The International Council on Infertility Information Dissemination, Inc

New York Becomes Tenth State to Require Coverage of IVF and Sixth State to Require Coverage for Fertility Preservation for Certain Patients

A map of New York State emphasizing the New Mandate insurance companies to cover IVF treatment

Apr 01, 2019 
By: ASRM 
Origin: ASRM Bulletin Vol.22 No.1 

ASRM Bulletin Volume 22 Number 1

April 1, 2019 
 

New York lawmakers passed a budget measure late yesterday which updates the state’s existing infertility statute to include a requirement for health plans operating in the large group market (employers with 100 or more full-time staff) to provide coverage for three cycles of in-vitro fertilization. The budget measure also includes a provision requiring that patients at risk for iatrogenic infertility
be covered for fertility preservation services. 

Passage of the budget measure with these provisions caps a multi-year effort
on the part of ASRM and coalition partners including RESOLVE, the Alliance for Fertility Preservation, EMD Serono and Ferring Pharmaceuticals to pass the Fair Access to Fertility Treatment Act.  Inclusion of major pieces of FAFTA in the budget measure is a major victory for patients in New York and brings the state in line with current medical standards of care.

Provisions to lift the existing ban on surrogacy in the state were not included in the budget measure despite the hard work of other coalition partners. ASRM will continue to seek passage of The Child Parent Security Act via the regular legislative process. 

ASRM issued the following press release.

Washington, DC - The American Society for Reproductive Medicine (ASRM) applauds the news that New York has passed a long overdue update to the state’s infertility statute as part of its budget bill today.

“We are ecstatic that the leaders in New York have voted to require insurance companies who
participate in the large group market in the state to provide infertility coverage, including IVF and fertility preservation. This measure will allow many New Yorkers to get the health care treatment they need
in order to build their families. New York’s reproductive medical professionals wish to express our gratitude to Governor Cuomo and his staff for their leadership and to the champions in the legislature, Assemblywoman Aravella Simotas and Sen. Diane Savino, who have made access to this care a priority for New York families,” stated Peter Schlegel MD, President of the American Society for Reproductive Medicine.

Dr. Schlegel
went on to add, “We
are not done in New York yet, however. Having passed this vital measure to improve access to IVF treatments, we call on the leaders of the legislature to follow the Governor’s lead and reform New York’s antiquated laws pertaining to surrogacy, another vital therapeutic option for patients.”


 

The ASRM Bulletin
is published by ASRM's Office of Public Affairs to inform Society members of important recent developments.
Republication or any other use of the contents of the Bulletin without permission is prohibited. To request permission to quote or excerpt material from the Bulletin, contact Sean Tipton at stipton@asrm.org.   

 

Contact

Sean Tipton 
Ph: 202-863-2494 
E: stipton@asrm.org

Eleanor Nicoll 
Ph: 202-863-2349 or 240-274-2209 (mobile) 
E: enicoll@asrm.org

Companies which may offer Infertility Benefits

List of Infertility and Adoption friendly Employers

This list is updated whenever anyone emails us about coverage.
If you have information about a company please send us an email and we will add it to the list.
A ~ B ~ C ~ D ~ E ~  F ~ G ~ H ~ I ~ J ~ K ~ L ~ M ~ N ~ O ~ P ~
  Q ~ R ~ S ~ T ~ U ~ V ~ W ~ X ~ Y ~ Z

If your company covers infertility and/or adoption expenses, please email us!
Please remember, this list is through word of mouth and you must 
CHECK the information as coverages OFTEN change.

Alphabetical List of Companies Offering Fertility Benefit Coverage

 

A

Abbott (Illinois)
All IF tx including IVF; prior approval required! Humana PPO and Aetna PPO covers Abbott & Tapp Pharmaceuticals employees for IF coverage anywhere in the U.S. Coverage is for up to 4 attempts (or only 2 add'l if live birth on #1). Adoption assistance of $2,500/child/year.
Source: Email submission 8/6/00

 

Accenture
All IF tx including IVF (BlueCross Blue Shield); infertility coverage is $35,000 lifetime maximum and covers diagnostic and any infertility treatments including IVF. Copay is $10. [Update] According to an email received 1-04-06, as of 1/01/06 the max lifetime benefit for Accenture's blue cross blue shield infertility treatment is $20,000. The Co-pay is still $10. (Email 1-4-06)

 

Ace Hardware (Illinois)
All IF tx including IVF (Cigna HMO Illinois); 4 attempts. All tx and drugs are covered with $10 copay.
Source: Email submission 4/12/01

 

Adecco in NY. Provides a max of $10,000 lifetime for infertility, including IVF, with United Healthcare. The $10K can be stretched over several cycles because they dont pay the RE's what the RE's charge. UHC has contracted rates with the doctors, which is much less than what you will pay out of pocket. They also offer up to $5,000 for meds, and have $2500 of adoption assistance (per child, up to 2 children). Please note you must be classified as a "colleague" with Adecco. If you are classified as an "associate" the coverage is different (I'm not sure if infertility is covered). (email 12-21-05)

 

Adobe in Seattle. They cover diagnosis and IVF after 6 trials (and failures) with IUI. (email - 2-14-04)

 

AEGON (Florida)
All IF tx including IVF (BlueCross Blue Shield); lifetime max is $15,000.
Source: Email submission 8/29/02

 

Aetna (Pennsylvania)
All IF tx not including IVF (Aetna); all diagnostic/testing covered. 6 IUIs per lifetime covered. Injectibles not covered. IVF/GIFT/ZIFT not covered. $5000 adoption assistance.
Source: Email submission 8/10/02

 

AgCo/AgChem (Minnesota)
All IF tx including IVF (BlueCross Blue Shield of Georgia); Will cover all types of infertility, $5000 limit per year, $10,000 maximum.
Source: Email submission 1/9/03

 

Agency Mortgage Corporation.  It covers all testing and unlimited IUI, no IVF or FET.  $20.00 copay each visit. Must have four month history of ttc.  Insurance is Aetna POS.  Meds covered but must be pre-certified-no copay. (Email: 11-17-04)

 

AIG (American International Group) - Illinois
All IF tx including IVF (United Healthcare PPO), Lifetime Max of $5000.00 includes meds. Illinois is a mandate state, however AIG is self-insured so they do not have to obey mandates. Considering that one cycle of IVF can cost $15,000.00+; $5000.00 limit is not nearly enough coverage!! $7500 reimbursement for adoption per child, maximum of 2 adoptions per employee. (Source 1-17-06 email)

 

Airborne Express
All IF tx including IVF; $10K lifetime coverage
Source: IVFConnections Financing IVF post 6/4/00

 

Albany International - Invitro limited to 6 attempts, reversal of sterilization 10-28-04

 

Albertsons. According to this consumer who wrote us, Albertson's has had IVF coverage for years. They just sold and now the LLC part under the BCBS of Idaho PPO plan continues to offer IVF coverage. 20k lifetime max. 5k lifetime max on drugs. Genetic testing with pre-auth. I believe they cover 20k for adoption too. GREAT COVERAGE. Need to work 6 months for coverage and then have 6 month pre-existing clause unless you fall under HIPPA rules and are exempt. (Email 7-26-07)

 

Allied Waste Management formerly BFI)
All IF tx not including IVF (Cigna); Insurance through Cigna HMO covers only labs, no meds and no procedures. They won't even cover the labs if you are getting insemination.
Source: Email submission 1/23/02

 

Alltel Corporation (Texas)
All IF tx including IVF; United Healthcare (Alltel Corporate EPO); covers 3 cycles of ART including meds
Source: Email submission 12/27/01

 

American Airlines (Missouri)
No IF tx beyond first diagnosis (United Healthcare PPO). Were told that they would cover only the cost of the initial doctor's visit IF infertility was diagnosed. Were also told that ART was not covered.
Source: Email submission 4/3/02

 

American Bureau of Shipping, International based in Houston TX
"A reduction in fertility benefits from the current three attempts, no maximum, to three attempts or $10,000 lifetime maximum (including drugs). ABS has also decided to offer adoption reimbursement to employees of up to $2,500 per child, maximum of three reimbursements per family." Effective 1-1-04 Email 12-9-04

 

American Express
90% coverage with 15,000.00 lifetime maximum for IF benefits including IVF (United Healthcare PPO)
Source: Email submission 11/18/00

 

America Online (New Mexico)
All IF tx including IVF (United Health); they cover 3 rounds IUI or IVF. Also provide adoption coverage.
Source: Email submission 5/30/02

 

AMS Inc. (Virginia)
All IF tx including IVF (Cigna HMO) and adoption coverage; unlimited IF coverage with small co-pays after approval.
Source: Email submission 8/14/00

 

AMS (California) --- update 6-21-04 no longer offers infertility coverage for those of us in California, anyway. They were sold to CGI, and infertility treatment is now excluded.

 

Anthem/Wellpoint (Denver, Colorado --- same coverage options in California and Nevada). 
PPO and the HMO plans up to $5000 (life-time maximum) for infertility treatments including IVF--coverage is at 50% after the in-network discounted rates.  Meds are covered under a separate $5000 annual maximum and are covered at 50% as well.These plans are for Anthem/Wellpoint EMPLOYEES ONLY, not for people with individual policies or group policies through their employers.  They would be restricted to what their group or individual policy states in reference to infertility. (Email: 5-11-05)

 

Applied Industrial Technologies (Ohio)
All IF tx including IVF (Aetna); up to $50,000 IF coverage, including IVF, GIFT, ZIFT/option to pay a little bit more a month to have zero out of pocket, otherwise it is 80/20 on most procedures
Source: Email submission 3/23/02

 

Arch Chemicals, Inc. (Global Company with locations in TN, CT, GA, LA, UK, and many others)Offers 90 % coverage for all fertility treatments including diagnostic and Meds, up to $25,000. (email 3-2004)

 

Arch Wireless (Texas)
All If tx including IVF (Blue Cross Blue Shield of Massachusetts); up to $35,000 including IVF. Great insurance based on Mass. laws but available in Texas.
Source: Email submission 4/18/01

 

Arkansas, State of (government employees)
All IF tx including IVF through BC/BS PPO
Source: FertileThoughts Insurance post 6/12/00

 

Armstrong World Industries PPO plan covers infertility treatments up to a maximum of $10,000.  This includes IVF, GIFT, IUI, etc. (Email 2-14-07)

 

Arnold & Porter (Washington, DC)
All IF tx including IVF; believe it is capped at $30,000.
Source: Email submission 11/2/02

 

Arrow Electronics in NY. They do not cover IVF but do cover up to 6 IUIs (Aetna), including injectible medications, due to the NYS mandate. (email 12-22-05)

 

AstraZeneca Pharmaceuticals (Delaware)
Astra Zeneca changed their infertility benefits effective 1/1/11. They are now as follows: $15,000.00 lifetime benefit  Employees who utilized benefits prior to 1/1/11 are “grandfathered” to retain the old benefit of $40,000.00but must use those benefits by 12/31/11. Effective 1/1/12, ALL employees are limited to a $15,000.00 lifetime maximum. (Email sent 07-15-11)

 

Atlantic Health System (New Jersey)
All IF tx including IVF (Coresource); Covers everything. After co-pay, Meds and all treatments covered 100%. Some Adoption costs reimbursed.
Source: Email submission 7/11/02

 

Automatic Data Processing-ADP and have my insurance through Aetna (for other details follow the link) PPO-Open Choice PPO.  They do cover IF, with a $5000 calendar year max, if you go to an in-network clinic then the rates are significantly lower (1/4 to 1/3 cash prices).  They cover IVF, IUIs, TESE etc., ICSI when necessary, and all necessary meds (with copays).

 

Avon Products, Inc. (headquartered in NY; DE, CA, GA, IL, and OH offices also covered)
All IF tx including IVF (Aetna/US Healthcare)
Source: Email submission 10/23/00

 

B

Baker & McKenzie (Texas)
All IF tx including IVF (Cigna Ppo); Baker & McKenzie is the largest law firm in the world. They offer Cigna PPO and it covers all IF treatments and drugs, including up to 4 IVF treatments. They've been fabulous and I have them to thank for my 2 beautiful IF children!
Source: Email submission 7/31/02

 

Ball Aerospace
Source: INCIID Pgw/Mult post 5/18/00

 

Bank of American covers up to 2 IVF (From email and posted 9-16-04)

 

Bank of New Hampshire (Maine)
All IF tx (HMO blue of new england managed by bc/bs of maine); they have full coverage for art, need referral from pcp to see re and you need to get prior approval from the infertility case manager @ bc/bs of me the re's office will help do this for you. They do not cover cryopreservation of embryos or sperm.
Source: Email submission 12/5/00

 

The Bank of New York (NY)
All IF tx including IVF (Oxford, United Healthcare, Aetna).
Source: Email submission 7/27/02

 

Bank One (Illinois)
All IF tx through an HMO plan (HMO Illinois?); must work 20 hours, covers 4 IVF
Source: Email submission 7/15/00

 

Bear Stearns (Texas)
All IF tx including IVF (Cigna PPO). $10,000 Infertility Max Life. $5,000 Adoption.
Source: Email submission 3/6/01

 

Bearing Point (Georgia)
All IF tx not inlcuding IVF (Cigna Network Plan); artificial insemination is covered, and according to the Cinga rep, medications are included!
Source: Email submission 10/17/02

 

Bemis (Illinois)
Covers IF testing and treatment; medications are covered for IF; Lupron IS NOT covered for IF (John Deere/Heritage National).
Source: Email submission 6/30/00

 

Berkshire Medical Center (Massachusetts)
All IF tx including IVF
Source: Email submission 3/1/02

 

Biogen Idec offers infertility coverage up to 20K (lifetime maximum benefit). This is after an itial $10 co-pay and is offered through Bluecross PPA.
(Email 9-8-07)

 

Blockbuster Video's (Colorado)
All IF tx including IVF (United Healthcare). Covers IVF, but not GIFT or ZIFT. 90% in network, 70% out. Covers IVF but not Gift or Zift. 90% in network, 70% out. I believe this is true for the entire BB chain. Even though they offer insurance to part-timers, you must work full time or your benefits are limited to $1000 for out patient services.
Source: Email submission 3/13/02 and 4/4/02

 

Blockbuster Video (Georgia)
No IF tx coverage (United Healthcare). Source: Email submission 7/9/02

 

Blue Cross Blue Shield (Georgia)
IF tx excluding IVF (Blue Cross Blue Shield). Source: Email submission 5/4/03

 

BMC Software (Texas)
No IF coverage (BC/BS of Texas); No Coverage for any reproductive assisted no iui,no sa, no ivf. $2500-5000 adoption assistance.
Source: Email submission 6/6/02

 

Borders Group Inc. (Michigan)
IF coverage not including IVF (Aetna); adoption expenses up to $3,000.
Source: Email submission 3/5/03

 

BpAmoco Oil Company (Missouri, but may include Illinois & other locations)
Prescriptions through Caremark Systems, IF drugs covered at $25 a px. All diagnostics are covered and meds are covered thru Caremark. IUI, IVF, ZIFT, and GIFT are NOT covered. They pay $3,000 for each Adoption.
Source: Email submission 3/1/02

 

Bright house Networks (Florida) offers insurance coverage for up to 3 cycles of IVF as well as coverage for Injectibles . Offered through United Heath care. There are 2 plans to chose from.Copay ranges from 15$ to 20$ on all Injectibles . They also offer adoption assistance.

