Infertility and Insurance Coverage Mandates in New York

Introduction

Let’s cut to the question everyone considering surrogacy or egg donation living in New York has: Does the law in New York require infertility coverage that includes procedures like egg retrieval on a donor or an embryo transfer on your surrogate?  Unlike Illinois and California in 2026, your infertility health plan coverage will cover only you, not a third party. Your plan may cover your own infertility treatment and, if you’re on a New York‑regulated large‑group fully insured plan, up to three IVF cycles subject to medical necessity and preauthorization. See the Department of Financial Services (DFS) overview of infertility, IVF, and fertility preservation requirements but no coverage for a surrogate’s or donor’s procedures to treat your infertility under your policy.. Coverage cannot discriminate in application to LGBTQ+ individuals, however, this doesn’t appear to mean the same thing as in Illinois or California.

What your plan may cover for you 

All fully insured policies in New York must cover “basic” infertility services such as diagnosis and non‑IVF treatments (like IUI) when you meet the definition of infertility. 

Under New York insurance rules, infertility means a disease or condition characterized by the inability to impregnate another person or to conceive, defined as failure to establish a clinical pregnancy after 12 months of regular, unprotected intercourse or therapeutic donor insemination (or after 6 months if the female partner is age 35 or older), with earlier evaluation and treatment when clinically indicated. Read the full definition. 

Large‑group fully insured policies must also cover up to three IVF cycles, including IVF‑related prescription drugs; prior authorization and step therapy are allowed. Self‑funded employer plans are not bound by these state mandates, so their benefits depend on the plan document. For details, start with DFS’s insurer Q&A on New York’s IVF and fertility preservation law. 

New York also requires coverage for fertility preservation when medical treatment may cause infertility (including gender‑affirming care). Collection, freezing, and storage are included, but IVF itself is not required as a preservation service. Storage linked to an intended IVF procedure is covered during the window in which the three mandated IVF cycles are available. 

Carriers cannot discriminate in infertility coverage based on sexual orientation, marital status, gender identity, age, or disability. DFS’s 2021 circular letter explains how plans must provide immediate access to basic infertility services for people who need medical intervention to conceive, while still allowing appropriate step therapy before IVF.

Surrogacy in New York: who pays for what 

Your plan may cover your IVF to create embryos if IVF is part of your benefit. It will not cover a gestational surrogate’s embryo transfer, prenatal care, delivery, or postpartum care unless the surrogate is actually enrolled under that same policy. DFS’s consumer guidance makes this “covered members only” rule explicit. 

Separate from insurance mandates, the Child‑Parent Security Act requires intended parents to provide a comprehensive health insurance policy for the surrogate from pre‑transfer meds through twelve months postpartum, plus certain other protections. New York’s Surrogates’ Bill of Rights and CPSA pages outline these obligations; build them into your agreement and escrow before medications begin.

Using donor eggs or sperm 

Plans generally process the recipient’s side of care (monitoring, transfer, embryology) under the member’s infertility/IVF benefit if the cycle meets medical‑policy criteria. However, the statute does not expressly guarantee donor‑egg IVF; approval is plan‑specific, so preauthorization is essential. 

A donor’s medical services and fees are different. Because insurance only covers its enrollees, your plan will not pay a donor’s screening, retrieval, medications, compensation, or agency costs. The Department of Health’s donor fact sheet notes that, in most cases, the program or recipient pays the donor’s medical bills, and programs may require separate complication coverage. Budget accordingly and confirm billing with your clinic. 

If you’re on a self‑funded plan or Medicaid 

Self‑funded plans set their own infertility and IVF terms; check your Summary Plan Description and the plan’s medical policy. New York Medicaid offers a limited infertility benefit (office visits, diagnostics, certain ovulation‑inducing drugs) and does not cover IVF. Medicaid covers maternity care for eligible members, which can include an eligible surrogate, but that is separate from the intended parents’ commercial plan. 

Need legal guidance? 

If you're pursuing egg donation, surrogacy, or both in New York, Tsong Law Group can help you protect your family and finances. Our attorneys are licensed in California, New York, Illinois, Washington, Arizona, and Oklahoma—and we’ve helped families nationwide navigate fertility law with confidence.

This article is for informational purposes only and does not constitute legal advice. It does not create an attorney‑client relationship with the reader.