yorkers. This means that regardless of sexual orientation or gender identity, New York State health insurers are now required to provide coverage of services for every patient’s infertility diagnosis and treatment. 

This new directive applies to people insured under individual, small group, and large group health insurance policies, but it is also specifically meant to protect individuals who are unable to conceive due to their sexual orientation or gender identity.

First proposed in Governor Cuomo’s State of the State Address, this new guidance is an important part of the Women’s Agenda and a significant step forward for protecting the rights of women and LGBTQ+ New Yorkers. 

the New York State flag
In the wake of New York State’s health insurance announcement, insurers will need to provide coverage for infertility treatments for all individuals — regardless of gender identity or sexual orientation. 

Cuomo’s Announcement: What It Means Going Forward

Although current insurance law requires insurers to cover infertility services, individuals and couples who are not able to conceive due to their sexual orientation or gender identity frequently pay six to 12 months out-of-pocket expenses for infertility treatments. Now with this new directive, these people will be protected. 

In the state’s most recent Insurance Circular Letter, the Department of Financial Services expressed this point, saying that it was brought to their attention that some issuers may be requiring certain individuals to incur costs due to their sexual orientation or gender identity. The department specifically noted that heterosexual individuals did not incur similar costs in order to meet the definition of infertility. 

Essentially, these extra costs result in unfair discrimination for individuals based on their sexual orientation or gender identity, and this is prohibited by Insurance Law. As a result of the state’s new directive, issuers must provide immediate coverage for basic infertility treatments that are covered under an insurance policy or contract. 

Now with this new directive, a wider range of couples and prospective parents will be protected. 

a baby mobile with hanging stuffed animals
Many prospective parents rely on fertility treatments to start their families, and anti-discriminatory policies can help ensure that any individual or couple who wants children has access to the care they need. 

Many couples and individuals experience fertility challenges and obstacles as they try to start their families. Because of this, fertility treatments are often essential for people trying to conceive. Through their new insurance directive, New York State is taking steps to ensure that all couples and individuals, regardless of their sexual orientation or gender identity, do not have to deal with discriminatory policies and costs when it comes to fertility treatments. 


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