 

Budget Group (Budget Rent A Car) (Florida)
This policy (Blue Cross Blue Shield (Blues Care HMO)) in Florida, said they will cover ART. They will pay for diag, testing and surgery to correct. But no IVF, GIFT, ZIFT. After 3 calls it is unclear as to it they will pay for any meds, even Clomid. This may be due to what policy the employer elected.
Source: Email submission 11/14/00

 

Budget RAC (Budget Rent A Car) (Illinois)
All IF tx including IVF (Definity Health); $10K lifetime max, includes IVF
Source: Email submission 10/17/02

 

C

CVS Pharmacy covers iui/ivf upto 10k lifetime max and 10klifetime max on fert meds. Source: Email submission 8-26-08

 

Cahners (New York)
All IF tx including IVF (Aetna and United Healthcare); $10,000 lifetime limit. Source: Email submission 4/3/01

 

California Supply North Inc
Covers diagnosis and treatment 100% (up to IVF, GIFT, and ZIFT) will cover up to 6 cycles of IUI's and Injectibles (Pru care HMO)
Source: Email submission 9/29/00

Capgemini Consulting: The US headquarters for Capgemini is based in IL. This company follows the IL Infertility Coverage Mandate.  The employee does not have to live in IL to receive the coverage.  This recipient in an email told INCIID she lives in PA and has been able to utilize the coverage completing 3 IVF cycles, PGD and PGS testing due to an inherited genetic issue (screening embryos).  For the IVF cycles only payment for embryo cryopreservation and co-pays for the fertility drugs (around  $100 - $200) for per cycle.   PGD and PGS might also be covered but must pay out of pocket first before submitting a claim for reimbursement.  (email submission to INCIID on 11/29/16)

Capital One
Effective January 1, 2004, changes to the infertility benefit include a new coinsurance limit of 50 percent on all network and non-network related infertility services. In addition, the lifetime maximun will be reduced to $10,000. The overall Capital One pharmacy benefit also will be changing for 2004, and infertility related prescriptions will be covered at 50 percent co-insurance with no maximun out of pocket expense." This is a big reduction, however, Capital One is adding additional benefits, including adoption assistance to it's package. (email submission 11-2003)

 

Cardinal Glennon Children's Hospital (Missouri)
IF tx excluding IVF (Exclusive Choice); : covers fertility drugs for iui and ivf up to $5000 reimbursement for adoption fees.
Source: Email submission 3/5/03

 

Careerbuilder.com (Illinois)
All IF tx including IVF (Alliance PPO); they even cover donor egg which is rare, treatment up to 25K, Operations in Atlanta and Illinois but have sales reps throughout country
Source: Email submission 9/11/02

 

Carlson Companies, corp. HQ in Minnesota (does not necessarily apply to other locations (i.e., Virginia))
All IF tx including IVF (50% co-pay on meds); $10K lifetime coverage
Source: INCIID IVF WR post 5/18/00

 

Casual Corner
All IF tx including IVF: 3 IVF's paid up to $10,000 each. IUI's paid for up to 4 times a month for one 6 month period in a lifetime. Coverage provided for employees that work 20 or more hours a week.
Source: Email submission 3/23/02  
Update: (email received June 11, 2005) You have a 90 day period before your insurance is effective then you have to wait one year! Effective 1/05

 

Cendant Corporation
All IF tx including IVF (one attempt)
Source: INCIID IVF WR post 5/18/00

 

Chase Bank
All IF treatments are covered, including IVF (various for medical; Merck Medco for Rx); $25,000 lifetime benefit for IF (not including meds); $5,000 lifetime benefit for IF-specific meds; Adoption benefit of $10,000
Source: Email submission 3/8/03

 

Children's Hospital of Philadelphia (Pennsylvania)
All IF treatments are covered, including IVF; through the HMO (Aetna) in NJ all Infertility procedures, ART and meds are covered under the new NJ mandate - Employees do not need to live in NJ only have a primary care physician in NJ. HMO -PA covers 6 IUI's and other
Source: Email submission 9/10/02 
(Email received 5-31-05) New Jersey Employees do receive coverage through the HMO up to and including IVF under NJ law.  However PA employees receive limited coverage Cigna's (Ohio) current infertility benefits are everything (IVF, IUI, injectibles, etc) is covered up to a $20,000 lifetime max on all three types of policies they offer (HMO, POS, PPO). Everything requires prior authorization, and to use the benefits, you must have a treatment plan in place with a case manager. This is at the Columbus, OH office on Polaris Pkwy. 7-4-04

 

Cingular Wireless (Oklahoma and Mississippi, perhaps nationwide?)
All IF treatments covered including IVF up to $10,000/year (United Health Care insurance). Covers IVF, GIFT and ZIFT up to $10,000 max for medical and $10,000 max for meds. Meds are covered by CareMark. PPO, On Network $10 co-pay, off network 80/20 after deductible. ($5,000 adoption benefit)
Source: Email submissions 4/10/03, 2/28/03 and 1/19/03.

 

Circuit City Stores, Inc.
All IF tx but not IVF (Empire Blue Cross/Blue Shield PPO). Covers drugs, office visits and monitoring b/w & u/s for ART procedures.
Source: Email submission 2/15/01

 

Cisco systems (headquartered in San Jose, CA) provides infertility benefits to its employees. They have 2 plans Cigna PPO $10k lifetime, includes diagnosis and treatment including IVF. Prescription drugs for IVF do not count towards the 10k max!!
United Healthcare PPO $10k lifetime, includes diagnosis and treatment including IVF. Prescription drugs for IVF do not count towards the 10k max!!
With an RE who is in-network, you can also get 2 full cycles in 1 year and then switch to the other insurance plan next year. (email 10-2003)

 

Citibank/Citicorp (South Dakota)
All IF tx including IVF (United Healthcare only -- changed for 2002) subject to these limitations: Limited to three artifical insemination procedures and three in-vitro fertilization procedures in a lifetime. Requires documented two-year history of infertility or a medical condition that either through surgery or other procedure would not reverse the infertility regardless of the two-year history. Network: $8000/yr. limit (changed in 2002) -- 100% after $50 copayment per visit.
Source: Email submission 12/27/01

Citimortgage, a division of Citigroup. We are covered for infertility treatment, including artificial insemination, IVF, GIFT and ZIFT : 90% for in-network and 70% for out-of-network. The lifetime max is $24,000.00. The provider was United Healthcare PPO and will be, effective 01/01/05, Empire BCBS PPO. Medco Health provides prescription coverage up to $7,000.00. (Email 12-23-04)

City of Cleveland Ohio - The City of Cleveland (Ohio) offers insurance which covers the medication for infertility, not procedures like IVF. You mail order the drugs with a $25 co-pay. (email 12-6-04)

City of Danville, Kentucky
All IF tx (Anthem Blue Cross and Blue Shield of Kentucky); covers fertility treatments and drugs at 50%, but does not recover retrieval and transfer for IVF. They've actually been covering bloodwork at 100% and ultrasounds at 80%.
Source: Email submission 4/26/01

 

City of East Point (Georgia)
100% infertility treatment is covered. IVF or artificial insemination is not covered. (Cigna)
Source: Email submission 3/2/02

 

City of New York (New York)
All IF medications (PICA Program); As of August 1 2002 the City of New York Office of Labor Relation and Municipal Labor Committee has implemented the PICA Program; this program will cover all employees and non-Medicare retirees enrolled ina health plan offered by the City's Health Benefits program. The PICA Program will cover all injectables (not used in Dr's office only ones you give yourself). This means all infertility meds used for IVF, phone number for info is 800-467-2006.
Source: Email submission 9/12/02

 

City of Tampa Police Department (Florida)
BCBS of Florida Health Options covers Dx for IF only, does not cover IVF,IUI,GIFT,ZIFT.
Source: Email submission 5/9/02

 

Clark Bardes (Minnesota)
All IF tx including IVF through Blue Cross/Blue Shield of Illinois. 80% of all infertility procedures, 100% lab and ultrasound procedures, Co-Pay ($20) on medications, $25,000 (4 attempts) lifetime maximum. Lab, ultrasound and medicines do not count towards lifetime maximum.
Source: Email submission 2/23/02

 

Cleary Gottlieb Steen & Hamilton covers infertility treatments for a diagnosed infertility or 12 months of trying without achieving pregnancy.  Has a 15K limit on infertility benefits plus a 6K limit on drugs. Source: Email submission 8-26-08

 

Colgate (New York)
All IF tx through United Healthcare (POS). 3 IVF attempts lifetime maximum, no age limit but must not be menopausal. In network co-pay only, out of network 80%, meds, copay $10.
Source: Email submission 12/7/00

 

Comcast Cable (Pennsylvania)
All IF tx through Indepedence Blue Cross. Covers all IF testing and treatment through plan providers. I go out of network (no provider in my aea) and I pay about $350 out of $500 in IUI's. $15,000 max. PCS Prescription Plan allows $95 for Clomid and $28 for Progesterone suppositories (personal experience) So, %90? Comcast also offers Aetna USHC. I can't remember what IF they cover.
Source: Email submission 10/13/00

 

Computer Horizons (New Jersey)
Will cover diagnostic IF as well as b/w & u/s for IVF (but not the actual IVF procedures) through Aetna; also covers adoption expenses
Source: Email submission 6/29/00

 

Community Medical Center - Payable 50% up to LTM of $3000 Invitro Fertilization Covered 10-28-04

Computershare, Canton, MA offers IVF 3 times per lifetime. (Email 11-21-06)

 

Con Edison (New York)
All IF tx, may include IVF (United Healthcare); $25k lifetime coverage for IF treatment
Source: Email submission 3/15/02

 

Continental Airlines (New Jersey)
All IF tx which MAY include IVF (Oxford Health Care); each work location varies in infertility coverage. IVF and other ART procedures not covered unless you live in a mandated state. $4K for each adoption up to 2 adoptions with assistance to travel to bring baby home. Note that there is NO COVERAGE for IF including IVF in Texas.
Source: Email submissions 3/4/03 and 3/20/02 and 5/22/02

 

Convergys Corporation (Florida)
All IF tx including IVF (United Health Care); will cover up to $7500 lifetime maximum in infertility benefits including IVF, ZIFT, GIFT and medications.
Source: Email submission 4/25/02

 

Culpeper Regional Hospital (Virginia) (Optimum Choice). Infertility diagnosis and treatment is covered at 50% with up to 6 cycles of IUI. Everything must be pre-authorized. (Email: 4-24-05)

 

D

Davis Electric: My husband works for Davis Electric.  They are out of Kansas and Canyon (tx).  They have BC/BS and it covers infertility.They will not cover the actual IUI or IVF or any insemination procedure.  But they will cover the meds, the u/s, bloodwork and sperm wash for IUI.  And they will cover all the meds and u/s and blood work for IVF.  They just wont cover the ER or ET.  They also cover everything that has to do with endometriosis.  (to every possible extent you can go with endo) (email 9-13-05)

 

Deloitte & Touche -- Coverage is available through the United Healthcare PPO plan (starting 1/1/2004).Infertility treatment (includes IVF) -- lifetime max of $25,000. Office visit is a $40 copay then the plan pays 100% (up to lifetime max). Non-office visit -- the plan pays 90% (up to lifetime max). Please note that coverage through United Healthcare includes coverage for both donor egg and sperm. (updated via email on 12-2-04) Prescription/pharmacy costs go towards the lifetime max.(email 11-23-03)

 

Dick's Sporting Goods (Ohio)
All IF tx including IVF (Blue Cross/Blue Shield); there is a $25K lifetime maximum. There is a 80/20 payment. You have to work there two months, 30 hours per week, in order to be eligible for this Blue/Cross coverage. (They offer Starbridge Ins. right off the bat, but this one does NOT cover IF/IVF).
Source: Email submission 10/11/02

 

Digitas Inc, . This is an advertising agency based in Boston. It also has offices throughout the country (www.digitas.com). They use BCBS of Mass. this consumer has a history of 2 IUI's and 3 IVF's=neg, then a fourth producing a live birth. According to the email, they covered 3 IVF's, almost 100%, except for some monitoring fees. The number of attempts (again according to the person emailing this to us) were determined on a case-by-case basis. The meds were a co-pay. (Email 3-2004)

 

Dillards
IF tx through BC/BS PPO Arkansas; $15K lifetime coverage (80/20 coverage)
Source: INCIID LII post 6/8/00

 

Diosynth (Akzo Nobel) (North Carolina)
All IF tx including IVF (MedCost Preferred); all infertility meds are covered with regular co-pays ($9-$15); IVF is covered up to $10,000 (normally 2 cycles).
Source: Email submission 8/13/02

 

Disney
Some IF tx -- NOTE: Effective 1/1/03, Disney's insurance benefits for infertility are drastically changing next year. They will cover some infertility (at 50% with a $10,000 maximum lifetime benefit), but if you have had treatment prior to the change it all counts toward the maximum.
Source: FertileThoughts Insurance board post 12/14/02

 

Dolch Computer Systems (California)
IF tx through Kaiser Permanente
Source: Email submission 2/22/02

 

Donaldson, Lufkin & Jenrette
IF tx through Oxford
Source: INCIID IVF WR post 5/18/00

 

Dun and Bradstreet
All IF tx through United Healthcare POS option B. Up to 15K at 80% coverage. Does not pay for ivf/icsi drugs. Does pay 5k on adoption process. This is nationwide, not sure about international though.
Source: Email submission 12/9/00

 

DuPont
All IF tx including IVF; $25K lifetime coverage has changed. DuPont now separates the $25k lifetime maximum into separate $15,000 for treatment of infertility and $10,000 for drug coverage (both are still lifetime maximums).
Source: email on 2-2-07

 

Dynegy (Texas)
All IF tx including IVF (UnitedHealth); 7,500 per calendar year $15.00 co-pay.
Source: Email submission 8/26/02

 

E

Electronic Data Systems (EDS) (Oklahoma)
All IF tx inclduing IVF (Cigna PPA Plus); covers 80% of all procedures up to $7,500 lifetime max (after $250 deductible). IF Drugs are covered at 80% - to be included in $7,500 max figure
Source: Email submission 6/12/01  

 

Electronic Data Systems (EDS) (Texas)
IF tx (not sure about IVF); EDS Health Benefits
Source: Email submission 9/21/00

 

EMC Corporation (Michigan)
Comprehensive IF coverage (Cigna PPO). IUI coverage as well as 2 IVF attempts. Infertilitiy $10,000.00 MAX Life. Meds covered thru NPA. Adoption benefits $5000. Source: Email submission 3/6/01

EMC Corporation (Massachusetts). Coverage appears to be company-wide. (Source an email from an employee in NC.

