Q: I’ve heard that the Family Building Act of New Jersey can help me qualify for infertility coverage. Is this true?
A: The Family Building Act of New Jersey was signed into law in 2001. This Act requires insurance policies to provide coverage for infertility benefits to SOME of those who fall into certain criteria.
Through working with our patients at DVIF&G and with the insurance companies, we have found that only about half of our patients have benefited from this new law. Most employer groups either are self-insured, self-funded, a union, or have less than 50 employees and are considered a small group. All of these are exempt from having to provide “this family building act.”
To make an informed decision, follow these tips from Carla Scott, DVIF&G’s insurance expert:
- Always call the insurance company yourself. Do not rely on what the benefit booklet says.
- Make sure your prescription plan is not carved out. Some companies will provide medical benefits from one company and the prescription plan through a completely different company. If that is the case, you need to call each one to check for what is specifically covered. We have come across some plans that will cover a patient for in vitro fertilization, but their prescription plans will not cover the drugs needed for this procedure. This makes no sense.
- If your company does not provide for infertility benefits, inquire to see if you can add a rider onto your individual plan and pay the difference for the rider.
- Make sure when checking your infertility coverage that you are specific. Some companies will say yes, you have infertility coverage, only to find out later that you only have diagnostic coverage. What this means is that treatment of infertility is not covered. Be very specific when asking questions.
One more tip for 2004: Most insurance companies will no longer be using your social security number as your I.D. number on your insurance card. The next set of I.D. cards you receive may reflect a new I.D. number. This is for your protection. Finally something that does make sense!
Q: My husband and I are receiving infertility treatment, which is covered under my husband’s insurance plan. At the end of this month, however, he will be laid off. I understand that we are eligible for COBRA insurance continuation. What is COBRA?
A: All employees, working for an employer with 20 or more employees, are eligible for health benefits via COBRA when they leave their jobs. Employees working for companies with less than 20 employees are eligible for State Continuation Insurance. COBRA is available for 18 months. State Continuation is available for 12 months.
Employees pay premiums directly to their employer, plus a 2 percent administrative fee. A person’s former employer cannot terminate coverage unless he or she fails to pay the monthly premium on time.
For more information on COBRA, contact the Benefits Representative at your husband’s place of employment.