1.What is your name?

2.What is your phone number?

3.What is your email address?

4.What years have you or your spouse been employed by the City of New York?

5.During your or your spouse's employment with the City, what health insurance plans were you enrolled in?

6.During your or your spouse’s employment with the City, were you interested in conceiving a child with the aid of IVF services

Yes

No

7.During the same period, did you or your spouse begin the IVF process or receive any IVF services, such as obtaining eggs from a donor, testing your sperm, or fertilizing eggs?

Yes

No

8.If you DID go through the IVF process, please identify if any of the following occurred

I did not receive reimbursement from my healthcare plan for all the IVF services we used

I or my doctor requested IVF coverage or reimbursement from WINFertility, but the request was denied

I or my doctor requested IVF coverage or reimbursement from my healthcare plan, but the request was denied

I did not request coverage or reimbursement for IVF services from the healthcare plan or WINFertility because I believed that gay men were ineligible for IVF benefits

I did not request coverage or reimbursement for IVF services from the healthcare plan or WINFertility, because I was told that gay men were ineligible for IVF benefits

I received reimbursement from the City’s healthcare plan for all the IVF services we used

9.If you were interested in conceiving a child with the aid of IVF but did NOT use any IVF services or if you delayed using IVF services, please identify one or more reasons why

I believed my healthcare plan did not cover IVF benefits for gay men

WINFertility told me that gay men were not eligible for IVF benefits

The healthcare plan told me that gay men were not eligible for IVF benefits

My doctor told me my healthcare plan did not cover IVF benefits for gay men

I or my doctor requested IVF coverage from WINFertility or the health care plan, but it was denied

IVF was too expensive without health insurance coverage for IVF

Other--Please describe in response to Question 10

10.Is there anything else you’d like to share about your experience with IVF? Please feel free to

· Describe the circumstances surrounding your answers to Questions 5-8, such as how you came to believe you would not be eligible for IVF coverage;

· How being denied IVF coverage or choosing not to pursue IVF coverage because you believed gay men were not eligible for coverage impacted you or your spouse?

· How your life would have been impacted if you could have obtained IVF coverage since 2019?