 

ERM
All IF tx including IVF; $5K lifetime coverage
Source: INCIID PgFoyer post 5/19/00

 

F

Fairfax County Public Schools, Fairfax County, Virginia
All IF tx including IVF (for tubal, endo, or 5-yr history)
Source: INCIID LII post 4/19/00

 

First Data (Florida)
All IF tx including IVF (CIGNA); not sure of adoption details, just know they do have benefits. They have locations in Colorado, Maryland, New York and Internationally
Source: Email submission (2/14/03)

 

FleetBoston Financial
All IF tx including IVF
Source: IVFConnections Financing IVF post 5/21/00

 

Ford Motor Company : My IVF is being covered by Ford Motor Company. They cover 3 attempts.This is thru Humana KPPA (email 11-16-05

 

FreddieMac (Virginia)
All IF tx including IVF thorugh Aetna PPO. All IVF TX covered ($10,000 lifetime max). Unlimited meds. covered w/$10 or $20 co-pays. Adoption expenses paid up to cost of avg. birth delivery in DC area.

 

Frito Lay/Pepsi Co/Pepsi Bottling Group/Pepsi North America/ Quaker Food - LTM $25,000, covered: IVF, GIFT, ZIFT, IVC, Artifical Insemination, drugs, and dx testing 10-28-04
Source: Email submission 2/23/02

 

Frontier Utilities (was Citizens Utilities) had a 25,000 dollar rider for IVF. I have heard they are changing their Blue Cross/Blue Shield plan in January and I don't know if it will continue to provide the IVF coverage. (Email submission 11-13-03)

 

G

Gap, Inc Point of Service insurance. $10,000 lifetime. limit includes any direct attempts to get pregnant (IUIs and/or IVF) Diagnostic procedures do not fall under the limit. Drugs for the procedures are covered under a seperate drug plan. Source email from Corporate Recruiting on 8-9-04.

 

Glaxosmithkline may have unlimited infertility coverage, but this needs to be confirmed by someone else
Source: Email submission 8-26-08

 

Genentech (California)
All IF tx including IVF subject to $10,000 limit (Aetna)
Source: Email submission 10/24/00

 

General Electric - covers infertility testing and surgery. Does not cover IUI, IVF, fertility drugs. Will reimburse up to $4,000 in adoption expenses. (Email 11-8-04)

 

Genetics & IVF Institute (Virginia)
All IF tx including IVF (Accordia National/Alliance); Coverage for IVF/ICSI/IUI and frozen transfer cycles are covered @ 90%. Medication also covered under prescription drug plan.
Source: Email submission 10/25/02

 

*Georgia State Plans through Kaiser: as of 1/1/06, all State plans through Kaiser dropped coverage of all treatment forms for infertility.  Really hit me hard since we have had coverage for all treatments up to IVF for past 6 years and then it got dropped without notice this year.  Might be good to update your list - this is an absolute fact I know since it hit me in the pocketbook!  Thanks for your website though - it's been a wonderful source of info. (email 2-17-06)

 

Glaxo Wellcome Pharmaceuticals (North Carolina)
All IF tx including 2 IVF cycles; adoption coverage
Source: Email submission 9/18/00

 

H

Harris Corporation (Florida)
All IF tx not including IVF (United Healthcare); Covers 80% of all diaonosis, bloodwork/tests, and treatment except IVF. Covers clomid and injectibles.
Source: Email submission 1/18/02

 

Harris County employees under the Aetna POS II plan covers all diagnostic testing, covers monitoring of ovulation induction and actual IUI, with $30 co-pay for each visit. Does not cover medications. Email 2011

 

Healthcare of America (Florida)
All IF tx not including IVF (Humana HMO). Covers first $2000 for infertility and 50% thereafter. Does not cover IVF or meds for IVF.
Source: Email submission 3/3/02

 

Healthsouth Rehabilitation Hospital in Kingsport, Tennessee - $5,000 lifetime through Blue Cross Blue Shield of Alabama. This includes meds. Source: Email 7-13-04

 

Herman Miller, Inc. (Michigan)
All IF tx including IVF (BCBS PPO); IVF max $4000.00 lifetime benefit; Adoption expenses $5000.00 per child.
Source: Email submission 4/12/01

 

Hewitt Associates, LLC (Illinois)
All IF tx including IVF (Aetna HMO); 6 IUIs per lifetime and 3 ART per lifetime, does not cover ANY injectable drugs. $10,000 adoption allowance.http://www.hewitt.com 
Source: Email submission 2/23/02 

 

Hitachi Consulting has fertility benefits: a $10,000 lifetime maximum. If you use a doctor who has an Aetna contract though, only the actual procedure falls under the $10k.  Important, or you go overthe $10k with just one try. They have many offices across the country, look on the website for locations. (email 5-11-07)

 

The HoneyBaked Ham Company of Georgia (Georgia)
All IF tx not including IVF (Guardian); $6000 Lifetime max on infertility treatment and meds but does not cover IVF. HBH of GA operates in 15 States including GA, TN, NC, SC, FL, LA, AK, MS, CO, UT, NV, MO/IL, NE, AL. Due to negotiated rates the $6000 can cover significant attempts at IUI.
Source: Email submission 10/7/02

 

Howmet Casting Inc.
All IF tx including IVF (4 cycles including meds)
Source: IVFConnections Financing IVF post 3/31/00

 

Humana, Inc.
All IF tx including IVF (Humana Healthplans) Covers 50% up to $5,000 per plan year of infertility treatments. Includes adoption assistance: has money assistance with legal fees up to $5,000.
Source: Email submission 4/5/02

 

Huntsville Hospital (Alabama) covers 90% IVF meds in-house, covers 80% IVF meds out of house. Does not Cover IVF or US and uses Blue cross/ Blue shield of Alabama (email 2-22-06)

 

I

IBM
Source: INCIID IVF WR post 5/18/00

 

IMC Chemicals - Artificial Insemination & InVitro to LTM $20,000 10-28-04

Illinois, State of (government employees)
All IF tx including IVF (four attempts)
Source: INCIID IVF WR post 5/18/00

 

Independence Blue Cross (located in Philadelphia, PA)
All IF tx including IVF (100% coverage for 3 cycles); In addition all meds are covered with a $15.00 co pay through their Rx plan. Any employment with the company full time entitles you to benefits after the 1st of the month following employment date. Also, if you leave for any reason you are entitled to the SAME EXACT benefits through their COBRA plan. It is the best plan in PA.
Source: Email submission 8/8/00

 

ING (Colorado)
ALl IF tx including IVF (United Healthcare Options PPO); $10,000 for ART (lifetime); prescription medication insurance (PAID/Medco) covers all fertility meds at usual rate (either $10, $20, or $30 co-pay depending on brand) - unlimited benefits for medications.
Source: Email submission 7/16/02

 

Inova Health Care System (Virginia)
All IF tx including IVF (Aetna); for employees working 20 or more hours per week. Covers $25,000 lifetime maximum for infertility - including IVF and any related procedures. They also give prescription coverage for up to 6 cycles - this is IN ADDITION to the $25,000 max for tx. Coverage begins the first month following your month of employment. There is no pre-existing condition clause. Inova owns a number of hospitals in the No. Virginia area - including Fairfax Hospital, Alexandria Hospital, Fair Oaks Hospital, and Mt. Vernon Hospital.
Source: Email submission 11/18/02

 

Integral Systems Incorporated. They have offices in Maryland, Colorado and several other states as well as internationally. They have Alliance PPO and have a $5,000 lifetime max for infertility and 3 IVF attempts per live birth up to $100,000 lifetime max. (email submission 10-8-03)

Integris Baptist Hospital (located in Oklahoma)

All IF tx including IVF (PPO Oklahoma/Mutual Assurance). They cover a maximum infertility benefit of 40,000.00 lifetime.
Source: IVFConnections Financing IVF post 2/21/00 and Email submission 3/1/02

 

Iron Mountain (New Jersey)

All IF tx including IVF (Cigna). In-vitro fert, GIFT, ZIFT, limite4d to 3 attempts per lifetime. No co-pay. Charges made for or in connection with all non-experimental infertility diagnosis and treatment procedures, including oral and injectable drug therapy; sperm, egg and/or inseminated egg procurement and processing; cryo preservation of sperm and embryos and related charges; artificial insemination; in vitro fertilization and embryo placement; intracytoplasmic sperm injection; gamete intrafallopian transfer; sygote intrafallopian transfer and similar procedures.
Source: Email submission 3/12/02

 

J

JPMorgan (New York)
All IF tx including IVF (various for medical; Merck Medco for Rx); Max lifetime coverage for IF is $25,000, not including meds. Rx insurance covers $5,000 lifetime for IF-specific meds. Adoption benefit of $10,000.
Source: Email submission 11/19/02

 

Jefferson Health System (located in Pennsylvania)
All IF tx including IVF (through Independence Blue Cross /Blue Shield) but no meds coverage.
Source: Email submission 8/8/00

 

Johns Hopkins University (and affiliated laboratories) In Maryland, through Aetna PPO 6 cycles lifetime injectables/IUI 3 cycles lifetime IVF (not sure if ICSI is included, but think so...) email 11-7-04

 

Johnson & Johnson (California and Ohio only?)

All IF tx including IVF (through Aetna PPO)
Source: FertileThoughts IVF post 6/4/00 and email submission 5/12/01

 

K

Kaiser Permanente
IF tx that MAY include IVF; Most DO NOT cover anything more elaborate than inj/IUI. In the Southern CA area the Drs will only do 3x cycles though there is no limitation described when you purchase the policy.
Source: Email submission 2/22/01

 

Kaiser Permanente, Southern California region, does offer IVF benefits to non-union employee groups such as physicians and other salaried employees. The policy is a supplemental policy through Harrington Benefits and it has a $30,000 lifetime cap. It pay 80% of costs and you pay 20% of costs from any provider. The cost is $23 a month for the policy. (Note: this is for Kaiser Permanente employees only. Not Kaiser members who are not employees.) ( Email: 1-30-06)

 

Kaiser Mid-Atlantic - states of DC & VA covered: IVI, ICI, IUI exclusive: InVitro, GIFT,AIFT, procurement, freezing/storage, assisted hatch, ICSI (If base or adv rider: invitro to 3 attempts per live birth LTM $100,000.) 10-28-04

 

Kaiser Hawaii -- Artificial Insemination: limit using spouse sperm. Invitro limit 1 procedure/lifetime, spouse sperm. exclused: reversal of sterilization 10-28-04

 

Kawasaki (in Nebraska only?)
Lincoln, Nebraska has up to $25,000 lifetime coverage for IF treatments.
Source: email 4/23/07 

 

Keane Inc (Ohio)
IF tx not including IVF (Aetna)
Source: Email submission 8/28/02

 

Kerr Drug
Source: Email submission 6/23/00

 

Kinkos
All IF tx including IVF (Aetna); 6 cycles of IUI or AI. The PPO is 3 cycles of ART at 90% after 1,000.00 deductible. The EPO and HMO are 100% of 3 cycles and no deductible. There are 2 PPO's. The second is a 250.00 deductible and then 90% for ART.
Source: Email submission (3/14/03) and misc.health.infertility post 4/28/00

 

K-Mart (in Illinois)
IF tx (not sure about IVF); Health Alliance.
Source: Email submission 6/28/00

 

K-Mart (in Michigan)
IF tx not covered; partial adoption donation (up to $3,000).
Source: Email submission 7/16/00

 

KSolutions, Inc. (Maryland and other locations)
All IF tx including IVF (BC/BS); we have employees all across the US and everyone is covered under our plan (BC/BS PPO) because we are a Maryland based company because of the "Maryland Mandate". Effective 10/01/00, Maryland Insurance Article Section 15-810 "Benefits for In Vitro Fertilization" was amended and several changes were made the law. Coverage includes 3 IVF attempts per live birth up to lifetime maximum of $100,000.
Source: Email submission 2/25/03

 

Kraft Foods
All IF tx including IVF
Source: Email submission 6/23/00

 

L

Laborer's Union 872 (Las Vegas, nevada)
All IF tx not including IVF (Health Plan of Nevada); they now cover up to 6 cycles of iui's but, no meds. and where you go has to be a provider for them so you might want to call them.
Source: Email submission 2/23/03

 

Lend Lease (includes Bovis and Cap Mark Services) (Georgia)
All IF tx including IVF (United Healthcare). Covers $50K Infertility and $10K meds.
Source: Email submission 2/28/02

 

Liberty Mutual Ins.
All IF tx including IVF
Source: Email submission 6/23/00

 

Long Island Railroad - Long Island, New York (LIRL):  UTU (union) negotiated insurance - Empire Plan/United Healthcare:

$50,000 lifetime maximum PER person.  No copays - 100% coverage if treatment is through

a "Center of Excellence".  Covered procedures - IVF, GIFT, ZIFT, ICSI, Assisted Hatching,

MESA, TESE, sperm, egg or inseminated egg procurement, processing, banking.  Need Pre-

Authorization for qualified procedures, except insemination.  Some transportation

expenses reimbursed when a Center of Excellence is used.   Fertility meds through Prescription plan -

copays ranging from $15 - $60, depending on whether it's a preferred medication. (Email 2-18-05)

 

Lucent Technologies (Illinois)
All IF tx including IVF through BC/BS HMO Illinois (only ins. co.). Lucent offers several health plans to choose from in Illinois, where as the others are self-insured, this one appears to be fully insured, therefore the state mandate applies. I am in the process of confirming this with Lucent Tech.
Source: Email submission 2/25/02

 

M

Madison Metropolitan School District in Madison, WI: offers the following benefits, depending on which insurance carrier you choose:

Alliance PPO: 
In-Network: Charges limited to infertility diagnostic service only. Artificial insemination is excluded.
Out-of-Network:  Subject to deductible and co-insurance.  Charges limited to infertility diagnostic service only. Artificial insemination is excluded.

