New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 54 - BENEFIT STANDARDS FOR INFERTILITY COVERAGE › Section 11:4-54.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise:
"Artificial insemination" means the introduction of sperm into a woman's vagina or uterus by noncoital methods for the purpose of conception, and includes intrauterine insemination.
"Assisted hatching" means a micromanipulation technique in which a hole is artificially created in the outer shell of an embryo to assist with the potential implantation of that embryo.
"Carrier" means a health service corporation, hospital service corporation, medical service corporation, insurance company and a health maintenance organization.
"Completed egg retrieval" means all office visits, procedures and laboratory and radiological tests performed in preparation for oocyte retrieval; the attempted or successful retrieval of the oocyte(s); and, if the retrieval is successful, culture and fertilization of the oocyte(s).
"Cryopreservation" means the freezing of embryos in liquid nitrogen until such time as required for a frozen embryo transfer. Cryopreservation also refers to the freezing of female gametes (ova) and male gametes (sperm).
"Egg retrieval" or "oocyte retrieval" means a procedure by which eggs are collected from a woman's ovarian follicles.
"Egg transfer" or "oocyte transfer" means the transfer of retrieved eggs into a woman's fallopian tubes through laparoscopy as part of gamete intrafallopian transfer (GIFT).
"Embryo" means a fertilized egg that has begun cell division and has completed the pre-embryonic stage.
"Embryo transfer" means the placement of an embryo into the uterus through the cervix or, in the case of zygote intrafallopian tube transfer (ZIFT), the placement of an embryo in the fallopian tube. Embryo transfer includes the transfer of cryopreserved embryos and donor embryos.
"Fertilization" means the penetration of the egg by the sperm.
"Gamete" means a reproductive cell. In a male, gametes are sperm; in a female, gametes are eggs or ova.
"Gamete intrafallopian tube transfer" or "GIFT" means the direct transfer of a sperm/egg mixture into the fallopian tube by laparoscopy. Fertilization takes place inside the fallopian tube.
"Gestational carrier" means a woman who has become pregnant with an embryo or embryos that are not part of her genetic or biologic entity, and who intends to give the child to the biological parents after birth.
"Infertility" means a disease or condition that results in the abnormal function of the reproductive system such that:
1. A male is unable to impregnate a female;
2. A female under 35 years of age is unable to conceive after two years of unprotected sexual intercourse;
3. A female 35 years of age and over is unable to conceive after one year of unprotected sexual intercourse;
4. The male or female is medically sterile; or
5. The female is unable to carry a pregnancy to live birth.
Infertility shall not mean a person who has been voluntarily sterilized regardless of whether the person has attempted to reverse the sterilization.
"Infertility coverage" means coverage required by P.L. 2001, c. 236 for the diagnosis and treatment of infertility.
"Intracytoplasmic sperm injection" or "ICSI" means a micromanipulation procedure whereby a single sperm is injected into the center of an egg.
"Intrauterine insemination" means a medical procedure whereby sperm is placed into a woman's uterus to facilitate fertilization.
"In vitro fertilization" or "IVF" means an ART procedure whereby eggs are removed from a woman's ovaries and fertilized outside her body. The resulting embryo is then transferred into a woman's uterus.
"Microsurgical sperm aspiration" means the techniques used to obtain sperm for use with intracytoplasmic sperm injection (ICSI) in cases of obstructive azoospermia. It can involve the extraction of sperm and fluid from epididymal tubules inside the epididymis ("MESA") or the provision of testicular tissue from which viable sperm may be extracted ("TESE").
"Oocyte" means the female egg or ovum.
"Ovulation induction" means the use of drugs (oral or injected) to stimulate the ovaries to develop follicles and eggs.
"Pregnancy-related benefits" means benefits for normal pregnancy and childbirth.
"Religious employer" means an employer that is a church, convention or association of churches, or any group or entity that is operated, supervised or controlled by or in connection with a church, convention or association of churches, as defined in 26 U.S.C. §
										3121(w)(3)(A) (Federal Insurance Contributions Act) and that qualifies as a tax-exempt organization under 26 U.S.C. §
										501(c)(3) (Internal Revenue Code, Exempt Organizations).
"Sexual intercourse" means sexual union between a male and a female.
"Surrogate" means a woman who carries an embryo that was formed from her own egg inseminated by the sperm of a designated sperm donor.
"Zygote" means a fertilized egg before cell division begins.
"Zygote intrafallopian tube transfer" or "ZIFT" means a procedure whereby an egg is fertilized in vitro, and the zygote is transferred to the fallopian tube at the pronuclear stage before cell division takes place.