We are sorry that there isn’t much if anything in the way of
Insurance Coverage for Infertility

Blue Shield Group Infertility Benefits 2 page pdf 2017

Additional Blue Shield Infertility Benefits for Your HSA Plan
Additional Blue Shield Infertility Benefits for Your PPO Plan

Blue Cross CA Small Group Flyer with rates (Rev 9.2013)

Diagnosis and treatment of underlying medical cause of Infertility is covered for all plans through the medical benefit — this is an EHB (Essential Health Benefit) requirement.
Medical Necessity   Medical Policies & Clinical UM (utilization management) Guidelines very technical

Check our introduction page for more info.

You might try doing a  Bronze Plan with a high deductible and lower premiums, click here for FREE Quotes in CA Nationwide,  then using an  HSA Plan  (Health Savings Account) or for Small Employers Section 105 HRA and writing off the infertility expenses that are not covered?  Learn More ⇒  (IRS Publication 502 Medical & Dental Expenses)    

Medication RX Assistance?    New Life Agency?  

How about Life Insurance for the Parents – send your new baby to college no matter what!

Blue Cross 40% discountWinfertility

HSA - Health Savings Account

Other pages in Infertility  Section

.

******************************

HISTORICAL!

Insurance Wholesaler’s Survey of  Infertility Coverage 5.2012  pdf for Small Group AB 1672

May 15, 2011

PacifiCare – United Health Care Unfortunately, we don’t cover IVF in Small Group.Choice Plus     Signature Advantage
Blue Cross – Anthem $2,000 Lifetime Max Rx limitations – Specialty List procedures or $1,500 Max.
General Agent – Wholesaler In vitro is covered, if at all, very limited by all carriers
Kaiser The only plans that offer limited infertility services are our $5 and $15 co pay plans.  I have taken a sample excerpt from our sample EOC for reference. Artificial Insemination is eligible for coverage but IVF is not.Kaiser $15  $5  Word Summary
Blue Shield Infertility Benefits – Rider
This optional benefit covers infertility services, which include procedures consistent with established medical practices by licensed physicians and surgeons, such as:
  • Medication
  • Surgery
  • Gamete Intrafallopian Transfer (GIFT)
  • In Vitro Fertilization (IVF), Intracyctoplasmic Sperm Injection (ICSI), and Zygote Intrafallopian Transfer (ZIFT) are excluded
    • The actual IVF act its self is not covered but other procedures that are involved are covered. There are so many moving parts to IVF that it can be very confusing.

Health Net  We don’t cover that at all.  We only cover treatment for infertility including medication and medical procedures.AetnaIVF is not covered on any of our California Small Group Plans.We do the underlying testing, for the causes. We have a limited benefit on some of our HMO/PPO Plans. It 50% of a lifetime maximum of benefit of $2,000 and doesn’t cover any of the drugs. Most carriers will test for the underlying causes ,but have  limited benefits out side of the testing, 

 

Availability INFORMAL – NON Binding! Survey of Individual Plans on Infertility Coverage

 

Company Coverage Date
Kaiser No further treatment
Aetna No further treatment
Anthem Might write if no attempts or treatment at fertilityhave been made in the last 2 years.Probably OK, if Post Menopausal, tubal ligation, hysterectomy
Blue Shield Might write if no attempts or treatment at fertility have been made in the last 2 years. 2010
Health Net No
Golden Rule – PacifiCare Unfortunately there are no plans for either company that would cover it. Sorry 3 Mar 2008
sd fertility.com/ There are no individual plans that we know of that offers infertility benefits. The most common way a person gets insurance coverage is through their employer “group plan”.
Even if we do find an Individual Carrier that covers Infertility – there may be a problem getting the policy issued in the first place for underwriting reasons and 2nd a waiting period for pre -x.   Try completing a “Pre Application.”
Pre Application

Get Quotes
Medical Underwriting in General

If all else fails, your employer might consider “self funding” the benefits with an HSA Plan (Health Savings Account) or HRA Plan (Health Reimbursement Account)

HSA HRA

 Coverage’s
Small Group Availability

(HMO SAVER – Group) covers 50% with no maximum on services, and up to $1,500.00 for drugs.
Infertility Brochure
blue cross ca.com/

The PPO 30 has a $2,000.00 lifetime maximum on all covered services.

Infertility Brochure
.blue cross ca.com/

CIGNA’s Position Paper on Infertility
More from a search on CIGNA’s website

Kaiser Small Group – Infertility Coverage
Infertilily - click to enlarge
Note – No footnotes on these plans!
$15 Co Pay Disclosure Form
kp.org/
Conception by artificial means

Except for artificial insemination covered under “Infertility Services” in the “Benefits and Cost Sharing” section, all other Services related to conception by artificial means, such as ovum transplants, gamete intrafallopian transfer (GIFT), semen and eggs (and Services related to their procurement and storage), in vitro fertilization (IVF), and zygote intrafallopian transfer (ZIFT) are not covered.

Coverage for newborn thru surrogate pregnancy. New Life Agency.com/

Leave a Reply

Your email address will not be published.

wp-puzzle.com logo