Group Health:
Covered within the limits of the policy. Please refer to certificate. Limited to 50% of Covered Expenses up to a Lifetime Benefits Maximum for each Member of $30,000 with a maximum payment by GHC of $15,000.

WPS Statewide PPO:
100% of charges limited to infertility diagnostic service only.
Submitted via email: 7-24-06

 

Marcus Evans (New York)
All IF tx including IVF (Aetna PPO). 6 cycles of fertility treatments are 100% covered ($20 copay). Cycles can be either IUI, IVF, GIFT etc. All meds are covered (even IVF meds) with a $5 or $15 copay. The insurance is expensive (app $300 per month for h/w) but a lot less then IF treatments.
Source: Email submission 3/7/01

 

Marriott (Maryland)
All IF tx including IVF (Kaiser Permanente); Kaiser covers 50% of infertility treatments and medications - patient pays the other 50%. IVF and associated medications are covered @50% copay; GIFT and ZIFT are not covered. Limitations on IVF: 3 cycles per live birth up to lifetime maximum of $100,000. Coverage required due to Maryland mandate. Adoption coverage is abysmal. If you get pregnant and have elected to participate in the short/long term disability insurance plan, then you are covered for ~ 6 weeks disability (whatever the doctor indicates is applicable to your case). However, if you do not have short/long term disability, you can either take PTO (vacation) or FMLA (up to 12 weeks unpaid). Fathers can only take PTO or FMLA. For adoption, there is no coverage whatsoever. Your choices are PTO (vacation) or FMLA. Marriott does not provide any assistance with adoption expenses. 
Source: Email submission 7/14/02

 

Mars Corporation
Source: INCIID LII post 6/7/00

 

Marsh McLennan/Mercer Human Resources Consulting
All IF tx including IVF (United Healthcare); caps infertility treatment at $15,000 lifetime max. Source: Email submission 11/2/02

 

Mary Kay (distribution center employees)
All IF tx including IVF
Source: Email submission 6/4/00

 

Maryland, State of (government employees)
All IF tx including IVF (three attempts for tubal, endo, or 2-yr history)
Source: Email submission (1/21/03) and RESOLVE of MD post 2/1/00

 

MasterCard International (New York)
All IF tx including IVF (United Healthcare); : Choice Plus plan offers 100% coverage for IVF and associated meds when using in-network doctors. Lesser coverage is available with out-of-network doctors.
Source: Email submission (3/11/03)

 

Mayo Clinic (Minnesota and Scottsdale, Arizona)
All IF tx including IVF (Mayo Comprehensive); infertility treatment covered at 50% - includes all. $5000 reimbursement for adoption expenses.
Source: Email submissions 4/2/03 and 4/26/01

 

Mendocino - Lake Comm - Artificial Insemination, Invitro,procedure to restore/enhance reversal of sterilization 10-28-04

 

Merck-Medco/Medco Health Solutions (Florida)
All IF tx not including IVF (Humana HMO); no longer offers IVF under their insurance plan, they do cover If dx,and Tx and will pay up to $2000 of tx 100% and then 50% thereafter; possible adoption coverage 
Source: Email submission 9/22/02, 8/20/02 and 9/18/00

 

Merrill Lynch (New York)
All IF tx including IVF (Empire)
Source: INCIID IVF WR post 5/18/00

 

Merrill Lynch (Ohio)
All IF tx including IVF (Blue Cross Blue Shield); 3 IVF attempts per liftetime.
Source: Email submission 4/17/01

 

Methodist Medical Center (Illinois)
Covers IF treatment including IVF; believe there is a $5,000 limit per year. Testing/Treatment covered but has the limited amount of coverage. Has a limit # amount on coverage (Employee Benefit Corp. - EBC)
Source: Email submission 6/30/00

 

MetLife
All IF tx including IVF (three attempts plue three alternative (GIFT/ZIFT) attempts); 80/20 coverage through United HealthCare; meds through mail-order for $8 co-pay
Source: INCIID Pgw/Mult post 5/19/00

 

Metropolitan Jewish Health System (New York)
All IF tx including IVF (Oxford Health Plans); includes diagnosis, IUI, and one IVF (1 fresh, 1 frozen cycle). Does not include meds.
Source: Email submission 1/4/02

 

Metropolitan Transit Authority (NYC MTA)
Source: IVFConnections Financing IVF post 5/22/00

 

Microsoft
All IF tx including IVF (Aetna Preferred Plan covers up to $15,000 lifetime max for infertility services)
Source: Email submission 3/26/02

 

Miami Valley Hospital (Dayton, Ohio) has a fertility rider policy provided by the hospital when an employee carries their insurance through one of the hospital supported plans. The plan includes up to $15,000 lifetime limit, 50% drug costs, 75% IVF costs. (Email: 6-5-05)

 

Midwest Employers Casualty Company (Missouri)
All IF tx but not IVF (Cigna PPA); will cover costs of all testing and treatments administered. It will even pay 100% of cost for drugs given by the physician i.e. injectibles! It covers monitoring, etc.
Source: Email submission 8/16/00

 

Mirant Corporation (Georgia) ID dx but no treatment (United HealthCare and BlueCross/Blue Shield of GA); Both UnitedHealth Care and BCBS of GA cover IF diagnostic testing only under Mirant's plan. Clomid was paid, but no blood work or U/S, IUI or any other treatment. Source: Email submission 7/16/02

 

Monsanto (Missouri)
All IF tx including IVF (United Health Care); 2 IUI OR 2 IVF per person/per lifetime; also offers adoption assistance.
Source: Email submission 9/4/02

 

Monumental Life Insurance Co. / AEGON USA pays for IVF And all infertility related. (From an email dated 7-28-04)

 

Morgan Stanley (New York)
All IF tx including IVF; also offers adoption assistance.
 Morgan Stanley in NY has a 12K lifetime maximum on infertility benefits, and a 10K maximum on drugs.
Source: Email submission 8-26-08

 

N

National Instruments (Texas)
All IF tx including IVF (Great West)
Source: Email submission 5/27/02

 

The Nature Conservancy
All IF tx including IVF (Aetna); everything is covered including meds.
Source: Email submission 4/15/02

 

NCR Corporation (New York)
All IF tx including IVF (Cigna); three IVF tries maximum, but better than nothing! DE is covered as well, though not the DE fee.
Source: Email submission 5/10/03

 

New Jersey, State of (most government employees)
All IF tx including IVF
Source: INCIID PgFoyer post 5/18/00

 

New York, City of (Dept. of Correction)
All IF tx including IVF (Aetna US Healthcare, GHI); Cap on ART procedures, three per length of enrollment period, lifetime.
Source: Email submission 8/11/00

 

New York, City of (Fire Department)
All IF tx including IVF (GHI)
Source: INCIID IVF WR post 5/18/00

 

New York, City of (Police Department)
All IF tx including IVF (GHI). IVF covered w/a $10 co-pay. No IVF meds covered (Lupron, Gonal-F, Profasi). As of Jan2000, they pay for cryopreservation of embryos.
NOTE: You have to be very very careful with them as I learned from experience. I went to Cornell to have my IVF done. Although my Doctor was a GHI Doctor, all procedures are done and billed from CORNELL HOSPITAL. Because GHI is a patient/Doctor provider and not a HOSPITAL provider, they wouldn't cover it!
Source: Email submission 11/28/00

 

New York, State of (government employees)
All IF tx including IVF (Empire)
Source: INCIID IVF WR post 5/18/00

 

Norland Products (New Jersey)
All IF tx not including IVF (Oxford Liberty Plan D); the insurance plan covers office visits, bloodwork, ultrasounds, some meds (all non-injectibles), though not the actual retrieval/transfers.
Source: Email submission 5/20/02

 

Northeast Utilities (Connecticut)
All IF Tx including IVF (BlueCross Blue Shield of MA & Connecticare), covers 100% after payment of $10 copay. Covers diagnostic and approved surgical and medical treatments including IVF and IUI including meds.
Source: Email submission 12/27/01

 

O

OAO Technology Solutions
All IF tx including IVF
Source: Email submission 6/1/00

 

OfficeMax (Ohio)
Covers testing, IUI, oral meds (but not injectibles) Does not include IVF. (Aetna)
Source: Email submission 11/14/00

 

Oracle Corporation (California)
All IF tx including IVF (United Healthcare); Covers all infertility diagnosis and treatment, up to 20K lifetime max. However, since United Healthcare negotiates reduced costs with healthcare providers, that 20K can be stretched to 30-40K of actual care, since the negotiated rates are sometimes 40-50% less than what the providers charge initially.
Source: Email submission 6/8/02

 

OSF (Illinois)
OSF-HMO covers medication and testing. No coverage for tx-insem. or ART procedures. Hospital employees.

OSF-infertility coverage through EBC. Covers testing and treatment. Includes ART procedures. Check with deductibles/copays especially for treatment! Companies can purchase this insurance for their employees.
Source: Email submission 6/30/00

 

P

PAREXEL (North Carolina)
All IF tx including IVF (Blue Cross Blue Shield); Covers up to 6 IVF cycles. Offers $5000 for adoption.
Source: Email submission 5/15/02

 

Pearson Education (New Jersey)
IF tx: Infertility coverage covers most ART including IVF (United Healthcare). Monetary lifetime limit of $15,000. Adoption benefit up to $3500 for adoption related costs.
Source: Email submission 9/9/00

 

Peoria Civic Center (Illinois)
Testing & treatment of infertility covered; medications covered; use OSF hospitals (OSF HealthPlans)
Source: Email submission 6/30/00

 

PG & E: Services for diagnosis and treatment of infertility coverage includes the following 
procedures (for 2003): Artificial Insemination, In-vitro fertilization, Gamete (GIFT) and Zygote (ZIFT) intrafallopian transfer procedures $7,000 lifetime maximum whether in or out of network. $10Copay/100% in-network, 75% out of network after $200 deductible
IVF Medication covered under different plan, deductible with $500 out-of-pocket maximum per year. (11-3-03)

 

PPG Industries
All IF tx including IVF
Source: Email submission 6/23/00

 

Philips Health Care provides $15,000 lifetime max for all infertility. Medications are covered by a separate company not counted in the $15,000. 8-9-09

As of 7/1/05 covers all ART (Aetna), including IVF up to $25,000 lifetime max and $10,000 lifetime max on medications. Out-of-network covered at 70% after $500 deductible. Coverage the same under new BCBS plan effective 7/1/06.
Source: Email submission 7/10/06

 

Primedia, Inc. (New York)
All IF tx inlcuding IVF (Aetna). They cover any IF treatment up to a lifetime cap of $10,000. I only had to pay 20% + $300 deductible. $3,200 worth of IVF drugs were only $115!
Source: Email submission 4/12/01

 

Prime Tanning- Artificial Insemination, Invitro - except AK, HI, MD, MA 10-28-04

 

Proctor & Gamble (Ohio and possibly nationwide)
All IF tx including IVF (Various plans - infertility & adoption coverage is the same across all currently); For infertility, covers 80% of infertility services up to an annual maximum of $2500, 50% coverage on infertility drugs (no maximum). For adoptions, reimburses employees up to $5,000.00 per adoption for qualified expenses and up to $2,500.00 per child (50% of $5,000.00 benefit) for adoption fees. Up to a maximum of $15,000.00 will be paid under the Plan to any family during any 12-month period.
Source: Email submission 4/29/03 and FertileThoughts IVF post 6/4/00

 

Pro Health Care (Wisconsin) WPS health insurance covers IVF 70% up to $5,000 in a lifetime. (Email:5-14-05)

 

Q

QVC
Source: INCIID LII post 6/7/00 

 

R

RBC Mortgage, parent company is RBC(Royal Bank of Canada) Financial Group. They have infertility coverage through Blue Cross Blue Shield. The lifetime max benefit is $10,000--includes ART. Exclusions are tubal reversal and gender selection. Prescription drugs are covered 100% (minus copay) through Express-Scripts--this is an excellent coverage since drugs for IVF can run from $2500-$7000!! (email 1-7-04)

RBC Mortgage - The medications are covered with 35$ co-pay for injectables. Meds are covered at $10K lifetime max. The meds do not count towards the $10,000 max of the IF treatments. There is no limit to the number of times you do IUI Source. Email we received also stated, they covered donor egg with some work and appeal. ( email November 19, 2006)

 

Railroad Commission of Texas (State of Texas)
IF tx limited to no ART (IUI, IVF, etc.) (Blue Cross Blue Shield); no adoption benefits. Will cover infertility only if you will not have artificial insemination. Also does not cover any ART or any treatment prior to ART or after ART.
Source: Email submission 6/2/03

 

Raytheon (California)
All IF tx including IVF (Definity); $15000 lifetime limit for IVF.
Source: Email submission 10/6/02

 

