Office of Legislative Services
State House Annex
P.O. Box 068
Trenton, New Jersey 08625
Legislative Budget and Finance Office
Phone (609) 847-3105
Fax (609) 777-2442
www.njleg.state.nj.us
LEGISLATIVE FISCAL ESTIMATE
SENATE, No. 1413
STATE OF NEW JERSEY
221st LEGISLATURE
DATED: MAY 1, 2025
SUMMARY
Synopsis: Requires health insurance coverage of preimplantation genetic testing
with in vitro fertilization under certain conditions.
Type of Impact: Annual State and local government expenditure increases.
Agencies Affected: Division of Pensions and Benefits in the Department of the Treasury;
Department of Banking and Insurance.
Office of Legislative Services Estimate
Fiscal Impact Annual
State Expenditure Increase for SHBP $93,600 to $500,000
Local Expenditure Increase for SEHBP/SHBP $117,000 to $623,800
Total Expenditure Increase $210,600 to $1.1 million
The Office of Legislative Services (OLS) estimates that requiring health insurance coverage
of preimplantation genetic testing with in vitro fertilization under certain conditions will result
in a total annual increase of $210,600 to $1.1 million in State and local government
expenditures. The OLS notes that the costs may be higher if the State Health Benefits Program
and the School Employees’ Health Benefits Program cover more than one test per cycle of in
vitro fertilization.
For reference, the OLS notes that there are currently three types of preimplantation genetic
testing available. These are the PGT-A, PGT-SR, and PGT-M tests, each of which varies in
purpose, as well as cost per cycle of in vitro fertilization.
BILL DESCRIPTION
This bill requires health insurance coverage of preimplantation genetic testing with in vitro
fertilization under certain conditions.
Under this bill, the State Health Benefits Commission and the School Employees’ Health
Benefits Commission would be required to provide coverage for preimplantation genetic testing, FE to S1413
2
including in vitro fertilization, where the covered person is not infertile for the purpose of
preventing certain serious genetic conditions from being passed to offspring. The commissions
may limit the coverage of preimplantation genetic testing to covered persons where (1) both
partners are known carriers of an autosomal recessive disorder; (2) one partner is a known carrier
of a single gene autosomal recessive disorder and the partners have one offspring that has been
diagnosed with that recessive disorder; (3) one partner is a known carrier of a single gene
autosomal disorder; (4) one partner is a known carrier of a single X-linked disorder; and (5) the
genetic condition, if passed on to the covered persons’ offspring, would result in significant health
problems or severe disability. The bill would require coverage for preimplantation genetic testing
to be provided at the same extent as for any other health care services under the contract. These
requirements would also apply to medical service corporation contracts, health service corporation
contracts, group health insurance policies, and health maintenance organization contracts.
FISCAL ANALYSIS
EXECUTIVE BRANCH
None received.
OFFICE OF LEGISLATIVE SERVICES
The OLS estimates that requiring the State Health Benefits Program and the School
Employees’ Health Benefits Program to provide health insurance coverage of preimplantation
genetic testing with in vitro fertilization under certain conditions will annually increase State
expenditures by $93,600 to $500,000 and local government expenditures by $117,000 to $623,800,
for a combined total annual expenditure increase of $210,600 to $1.1 million. The OLS notes that
the costs may be higher if more than one test is conducted during in vitro fertilization and if more
than one test is covered by the State Health Benefits Program and the School Employees’ Health
Benefits Program.
Current trends indicate that about five percent of births in New Jersey utilize in vitro
fertilization. Out of the births that were conceived via in vitro fertilization nationwide, about 16.6
percent utilized in vitro fertilization to conduct genetic testing in cases with heightened risk of
passing along genetic abnormalities. Both of these factors would lead to an annual average of 94
births that require preimplantation genetic testing to be covered by the State Health Benefits
Program and the School Employees’ Health Benefits Program. Under the bill, the State Health
Benefits Program is estimated to provide coverage for 63 births utilizing preimplantation genetic
testing, with 42 births covered by the State part and 21 births being covered by the local part. The
School Employees’ Health Benefits Program is estimated to provide coverage for 31 births
utilizing preimplantation genetic testing.
The OLS notes that there are currently three types of preimplantation genetic testing available:
PGT-A, PGT-SR, and PGT-M. Each type of preimplantation genetic test varies in purpose, as
well as cost. Under the bill, the State Health Benefits Program and the School Employees’ Health
Benefits Program are required, at a minimum, to provide coverage of preimplantation genetic
testing to covered persons where (1) both partners are known carriers of an autosomal recessive
disorder; (2) one partner is a known carrier of a single gene autosomal recessive disorder and the
partners have one offspring that has been diagnosed with that recessive disorder; (3) one partner
is a known carrier of a single gene autosomal disorder; (4) one partner is a known carrier of a
single X-linked disorder; and (5) the genetic condition, if passed on to the covered persons’ FE to S1413
3
offspring, would result in significant health problems or severe disability. Based on the scenarios
outlined in the bill for which coverage must be provided and OLS research, it appears that such
scenarios typically lead to the PGT-M test being conducted during in vitro fertilization. Also based
on its research, the OLS notes that the average cost of the PGT-M test ranges from $7,000 to
$12,000 per cycle, while the average cost of the PGT-A test ranges from $2,250 to $4,000 per
cycle, and the average cost of the PGT-SR test ranges from $5,000 to $7,000 per cycle. The table
below illustrates the estimated costs of each type of preimplantation genetic test by State-
administered benefit program.
Currently, the State Health Benefits Program and the School Employees’ Health Benefit
Program do not provide coverage for preimplantation genetic testing. The OLS does not know the
exact extent to which the programs will cover preimplantation genetic testing, as this will depend
on decisions made by the State Health Benefits Commission and the School Employees’ Health
Benefits Commission. Factors such as whether the benefit programs will provide coverage for
more than one type of preimplantation genetic test per cycle and whether there will be a monetary
limit to coverage related to preimplantation genetic testing will impact costs for the State and
participating local governments.
Section: State Government
Analyst: Camryn Mathews
Assistant Fiscal Analyst
Approved: Thomas Koenig
Legislative Budget and Finance Officer
This legislative fiscal estimate has been produced by the Office of Legislative Services due to the
failure of the Executive Branch to respond to our request for a fiscal note.
This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.). Benefit Program
SHBP 93,612.33$ 166,421.91$ 208,027.39$ 291,238.35$ 291,238.35$ 499,265.74$
SHBP - Local 47,021.70$ 83,594.13$ 104,492.66$ 146,289.72$ 146,289.72$ 250,782.38$
SEHBP 69,932.95$ 124,325.25$ 155,406.56$ 217,569.18$ 217,569.18$ 372,975.74$
Total 210,566.97$ 374,341.29$ 467,926.61$ 655,097.25$ 655,097.25$ 1,123,023.86$
Cost for PGT-A Cost for PGT-SR Cost for PGT-M