RealNetworks, Inc. (Washington)
All IF tx including IVF (Regence Blue Shield); Covered in PPO Network at 90%, includes regular ART including but not limited to artificial insemination, IVF GIFT, ZIFT. Also covered is donor oocyte harvesting. Fertility drugs for subscriber, spouse, or oocyte donor are covered under the prescription drug card program.
Source: Email submission 5/24/02

Riceland foods inc in Arkansas:  Offers Blue cross and blue shield to its employees. And it covers infertility and ivf upto 15,000 lifetime max (email 2014)

RT Environmental Services.  It covers all testing and up to 4 IVF/FET with a 700 deductible each year.  Must have a two year history of ttc first.  Insurance company is Guardian.  All meds covered with 20.00 copay.  No lifetime max. (Email: 11-17-04)

 

S

Sabre Inc (Oklahoma)
All IF tx including IVF (United Healthcare "PPO Plan 1"); will cover 50% of all procedures up to $10,000 lifetime max. Dx is covered at normal office visit copays ($10/$20 specialist).
Source: Email submission 6/12/01

 

SAIC - Science Applications International Corp (California)
All IF tx including IVF (Aetna PPO - Company PPO through Aetna offers IVF coverage with a 5K maximum.)
Source: Email submission 1/21/03

 

Salomon Smith Barney
All IF tx including IVF (United Healthcare/Aetna/Oxford). United Health Care & Aetna $15,000 max lifetime -- 100% in network/70% out of network, Drugs too. Oxford $15,000 lifetime max ONLY in Network.
Source: INCIID IVF WR post 5/18/00 and Email submission 4/12/01

 

Sanofi
Source: INCIID Pgw/Mult post 5/19/00

 

Sapphire Technologies (Texas)
All IF tx including IVF (One Health Plan PPO). $5000 max lifetime; medications 120 day supply per year.
Source: Email submission 4/16/01

 

SAS Institute (Cary, NC)
All IF tx including IVF
Source: Email submission 6/23/00

 

Scholastic Corp cover IVF and IUI under United Health Care PPO with a lifetime max of $10,000 not including IVF medication - which is covered under prescription drugs. Source: Email submission 8-26-08

 

Sears
All IF tx (with HMO IL insurance plan only) Note: IL is a mandated state.
Source: INCIID Pgw/Mult post 5/19/00

 

Sears - Sears does not cover IVF, ZIFT,GIFT or IUI. (email 11-1-03)

 

Shand's Hospital (Florida)
All IF tx including IVF (BC/BS Florida); IVF Covered under the Shand's Basic Plan only. All IVF procedures must be done at the Shand's facility. $50,000 lifetime max (approx 7 tries).
Source: Email submission 8/1/02

 

Siebel Systems (California)
All IF tx including IVF (Blue Cross/Blue Shield); Coverage includes all fertility treatments; 25k lifetime max; includes all meds
Source: Email submission 10/8/02

 

Sogeti USA (Ohio)
No IF tx; $5K for adoption assistance
Source: Email submission 8/28/02

 

Sony (California)
No IF tx
Source: Email submission 8/13/02

 

South Carolina, State of (government employees)
All IF tx including IVF (one attempt) at 70% coverage; $15K lifetime coverage
Source: INCIID IVF WR post 5/18/00

 

Sprint 
As of Jan. 1 2004, Sprint will no longer be offering infertility treatments and they will not be covering infertility medication. Before 1-1-04 they paid for 100% of treatments up to lifetime max of $25,000. You only had to pay co pays. But due to the rising cost of healthcare, they have decided to eliminate infertility treatment. The only thing covered is some diagnostic testing. This will be for all 5 health plans that they offer. (email submission 12-2-03)

 

Southwestern Bell aka SBC (texas)
All IF tx including IVF (BCBS of IL is PPO) as well as adoption; not sure amount on adoption but on IF they cover 6 attempts all drugs have copay $10/$20 or $30 there is only $150 deductable a year everything else is covered. SBC has an 3 plans to choose from the PPO HMO and another not sure but from United Health Care.
Source: Email submission 5/29/03

 

Sprint PCS (All States with Sprint PCS)
All IF tx including IVF (Insurance: CIGNA - Indemnity (High or Low Deductible Plan), SprintChoice, SprintSelect). IF coverage is ANYTHING up to 25K per lifetime.
Indemnity Plan pays 80% of R&C charges after deductable 1) Low Plan $600/ind., $1200/family, annual out of pocket max. incl. deductable $1600/ind., $3200/family; 2) High Plan $1500/ind., $3000/family, annual out of pocket max. incl. deductable $2500/ind., $5000/family.

SprintChoice (PPO plan): In-Network 100%, $10/co-pay

SprintSelect (EPP plan): In-Network only, 100%, $10/co-pay
All four plans cover $25K maximum IF to include procedures for correction of IF, artificial insemination, IVF, GIFT, ZIFT, etc. Experimental procedures/treatment/drugs not covered.
Drugs are covered on separate drug plan, Express Scripts. Have verified following covered: Follistim, Gonal F, Lupron. 
We chose an out of network provider, and they are covering 70% after deductables. I don't know what the adoption benefit is, but I know we have one.
Source: Email submissions 2/24/02, 2/28/02, and 3/20/02 

Sprint PCS:  Offers adoption assistance (Email 4-21-05) 

 

Staples (Massachusetts)
All IF tx inclduing IVF (Cigna); these are for full-time employees only. Corporation will offer $4000-5000 towards an adoption. Cigna Healthcare out-of-network benefits offer $50,000 to cover ART. They do not cover donor eggs, ICSI, FET or cryoperservation.
Source: Email submission 3/22/03

 

Starbucks (Texas)
Adoption= $3000.00 per attempted or successful adoption, up to $9000.00 total. No ART coverage, but infertility drugs are covered.
Source: Email submission 1/4/01

Starbucks covers all diagnostic and medications for IUI and IVF.  They do not cover IVF treatments.  You have to be a full time employee or a 20hr a week part-time employee.  Aetna is their carrier. (Email 6-17-05)

 

State of Texas (Texas)
IF tx exclduing IVF (Blue Cross/Blue Shield); Covers diagnosis and some treatment of infertility with a 10% co-pay. Most services are covered under your $15 or $20 office visit (depending on the plan). Special services such as ultrasounds, etc. are covered at 90%. No IVF or Intrauterine insemination.
Source: Email submission 5/6/03

 

Sun Microsystems
All IF tx; $5K lifetime coverage
Source: INCIID IVF WR post 5/18/00

 

Symbol Technologies (Georgia)
All IF tx, including meds, ART max $10K (United Healthcare). None of my preliminary workup was taken from this max, only once the IVF began. This company is based in NY, but has offices in NJ, GA, FL (and maybe others).
Source: Email submission 10/28/00

 

T

Talbots (All States)
All IF tx including IVF (Cigna); Company offers Cigna HMO 3 IVF attempts, bloodwork, & ultrasounds. Plan offerred in all 50 states; must be Full-time or Part-time 'B'. Adoption expenses may be reimbursed up to $3,000 Source: Email submission 8/7/02; Meds for IVF not covered (Email received 11-19-06)

 

Tapp Pharmaceuticals (Illinois)
All IF tx including IVF; prior approval required! Humana only covers Tapp Pharmaceuticals and Abbott employees for IF coverage in IL.
Source: Email submission 6/30/00

 

TEKsystems
All IF tx including IVF (three attempts for tubal, endo, or 5-yr history) with 80/20 coverage
Source: INCIID IVF WR post 5/18/00

 

Tellabs (IL): IF Coverage : 4K life time max and 6K for prescriptions (email 8-26-08)

 

Teradyne (company based in Mass.; coverage for all US-nationwide employees)
All IF tx including IVF (Cigna PPO/POS); up to 8 IUIs per lifetime, and 4 IVF/GIFT/ZIFT or more if medically approved. In-network $10 office visit, $5/$10 for Rx including injectables, surgery 100%. Out-of-network 80% coverage with $200 deductible to be met first, Rx 80% after $50 deductible, surgery 80% after deductible.
Source: Email submission 11/3/00

 

Time Warner Cable
All IF tx including IVF
Source: Email submission 6/23/00

 

Time Warner and all sub-companies offer ivf 3xs, IUI 3xs, 100% (email 2-1-06)

 

T Mobile: They offer 10K lifetime w/ 2,500.00 for meds. They cover infertility - including IVF, GIFT, ZIFT etc. (email submission 11-20-03)

 

Towers Perrin (Pennsylvania)
All IF tx including IVF (United Health Care); $10K per procedure/$20 lifetime. Towers Perrin has over 80 offices thru-out the country and multiple offices overseas. Please see www.towers.com for more inforamtion on office locations.
Source: Email submission 5/19/03

 

Tribune Company (Illinois)
All IF tx including IVF (Cigna HMO); 100% up to $35,000 lifetime maximum (plus $15,000 lifetime maximum for infertility drug coverage). $5,000 Adoption Assistance Reimbursement
Source: Email submission 11/3/02

 

TriHealth (Ohio)
All IF tx including IVF (Anthem HMO).
Source: Email submission 6/5/02

 

Tru-Serv (headquarters in Chicago, IL) Warehouse for True Value Retail Stores. However, according to Illinois law, you MUST live in Illinois to get the Infertility coverage. (From an email dated July 2004)

Travelers Insurance Co. (St. Paul) offers adoption assistance of $5,000 ( I think this can be tapped more than once) and a lifetime fertility benefit of $20,000 plus pays 50% of the cost of fertility drugs. Email (10-10-04)

 

TRW (Utah)
All IF tx excluding IVF (Aetna); Insurance covers meds, treatments, testing, everything EXCEPT harvesting and handling of eggs. TRW will reimburse up to $5000 of some adoption fees. Will not go to reimburse gifts to birth mother or travel.
Source: Email submission 4/12/01

 

U

Ukiah Unified School - Artificial Insemination, Invitro, reversal of sterilization 10-28-04

 

Uline, Inc., based out of Illinois, offers infertility coverage to all employees in all states. Employees must have 2 years of documented infertility. There is no dollar limit and you are allowed up to 4 IVF cycles for the first pregnancy, and 2 more for subsequent pregnancies, for a total of 90% coverage in-network, 70% out of network. Meds also covered.Uline's coverage is based on Illinois law but they extend it to employees who do not live in Illinois. (email 5-17-07)

 

United Parcel Service (UPS) (New York)
All IF tx including IVF (Aetna US Healthcare). As of January 1, 2003, will only cover 1 attempt per lifetime. Have to make sure you choose the hmo over the regular Aetna in order to get coverage. All meds covered 100% but must be from an authorized mail order pharmacy to be covered. 
Source: Email submission 1/10/03 and 3/1/02

 

The University of Phoenix (Apollo Group) in Philadelphia, PA offers fertility benefits to their employees through Cigna Healthcare PPO.  They offer $1000 deductible,  but afterwards all surgery, meds and IUI are covered.  IVF is not covered.  Email: 5-26-05

 

U.S. Government (federal employees)
Some IF tx covered through HMOs (Kaiser Permanente); IVF covered by Kaiser-Permanente HMO (DC, MD, VA) and MD-IPA HMO (DC, MD, VA)
Source: http://www.opm.gov/insure/index.html10/27/00

 

US Oncology Associates: (BC/BS of TX) covers Infertility treatment & meds. Labs, u/s & office visits are covered under the copay. The retrieval & transfer are covered at either 10%, 15% or 20% of contracted rates depending which tier (there are 3) you choose. The majority of meds are covered at a $10, $35 or $50 copay (it does not cover progesterone). US Oncology has cancer centers throughout most of the United States. One just needs to call the cancer center to see if it is affiliated with US Oncology or go to it's websitehttp://www.USOncology.com. (Email: 3-10-05)

 

V

Verizon Wirless (Florida): All diagnostic/testing  and correction covered  . Injectibles not covered. IVF/GIFT/ZIFT not covered. $5000 adoption assistance (Email 4-21-05)

 

Verizon - Maine to WV (East Coast). $10,000 annual with a $20,000 lifetime cap. These figure includes any IF related procedures and meds.Verizon to your list. From Maine to WV (East Coast). $10,000 annual with a $20,000 lifetime cap. These figure includes any IF related procedures and meds. (Email submission 12-8-03)

 

Vision Enterprises (Illinois) All IF tx including IVF (Blue Cross Blue Shield Illinois)
Source: Email submission 7/16/00

 

Volvo
Source: INCIID LII post 6/7/00

 

W

Wake Forest Baptist Hospital (Winston-Salem NC)
All IF tx including IVF (lifetime max of $25,000, drugs lifetime max of $5,000)
Source: ParentsPlace IVF post (7/15/00)

 

Walgreens
IVF COVERAGE WILL BE LIMITED TO EMPLOYEES WITH 5 YEARS OR MORE OF SERVICE EFFECTIVE SEPTEMBER 2003
All IF tx including IVF covers all States through Blue Cross/Blue Shield of Illinois (either the PPO or Traditional plan). The maximum benefit is $75,000/person for employees with less than 1 year of service, $150,000 with at least 1 year of service, and $250,000 for 2 to 5 years of service, and $850,000 for more than 5 years of service. You have to work 30 or more hours per week, and be employed 90 days before coverage begins. Medication is covered through Walgreen's. *THIS PRICE HAS CHANGED EFFECTIVE 3/1/02 -- AS FOLLOWS* Generics $5/30 day supply $10/90 day supply Preferred brand name 18.50/30 day supply 51/90 day supply Non-preferred brand $35/30 day $100/90 day supply. Fertility drugs will still be covered but most fall in the non-preferred brand category. 4 lifetime IVF attempts. *MAY* cover tubal reversal surgery.
Source: Email submission 1/3/03; 4/21/01; 3/1/02; 6/2/03

 

The Washington Post (Washington DC)
All IF tx including IVF (Aetna PPO, Alliance or Kaiser Perm.); 5k for adoption benefits, 10k for IVF ,GIFT, ZIFT
Source: Email submission 9/11/02

 

Wells Fargo
Wells Fargo covers infertility, up to diagnosis. It does not cover IUI, IVF, GIFT, ZIFT, or injectible drugs, except in states that mandate it. Possibly covers $5000 per adoption.
Source: Email submission 2/19/01

 

Westchester County (New York)
All IF treatement including IVF (through POMCO). Upto 3 IVFs including medications.
Source: Email submission 2/24/02

 

Wiley (book publishers), offers insurance that covers some infertility costs. All diagnosis/tests are covered. Surgeries (ie - laparoscopy, blocked tube, varicocele repair) are covered. IUI and IVF are not covered, but ultrasounds, bloodwork, and meds (including injectables) are covered. Meds have a co-pay of $35 for brand names. They also pay up to $5,000 of adoption expenses. Wiley's main office is in Hoboken, NJ, but there's also a large office in Indianapolis, IN. Source email 7-14-04

 

William Beaumont Hospital in michigan covers 5000 toward IVF. Email submission 9-24-04  

Wyeth Pharmaceuticals (Pennsylvania)
All IF tx including IVF (Wyeth, Horizon Blue Cross of NJ); through Horizon BC's PPO plan - $30,000 lifetime max for any and all infertility including IUI& IVF. All meds (including injectibles) covered with $9 copay through Wyeth Prescription Plan. Wyeth Health Plan covers all infertility (including IVF) no limit at 80/20. HQ in PA, but offices all over the states and rest of the world.
Source: Email submission 8/26/02

 

Wyeth Pharmaceuticals and they provide IF coverage (all areas.) They have 3 insurance plans (one is even completely free) and all offer coverage for up to $25,000. The plans range from paying 80% to copays of $40. We found that the free plan pays 80% and that was actually the best deal for IVF.
2-14-04 (email)

 

X

Xerox Corporation (All States)
All IF tx including IVF (BCBS, United, Aetna). Coverage is provided in all the states where Xerox is located. Coverage is limited to 3 IUI and 3 ART (IVF, GIFT, and/or ZIFT) attemps per lifetime per insurance; treatments and medications are covered 100% with regular co-payments of 10-15$$. After 1 insurance is used up, changing insurances will give you the fresh start!
Source: Email submission 4/13/01

 

Xerox Corporation (New York)
All IF tx including IVF (3 cycles of ART per lifetime; 6 medicated cycles), United Healthcare insurance.
Source: Email submission 4/12/01

 

Xerox Corporation (Texas)
All IF tx including IVF (United Healthcare); UHC has a $500 per person deductible with a yearly max out of pocket of $5,000 per family. Covers 3 IUI or IVF procedures including drugs at 80%. They do not cover ICSI. Adoption assistance of $2,000 through the LIfe Cycle assistance program for employees with 5 years tenure or more.
Source: Email submission 4/12/01

 

Y

Yale University
All IF tx including IVF (Blue Care (Blue Cross & Blue Shield)). 50% coverage of all IF tx's. $15,000.00 Max.
Source: Email submission 3/2/01

 

Young and Rubicam (Florida)
All IF tx including IVF (United Healthcare); $10,000 Lifetime Max for infertility coverage--can be used for any infertility treatment. Also offers adoption assistance.
Source: Email submission 8/14/02

 

Z

Zurich Insurance (Kansas)
Dx and tx of conditions causing IF (Aetna; UHC); Covers IF drugs, including injectibles. Doesn't pay for ART or IUI. Will pay for max. 6 cycles of drug therapy (lifetime).
Source: Email submission 11/25/02 

 

Join our Insurance for IVF Mailing list
Have information to add or correct on the list? Email us!

Insurance Carriers that may offer infertility insurance or riders

Insurance Carriers That May Offer 
Infertility Treatment Coverage to Employers in the U.S.

Have information to add or correct on the list?
Please Contact Us 
Find a job with a company that offers infertility coverage.

Alphabetical Insurance Carrier List
A ~ B ~ C ~ D ~ E ~ F ~ G ~ H ~ I ~ J ~ K ~ L ~ M ~ N ~ O ~ P ~ Q ~ R ~ S ~ T ~  U ~ V ~ W ~ X ~ Y ~ Z

 

 

A

Admar PPO

Adventist Healthcare

Aetna HMO

Aetna Managed Care

Aetna Managed Choice

Aetna PPO

Affordable Medical Network

Airline Employees Union

Alliance (PPO)

Arlington HealthQuest

American Heritage Life

American Medical HealthCare

America's Health Plan

Amerihealth HMO

 

B

Beacon Health Plan (Commercial HMO)

Beech Street PPO

Bellsouth (Blue Cross/Blue Shield of Alabama)

Blue Cross Blue Shield Illinois

Blue Cross/Blue Shield of Maryland

Blue Cross and Blue Shield of Massachusetts

Blue Cross and Blue Shield of Minnesota

Blue Cross/Blue Shield - National Capital Area

Blue Cross and Blue Shield of Rhode Island

Blue Cross Prudent Buyer

Blue Shield HMO

 

C

California Advantage

CAL/PERS (California State Employees)

Capp Care PPO

Care First Blue Cross/Blue Shield

Carrollton-Farmers Branch ISD PPO

CHAMPUS (some policies)

Choice One PPO/EPO/POS

CHS Healthnet

Cigna HMO

Cigna PPO

City of Carrollton (TX) PPO

City of Richardson (TX) PPO

Cleveland Clinic Florida Health Plan

CCN (Community Care Network)

Culinary Workers; Las Vegas

 

D

Delta Airlines Employee Plan

Dimension

 

E

 

F

Federal Reserve Bank of Dallas

FHP

Florida Health Alliance

Florida Health Choice Select HMO

Florida Health Choice Plan PPO

Florida Health Network

Food and Beverage Workers (Las Vegas)

Foundation Health

 

G

Galaxy Healthcare PPO

Great Western

Guardian PHCS

Guardian PHS

 

H

Harris Methodist HMO/PPO Harvard Community Health Plan

Health Advantage Network

Health Net (HMO and PPO)

Healthcare Management Solutions

Healthcare Partners of East Texas

HealthKeepers

HealthSmart Preferred Care PPO

Healthsource PPO

Humana HMO

Humana PPO

 

I

Integrated Medical System

 

J

John Alden PPO (Dimension PPO)

John Deere

John Hancock

 

K

Kaiser Foundation Health Plans

Kaiser-Permanente HMO

 

L

 

M

MAMSI

MAPSI

Managed Care Of America (MCA)

Managed Healthcare Inc PPO

Massachussets Mutual

MDIPA Optimum Choice

Medical Control Inc PPO

Medview PPO

MetLife

 

N

Northrup / Blue Cross

NTHN Gated EPO/POS/PPO

 

O

Optimum Choice

Oxford Health Plans (Freedom Select Plan)

 

P

Physicians Health Network

Plaines Health Network

Plano ISD PPO

Potomac Physician HMO

Preferred Health Network

Preferred Health Providers (PHP)

Preferred Plan of Texas PPO

Preferred Provider Mid-Atlantic

Principal Health Care PPO

Private Healthcare Systems (PHCS)

ProAmerica Managed Care PPO

Pro-Net PPO

Prudential PPO/POS/EPO

 

Q

 

R

 

S

Screen Actors Guild (SAG-Producer's Health Plan)

Selectcare Southwest Airlines Health Plans

Southwest Medical Provider PPO

Summit TPA

Sunrise Healthcare

 

T

Teachers Retirement System PPO

Tenet Select Health Plan

Texas Municipal League PPO

Total Health Choice (Commercial HMO)

Trigon Blue Cross/Blue Shield (formerly BC/BS of Virginia)

Tufts Health Plan

 

U

Unicare PPO

United Healthcare POS

United Healthcare PPO

USA Health Network

USA Managed Care Organization

USC (University of Southern California) IPA

 

V

VHA Southwest Preferred PPO

 

W

Well Care (Commercial HMO)

WellPath

Wilson N Jones PHO

 

X

 

Y

 

Z

 

Insurance Companies / Carriers Known to Cover Infertility

Insurance Carriers That May Offer 
Infertility Treatment Coverage to Employers in the U.S.

Have information to add or correct on the list?
Please EMAIL US

Alphabetical Insurance Carrier List
A ~ B ~ C ~ D ~ E ~ F ~ G ~ H ~ I ~ J ~ K ~ L ~ M ~ N ~ O ~ P ~ Q ~ R ~ S ~ T ~  U ~ V ~ W ~ X ~ Y ~  Z

 

 

A

Admar PPO

Adventist Healthcare

Aetna HMO

Aetna Managed Care

Aetna Managed Choice

Aetna PPO

Affordable Medical Network

Airline Employees Union

Alliance (PPO)

Arlington HealthQuest

American Heritage Life

American Medical HealthCare

America's Health Plan

Amerihealth HMO

Avmed

 

B

Beacon Health Plan (Commercial HMO)

Beech Street PPO

Bellsouth (Blue Cross/Blue Shield of Alabama)

Blue Cross Blue Shield Illinois

Blue Cross/Blue Shield of Maryland

Blue Cross and Blue Shield of Massachusetts

Blue Cross and Blue Shield of Minnesota

Blue Cross/Blue Shield - National Capital Area

Blue Cross and Blue Shield of Rhode Island

Blue Cross Prudent Buyer

Blue Shield HMO

 

C

California Advantage

CAL/PERS (California State Employees)

Capp Care PPO

Care First Blue Cross/Blue Shield

Carrollton-Farmers Branch ISD PPO

CHAMPUS (some policies)

Choice One PPO/EPO/POS

CHS Healthnet

Cigna HMO

Cigna PPO

City of Carrollton (TX) PPO

City of Richardson (TX) PPO

Cleveland Clinic Florida Health Plan

CCN (Community Care Network)

Culinary Workers; Las Vegas

 

D

Delta Airlines Employee Plan

Dimension

 

E

 

F

Federal Reserve Bank of Dallas

FHP

Florida Health Alliance

Florida Health Choice Select HMO

Florida Health Choice Plan PPO

Florida Health Network

Food and Beverage Workers (Las Vegas)

Foundation Health

 

G

Galaxy Healthcare PPO

Great Western

Guardian PHCS

Guardian PHS

 

H

Harris Methodist HMO/PPO Harvard Community Health Plan

Health Advantage Network

Health Net (HMO and PPO)

Healthcare Management Solutions

Healthcare Partners of East Texas

HealthKeepers

HealthSmart Preferred Care PPO

Healthsource PPO

Humana HMO

Humana PPO

 

I

Integrated Medical System

 

J

John Alden PPO (Dimension PPO)

John Deere

John Hancock

 

K

Kaiser Foundation Health Plans

Kaiser-Permanente HMO

 

L

 

M

MAMSI

MAPSI

Managed Care Of America (MCA)

Managed Healthcare Inc PPO

Massachussets Mutual

MDIPA Optimum Choice

Medical Control Inc PPO

Medview PPO

MetLife

 

N

Northrup / Blue Cross

NTHN Gated EPO/POS/PPO

 

O

Optimum Choice

Oxford Health Plans (Freedom Select Plan)

 

P

Physicians Health Network

Plaines Health Network

Plano ISD PPO

Potomac Physician HMO

Preferred Health Network

Preferred Health Providers (PHP)

Preferred Plan of Texas PPO

Preferred Provider Mid-Atlantic

Principal Health Care PPO

Private Healthcare Systems (PHCS)

ProAmerica Managed Care PPO

Pro-Net PPO

Prudential PPO/POS/EPO

 

Q

 

R

 

S

Screen Actors Guild (SAG-Producer's Health Plan)

Selectcare Southwest Airlines Health Plans

Southwest Medical Provider PPO

Summit TPA

Sunrise Healthcare

 

T

Teachers Retirement System PPO

Tenet Select Health Plan

Texas Municipal League PPO

Total Health Choice (Commercial HMO)

Trigon Blue Cross/Blue Shield (formerly BC/BS of Virginia)

Tufts Health Plan

 

U

Unicare PPO

United Healthcare POS

United Healthcare PPO

USA Health Network

USA Managed Care Organization

USC (University of Southern California) IPA

 

V

VHA Southwest Preferred PPO

 

W

Well Care (Commercial HMO)

WellPath

Wilson N Jones PHO

 

X

 

Y

 

Z

 

Pregnancy Discrimination Act and How to File

Facts About Pregnancy Discrimination
The Pregnancy Discrimination Act is an amendment to Title VII of the Civil Rights Act of 1964. Discrimination on the basis of pregnancy, childbirth or related medical conditions [including infertility or reproductive failure] constitutes unlawful sex discrimination under Title VII. Women affected by pregnancy or related conditions must be treated in the same manner as other applicants or employees with similar abilities or limitations.

 

Hiring
An employer cannot refuse to hire a woman because of her pregnancy related condition as long as she is able to perform the major functions of her job. An employer cannot refuse to hire her because of its prejudices against pregnant workers or the prejudices of co-workers, clients or customers.

 

Pregnancy and Maternity Leave
An employer may not single out pregnancy related conditions for special procedures to determine an employee's ability to work. However, an employer may use any procedure used to screen other employees' ability to work. For example, if an employer requires its employees to submit a doctor's statement concerning their inability to work before granting leave or paying sick benefits, the employer may require employees affected by pregnancy related conditions to submit such statements.

 

If an employee is temporarily unable to perform her job due to pregnancy, the employer must treat her the same as any other temporarily disabled employee; for example, by providing modified tasks, alternative assignments, disability leave or leave without pay.

 

Pregnant employees must be permitted to work as long as they are able to perform their jobs. If an employee has been absent from work as a result of a pregnancy related condition and recovers, her employer may not require her to remain on leave until the baby's birth. An employer may not have a rule which prohibits an employee from returning to work for a predetermined length of time after childbirth.

 

Employers must hold open a job for a pregnancy related absence the same length of time jobs are held open for employees on sick or disability leave.

 

 

 

******** HEALTH INSURANCE**********

Any health insurance provided by an employer must cover expenses for pregnancy related conditions on the same basis as costs for other medical conditions. Health insurance for expenses arising from abortion is not required, except where the life of the mother is endangered.

 

Pregnancy related expenses should be reimbursed exactly as those incurred for other medical conditions, whether payment is on a fixed basis or a percentage of reasonable and customary charge basis.

The amounts payable by the insurance provider can be limited only to the same extent as costs for other conditions. No additional, increased or larger deductible can be imposed.

 

Employers must provide the same level of health benefits for spouses of male employees as they do for spouses of female employees.

 

Fringe Benefits
Pregnancy related benefits cannot be limited to married employees. In an all-female workforce or job classification, benefits must be provided for pregnancy related conditions if benefits are provided for other medical conditions.

 

If an employer provides any benefits to workers on leave, the employer must provide the same benefits for those on leave for pregnancy related conditions.

Employees with pregnancy related disabilities must be treated the same as other temporarily disabled employees for accrual and crediting of seniority, vacation calculation, pay increases and temporary disability benefits.

 

 

See also: How To File A Charge of Employment Discrimination

 

New York State and Infertility Insurance

01/04/02 - New York State Senate - http://www.senate.state.ny.us

January 23, 2001
Senator Bruno
SENATE PASSES SWEEPING WOMEN'S HEALTH BILLS

Expanded Coverage for Early Cancer Detection, Contraception, Infertility The New York State Senate today passed two measures that dramatically enhance women's access to a broad range of critical health services, including obstetrical/gynecological services, screenings for breast, cervical cancer and osteoporosis, infertility 
treatment and contraceptives. The bills are part of the Senate Majority's comprehensive review of existing state laws concerning New Yorkers' health coverage that is being undertaken by the Senate Majority Task Force on 
Health & Wellness. 

 

"The Senate Majority has long been a forceful advocate for women's health issues, from expanding coverage to help fight women's cancers, to ending the practice of 'drive-thru' mastectomies and requiring coverage for 48-hour hospital stays after giving birth," Senate Majority Leader Joseph L. Bruno said. 

 

" Once again, we are showing the way with comprehensive legislation that further protects and expands women's health services, and helps put New York at the forefront of promoting healthy lives." The Women's Health bill, S. 3, is sponsored by Sen. Bruno, Task Force Co-chairs Sen. John J. Bonacic, Sen. Mary Lou Rath, and members of the Task Force. The infertility measure, S. 1265, is sponsored by Sen. Kenneth P. LaValle, a Task Force member. 

 

BREAST/CERVICAL CANCER SCREENING 
The Women's Health bill expands women's access to mammography and cervical cancer screenings by closing a loophole in earlier laws requiring coverage that exempted some policies. Additionally, it enhances coverage by requiring insurers to pay for breast cancer-detecting mammograms for women beginning at age 40 at least 
annually, based on a doctor's recommendation. Current law requires coverage from age 50. Cancer is the leading cause of death among women and the recovery rate for these diseases is far higher with early detection. 

 

OSTEOPOROSIS EXAMS 
It requires coverage for medically necessary tests, like routine bone density exams, to detect the bone-crippling disease osteoporosis. Current law does not address coverage for osteoporosis, which affects half of women over 50 by gradually weakening their bones. 

 

CONTRACEPTIVE COVERAGE 
Additionally, the measure requires coverage for doctor-prescribed contraceptives. In every case, the expanded coverage would be subject to a policyholder's regular deductibles and co-payments. "New York women comprise half of the state's workforce, but still are forced to pay a disproportionate share of out-of-pocket expenses for 
important medical care and services," said Senator Bonacic (R-Mount Hope). 

 

OBSTETRICS/GYNECOLOGY 
A 1994 state law already requires insurers to cover a woman's visit to the obstetrician/gynecologist of her choice without first requiring a referral from a primary care physician. The Women's Health bill closes technical oopholes in the law to ensure consistent coverage for even more women who belong to HMOs that are currently exempt 
from the requirement. New York already requires coverage for a host of medical exams, including tests for breast and cervical cancers, that are aimed at early detection of potentially fatal diseases, when treatment options offer the best hope for full and healthful recovery. "These earlier efforts have certainly resulted in dramatic declines in the number of women who were previously undiagnosed with often preventable and treatable diseases," said

Senator Rath (R-C, Williamsville). "Women make three-quarters of the health care decisions in American households, and spend almost two or every three health care dollars. This bill increases access and expands critical health services for women; in short, we are ensuring that the caregivers are eligible for care." "Diseases like cancer and osteoporosis take a tremendous toll on New York women, affecting tens of thousands of families each year," said Senate Health Committee Chairman Kemp Hannon (R-Garden City), a Task Force member. "This measure will help women protect themselves from disease by enabling them to take steps early to find and treat illness before it debilitates them." 

 

"Early detection of diseases that affect women can not only save lives, but also spare them from more intrusive and expensive procedures required to treat advanced stages of cancer and other diseases," said Senate Insurance Committee Chairman James L. Seward (R-C, Oneonta). "This measure is the type of forward-thinking plan that not only protects women's health, but also encourages a healthier society." The bill also requires insurers to provide coverage for contraceptives prescribed by a woman's doctor. It is estimated that women under 44 pay 68 percent more in out-of-pocket medical expenses than men, largely due to health costs including contraception, though 90 percent of HMOs cover the costs of some of these services. 

 

At least 20 states already require coverage for routine, doctor-prescribed contraceptives. Like many of these states, the Women's Health measure includes a carefully crafted opt-out provision for health care plans and providers with moral or religious objections to providing the additional coverage. The Women's Health measure stems from the ongoing study of health and wellness issues by the Task Force, which has been conducting roundtable discussions across the state to gather information 
and expert testimony from health professionals, providers, health officials and others. 

 

INFERTILITY 
The infertility bill mirrors a bill passed last year by the Senate that would require insurers to provide coverage for those aged 25 to 44 for procedures that are recognized and sanctioned by leading medical specialists. 

"As many as one out of five couples are known to have experienced difficulty in having children, and this legislation removes the often frustrating financial obstacles to those couples gaining access to procedures and treatments that are known to be effective," said Senator LaValle (R-C, Port Jefferson). Coverage for infertility treatment is already offered to many insured, including over 200,000 state workers, who have seen no premium increase associated with the cost of covering the procedures. 
Senator Bruno said the Majority Task Force on Health & Wellness would continue its work with the goal of proposing measures and initiatives that will encourage healthier lifestyles, enhanced efforts at disease prevention and better health treatment for the sick. 

Other Task Force members include Sens. John R. Kuhl (R-C, Hammondsport), William Larkin (R-C, New Windsor), Dean G. Skelos (R, Rockville Centre), Nancy Larraine Hoffmann (R, Syracuse), Nicholas Spano (R, Yonkers), Roy M. Goodman (R, Manhattan) and Thomas P. Morahan (R-C, New City).

 

States Mandating Insurance Coverage for Infertility and Pregnancy Loss

Arkansas

This law requires all health insurers that cover maternity benefits to cover the cost of in vitro fertilization (IVF) Health maintenance organizations, commonly called HMOs, are exempt from the law.

Patients need to meet the following conditions in order to get their IVF covered:

 

  • The patient must be the policyholder or the spouse of the policyholder and be covered by the policy;
  • The patient's eggs must be fertilized with her spouse's sperm;
  • The patient and her spouse must have at least a two-year history of unexplained infertility,
  • OR the infertility must be associated with one or more of the following conditions:
    • Endometriosis;
    • Fetal exposure to diethylstilbestrol, also known as DES;
    • Blocked or surgically removed fallopian tubes that are not a result of voluntary sterilization; or
    • Abnormal male factors contributing to the infertility.

 

The IVF benefits are subject to the same deductibles and co-insurance payments as maternity benefits. The law also permits insurers to limit coverage to a lifetime maximum of $ 15,000.

(Arkansas Statutes Annotated, Sections 23-85-137 and 23-86-118).

 

Maryland

The Maryland law requires health and hospital insurance policies that provide pregnancy benefits to also cover the cost of in-vitro fertilization. However, the law does not apply to health maintenance organizations, or HMOs. Policies that must provide the coverage include those covering people who live and work in the state, regardless of whether the policy is issued in or outside the state.

Patients need to meet the following conditions in order to get their IVF covered:

 

  • The patient's eggs must be fertilized with the sperm of the patient's spouse;
  • The patient is unable to get pregnant through less expensive covered treatments;
  • The IVF is performed at facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.
  • The patient and his or her spouse must have at least a five-year history of infertility;
  • OR their infertility must be associated with one or more of the following conditions:
    • Endometriosis;
    • Fetal exposure to diethylstilbestrol, also known as DES; or
    • Blocked or surgically removed fallopian tubes.

 

Regulations that took effect in 1994 exempt businesses with 50 or fewer employers from having to provide the IVF coverage.

(Annotated Code of Maryland, Article 48A, Sections 354DD, 470W and 477EE).

 

Massachusetts

This state's law requires health maintenance organizations and insurers companies that cover pregnancy-related benefits to cover medically necessary expenses of infertility diagnosis and treatment.

The law defines infertility as "the condition of a presumably healthy individual who is unable to conceive or produce conception during a one-year period."

Benefits covered include:

 

  • Artificial insemination;
  • In vitro fertilization;
  • Gamete Intrafallopian Transfer;
  • Sperm, egg and/or inseminated egg retrieval, to that extent that those costs are not covered by the donor's insurer;
  • Intracytoplasmic Sperm Injection (ICSI) for the treatment of male infertility; and
  • Zygote Intrafallopian Transfer (ZIFT).
  •  

Insurers may, but are not required, to cover experimental procedures, surrogacy, reversal of voluntary sterilization or cryopreservation of eggs.

(Annotated Laws of Massachusetts, Chapters 175,@ 47H; 176A,@8K;176B,@4J; and l76G,@4).

 

Montana

This state's law requires health maintenance organizations (Blue Cross Blue Shield is the only one in Montana) to cover infertility services as part of basic preventive health care services.

The law does not define infertility or the scope of services covered; nor did the state ever draft regulations explaining what infertility services entail. As for health insurers other than HMOs, the law specifically excludes infertility coverage from the required scope of health benefits those insurers must provide.

(Montana Code Annotated, Sections 33-22-1521 and 33-31-102)

 

New York

The New York law requires insurers to cover the diagnosis and treatment of correctable medical conditions and makes clear that coverage cannot be withheld for a correctable condition solely because the condition results in infertility.

 

However, the law DOES NOT require coverage for the reversal of voluntary sterilization, experimental procedures, or procedures intended solely to produce pregnancy - like IVF.

(New York Consolidated Laws, Insurance, Sections 3216, 3221 and 4303).

 

Ohio

Ohio's law requires health maintenance organizations to cover basic preventive health services, including infertility

 

The Ohio Insurance Department has no written definition of infertility services, but the following general interpretation is applied to the code:

 

Up to $2,000 worth of infertility services are to be covered if the couple experiences an inability to conceive purely as a result of infertility problems (unexplained infertility, for example). The $2,000 cap is not applied if another condition or medically related problem (endometriosis, for example) is involved. Experimental procedures - determined on a case-by-case basis by the Insurance Department -- are not covered.

(Ohio Revised Code Annotated, Chapter 1742).

 

Rhode Island

The Rhode Island law requires insurers that cover pregnancy services to cover the cost of medically necessary expenses of diagnosis and treatment of infertility.

 

The law defines infertility as "the condition of an otherwise healthy married individual who is unable to conceive or produce conception during a period of one year."

 

The patient's co-payment cannot exceed 20 percent (Rhode Island General Laws @ 27-18-30, 27-19-23, 27-20-20 and 27-41-33).

 

Texas

This state's law requires certain insurers that cover pregnancy services to offer coverage for infertility diagnosis and treatment - including in vitro fertilization. Therefore insurers must let employers know this coverage is available. However, the law does not require those insurers to provide the coverage; nor does it force employers to include it in their health plans.

Patients need to meet the following conditions in order to get their IVF covered:

 

  • The patient must be the policyholder or the spouse of the policyholder and be covered by the policy;
  • The patient's eggs must be fertilized with her spouse's sperm;
  • The patient has been unable to get and stay pregnant through other infertility treatments covered by insurance;
  • The IVF is performed at medical facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists; and
  • The patient and her spouse must have at least a continuous five-year history of unexplained infertility,
  • OR the infertility must be associated with one or more of the following conditions:
    • Endometriosis.
    • Fetal exposure to diethylstilbestrol (DES);
    • Blocked or surgical removal of one or both fallopian tubes; or
    • Oligospermia

 

The law does not require organizations that are affiliated with religious groups to cover treatment that conflicts with the organization's religious and ethical beliefs.

(Texas Insurance Code, Article 3.51-6).

 

Insurance Advocacy Forum

In the United States, one of the richest and most technically advanced nations on earth, millions of couples remain involuntarily childless. A conservative estimate places the number of U.S. couples that grapple with infertility annually at 5,000,000, yet less than 20% of those couples will undergo some form of definitive treatment. The high cost of infertility treatment, especially the advanced Assisted Reproductive Technologies (ART) such as In Vitro Fertilization (IVF), has resulted in reluctance on the part of most insurance companies to provide benefits for infertility and therefore, has rendered such medical intervention financially inaccessible to the general infertile population. Although a few states have enacted legislation requiring health insurance providers to offer or provide infertility benefits, such coverage is often limited, or absent altogether due to regulatory loopholes. The majority of employer groups as well as health insurance providers continue to avoid voluntarily including infertility benefits. They recognize that such benefits would spawn an increase in the demand for these specialized services. This fuels their fear of the spiraling costs that might be brought about by a disproportionate increase in the demand for expensive ART, and the costly neonatal services required to deal with the potential influx of premature babies resulting from IVF-related multiple births.

 

Visit the insurance Advocacy forum on INCIID

 

What you should know about Managed Care Insurance

Provider or Managed Care Networks
(HMOs, PPOs)

 

 

Staff Model HMO --- provides health services through a physician group controlled by the HMO
Physicians participating in the staff model HMO are salaried employees of the HMO and spend their time providing services exclusively to HMO enrollees. These providers are salaried and although there may be a bonus system for the physicians, the HMO is at financial risk for the entire cost of health care services being rendered to the HMO’s members.

 

Group Model HMO --- In most group model HMOs, the HMO contracts with multi specialty physician groups to provide all physician services to the HMO’s members. These physicians are not employees of an HMO and are typically paid via monthly capitation checks.

 

IPA (Independent Practice Association) Model HMO ---provides services through direct contact with physicians in independent medical practices. The IPA model HMO contracts with several physician groups, which in turn contract with individual physicians to provide healthcare for the HMO's enrollees. These individual physicians may continue to see non-HMO patients. Enrollees sign-up with a specific IPA or medical group when they join the HMO. Although the HMO may contract with thousands of physicians, enrollees may only have access to those that are members of the particular medical group/IPA. In most cases, physicians are paid on a capitated basis.

 

Fee-for-Service

This is the traditional kind of health care policy. Insurance companies pay fees for the services provided to the insured people covered by the policy. This type of health insurance offers the most choices of doctors and hospitals. You can choose any doctor you wish and change doctors any time. You can go to any hospital in any part of the country.

With fee-for-service, the insurer only pays for part of your doctor and hospital bills. 
This is what you pay:

  • A monthly fee, called a premium.
  • A certain amount of money each year, known as the deductible, before the insurance payments begin.

 

In a typical plan, the deductible might be $250 for each person in your family, with a family deductible of $500 when at least two people in the family have reached the individual deductible. The deductible requirement applies each year of the policy. Also, not all health expenses you have count toward your deductible. Only those covered by the policy do.

 

You need to check the insurance policy to find out which ones are covered. After you have paid your deductible amount for the year, you share the bill with the insurance company. For example, you might pay 20 percent while the insurer pays 80 percent. Your portion is called coinsurance.

To receive payment for fee-for-service claims, you may have to fill out forms and send them to your insurer. Sometimes your doctor's office will do this for you. You also need to keep receipts for drugs and other medical costs.

 

You are responsible for keeping track of your medical expenses. There are limits as to how much an insurance company will pay for your claim if both you and your spouse file for it under two different group insurance plans. A coordination of benefit clause usually limits benefits under two plans to no more than 100 percent of the claim.

Most fee-for-service plans have a "cap," the most you will have to pay for medical bills in any one year. You reach the cap when your out-of-pocket expenses (for your deductible and your coinsurance) total a certain amount. It may be as low as $1,000 or as high as $5,000. Then the insurance company pays the full amount in excess of the cap for the items your policy says it will cover. The cap does not include what you pay for your monthly premium.

 

Some services are limited or not covered at all. You need to check on preventive health care coverage such as immunizations and well-child care.

 

There are two kinds of fee-for-service coverage: basic and major medical.

Basic protection pays toward the costs of a hospital room and care while you are in the hospital. It covers some hospital services and supplies, such as x-rays and prescribed medicine. Basic coverage also pays toward the cost of surgery, whether it is performed in or out of the hospital, and for some doctor visits.

Major medical insurance takes over where your basic coverage leaves off. It covers the cost of long, high-cost illnesses or injuries. Some policies combine basic and major medical coverage into one plan. This is sometimes called a "comprehensive plan." Check your policy to make sure you have both kinds of protection.

 

What Is a "Customary" Fee?

Most insurance plans will pay only what they call a reasonable and customary fee for a particular service. If your doctor charges $1,000 for a hernia repair while most doctors in your area charge only $600, you will be billed for the $400 difference. This is in addition to the deductible and coinsurance you would be expected to pay.

To avoid this additional cost, ask your doctor to accept your insurance company's payment as full payment. Or shop around to find a doctor who will. Otherwise you will have to pay the rest yourself.

 

Questions to Ask About Fee-for-Service Insurance

  1. How much is the monthly premium?
  2. What will your total cost be each year?
  3. Are there individual rates and family rates.
  4. What does the policy cover?
  5. Does it cover prescription drugs, out-of-hospital care, or home care?
  6. Are there limits on the amount or the number of days the company will pay for these services?
  7. The best plans cover a broad range of services.
  8. Are you currently being treated for a medical condition that may not be covered under your new plan?
  9. Are there limitations or a waiting period involved in the coverage?
  10. What is the deductible? Often, you can lower your monthly health insurance premium by buying a policy with a higher yearly deductible amount.
  11. What is the coinsurance rate?
  12. What percent of your bills for allowable services will you have to pay?
  13. What is the maximum you would pay out of pocket per year?
  14. How much would it cost you directly before the insurance company would pay everything else?
  15. Is there a lifetime maximum cap the insurer will pay?
  16. The cap is an amount after which the insurance company won't pay anymore. This is important to know if you or someone in your family has an illness that requires expensive treatments.

 

The preferred provider organization is a combination of traditional fee-for-service and an HMO. Like an HMO, there are a limited number of doctors and hospitals to choose from. When you use those providers (sometimes called"preferred" providers, other times called "network" providers), most of your medical bills are covered.

When you go to doctors in the PPO, you present a card and do not have to fill out forms. Usually there is a small copayment for each visit. For some services, you may have to pay a deductible and coinsurance.

As with an HMO, a PPO requires that you choose a primary care doctor to monitor your health care. Most PPOs cover preventive care. This usually includes visits to the doctor, well-baby care, immunizations, and mammograms.

 

In a PPO, you can use doctors who are not part of the plan and still receive some coverage. At these times, you will pay a larger portion of the bill yourself (and also fill out the claims forms). Some people like this option because even if their doctor is not a part of the network, it means they don't have to change doctors to join a PPO.

 

Questions to Ask About a PPOs

 

  1. Are there many doctors to choose from?
  2. Who are the doctors in the PPO network?
  3. Where are they located?
  4. Which ones are accepting new patients?
  5. How are referrals to specialists handled?
  6. What hospitals are available through the PPO?
  7. Where is the nearest hospital in the PPO network?
  8. What arrangements does the PPO have for handling emergency care?
  9. What services are covered?
  10. What preventive services are offered?
  11. Are there limits on medical tests, out-of-hospital care, mental health care, prescription drugs, or other services that are important to you?
  12. What will the PPO plan cost?
  13. How much is the premium?
  14. Is there a per-visit cost for seeing PPO doctors or other types of copayments for services?
  15. What is the difference in cost between using doctors in the PPO network and those outside it?
  16. What is the deductible and coinsurance rate for care outside of the PPO?
  17. Is there a limit to the maximum you would pay out of pocket? 

 

 

Health Maintenance Organizations (HMOs)

 

Health maintenance organizations are prepaid health plans. As an HMO member, you pay a monthly premium. In exchange, the HMO provides comprehensive care for you and your family, including doctors' visits, hospital stays, emergency care, surgery, lab tests, x-rays, and therapy.

 

The HMO arranges for this care either directly in its own group practice and/or through doctors and other health care professionals under contract. Usually, your choices of doctors and hospitals are limited to those that have agreements with the HMO to provide care. However, exceptions are made in emergencies or when medically necessary.

 

There may be a small copayment for each office visit, such as $5 for a doctor's visit or $25 for hospital emergency room treatment. Your total medical costs will likely be lower and more predictable in an HMO than with fee-for-service insurance.

 

Because HMOs receive a fixed fee for your covered medical care, it is in their interest to make sure you get basic health care for problems before they become serious. HMOs typically provide preventive care, such as office visits, immunizations, well-baby checkups, mammograms, and physicals.

 

The range of services covered vary in HMOs, so it isimportant to compare available plans. Some services, such as outpatient mental health care, often are provided only on a limited basis.

 

Many people like HMOs because they do not require claim forms for office visits or hospital stays. Instead, members present a card, like a credit card, at the doctor's office or hospital. However, in an HMO you may have to wait longer for an appointment than you would with a fee-for-service plan.

 

In some HMOs, doctors are salaried and they all have offices in an HMO building at one or more locations in your community as part of a prepaid group practice. In others, independent groups of doctors contract with the HMO to take care of patients. These are called individual practice associations (IPAs) and they are made up of private physicians in private offices who agree to care for HMO members. You select a doctor from a list of participating physicians that make up the IPA network. If you are thinking of switching into an IPA-type of HMO, ask your doctor if he or she participates in the plan.

 

In almost all HMOs, you either are assigned or you choose one doctor to serve as your primary care doctor. This doctor monitors your health and provides most of your medical care, referring you to specialists and other health care professionals as needed. You usually cannot see a specialist without a referral from your primary care doctor who is expected to manage the care you receive. This is one way that HMOs can limit your choice.

Before choosing an HMO, it is a good idea to talk to people you know who are enrolled in it. Ask them how they like the services and care given.

 

Questions to Ask About an HMO

 

  1. Are there many doctors to choose from?
  2. Do you select from a list of contract physicians or from the available staff of a group practice?
  3. Which doctors are accepting new patients?
  4. How hard is it to change doctors if you decide you want someone else?
  5. How are referrals to specialists handled?
  6. Is it easy to get appointments?
  7. How far in advance must routine visits be scheduled?
  8. What arrangements does the HMO have for handling emergency care?
  9. Does the HMO offer the services I want?
  10. What preventive services are provided?
  11. Are there limits on medical tests, surgery, mental health care, home care, or other support offered?
  12. What if you need a special service not provided by the HMO?
  13. What is the service area of the HMO?
  14. Where are the facilities located in your community that serve HMO members?
  15. How convenient to your home and workplace are the doctors, hospitals, and emergency care centers that make up the HMO network?
  16. What happens if you or a family member are out of town and need medical treatment?
  17. What will the HMO plan cost?
  18. What is the yearly total for monthly fees?
  19. In addition, are there copayments for office visits, emergency care, prescribed drugs, or other services?
  20. How much?

 

 

 

Understanding your health insurance

There are no real standards for infertility coverage and every policy seems to read a little differently. The people writing these policies don't have, in many cases, the understanding of infertility that you do. While certain areas under the auspices of infertility are covered --- others are not. Because this is such a gray area, don't take a denial as the final word.

 

Don't take NO for an answer!

Many times when you call your insurance company for a referral or for permission to see a particular physician, you will be speaking to a customer service person who knows far less about what is covered or even what is being asked than you do.

Much of what is or is not covered would seem many times to lack the most basic logic. Infertility is one of the few areas where many times diagnosis is covered but not treatment! Insurance coverage varies drastically not only by plan but also by employer.

It is as important to look at the what is written in your policy as to look at what is NOT written. Many times if the procedure is NOT EXCLUDED... it will be covered. You are the person who needs to look critically at your policy and decide what is covered. Do not leave this task to other people because YOU need to be your own best advocate. No one in human resources is going to have the vested interest that you do.

Review your insurance contract. Your contract guarantees you (the insured) the right to have certain types of care and procedures and all the covered components surrounding said procedures. Question, read and reread the contract until you are sure there is a complete understanding of what exactly is included and/or excluded in your contract. Do NOT stop until you are completely satisfied with the answers you receive.

 

Understanding Insurance Coverage

Most Americans get health insurance through their jobs or are covered because a family member has insurance at work. This is called group insurance. Group insurance is generally the least expensive kind. In many cases, the employer pays part or all of the cost.

Some employers offer only one health insurance plan. Some offer a choice of plans: a fee-for-service plan, a health maintenance organization (HMO), or a preferred provider organization (PPO), for example. Explanations of fee-for-service plans, HMOs, and PPOs are provided in the section called Types of Insurance.

 

Group Insurance

Group insurance is generally the least expensive kind. In many cases, the employer pays part or all of the cost. Some employers offer only one health insurance plan. Some offer a choice of plans:

Fee-for-service plan,

A health maintenance organization (HMO),

Preferred provider organization (PPO), for example.

 

Explanations of fee-for-service plans, HMOs, and PPOs are provided in the section called Types of Insurance.

What happens if you or your family member leaves the job?
You will lose your employer-supported group coverage. It may be possible to keep the same policy, but you will have to pay for it yourself.

 

This will certainly cost you more than group coverage for the same, or less, protection. A Federal law makes it possible for most people to continue their group health coverage for a period of time. Called COBRA (for the Consolidated Omnibus Budget Reconciliation Act of 1985), the law requires that if you work for a business of 20 or more employees and leave your job or are laid off, you can continue to get health coverage for at least 18 months.

You will be charged a higher premium than when you were working. You also will be able to get insurance under COBRA if your spouse was covered but now you are widowed or divorced. If you were covered under your parents' group plan while you were in school, you also can continue in the plan for up to 18 months under COBRA until you find a job that offers you your own health insurance.

Not all employers offer health insurance. You might find this to be the case with your job, especially if you work for a small business or work part-time. If your employer does not offer health insurance, you might be able to get group insurance through membership in a labor union, professional association, club, or other organization. 
Many organizations offer health insurance plans to members.

 

Individual Insurance

If your employer does not offer group insurance, or if the insurance offered is very limited, you can buy an individual policy.

Insurance is provided through two major sources:

Public -- Medicare for the elderly, Medicaid for the disabled or needy, Veteran's Administration for those who have served in the Armed Forces, and Champus for Military Families or

  • Private --- Includes insurance provided for by private companies

·          

  • Commercial Insurance Companies
  • Nonprofit Insurance Companies and
  • Self-insured Groups (employers who pay benefits directly rather than using an insurance carrier).

 

You can get a Fee-for-service planHMO, or PPO protection. But you should compare your options and shop carefully because coverage and costs vary from company to company.

Individual plans may not offer benefits as broad as those in group plans. If you get a noncancellable policy (also called a guaranteed renewable policy), then you will receive individual insurance under that policy as long as you keep paying the monthly premium.

The insurance company can raise the cost, but cannot cancel your coverage. Many companies now offer a conditionally renewable policy. This means that the insurance company can cancel all policies like yours, not just yours.

This protects you from being singled out. But it doesn't protect you from losing coverage. Before you buy any health insurance policy, make sure you know what it will pay for...and what it won't.

To find out about individual health insurance plans, you can call insurance companies, HMOs, and PPOs in your community, or speak to the agent who handles your car or house insurance.

 

Tips when shopping for individual insurance:

  • Shop carefully. Policies differ widely in coverage and cost.
  • Contact different insurance companies, or ask your agent to show you policies from several insurers so you can compare them.
  • Make sure the policy protects you from large medical costs.
  • Read and understand the policy.
  • Make sure it provides the kind of coverage that's right for you. You don't want unpleasant surprises when you're sick or in the hospital.
  • Check to see that the policy states: the date that the policy will begin paying (some have a waiting period before coverage begins), and what is covered or excluded from coverage.
  • Make sure there is a "free look" clause. Most companies give you at least 10 days to look over your policy after you receive it. If you decide it is not for you, you can return it and have your premium refunded.
  • Beware of single disease insurance policies. There are some polices that offer protection for only one disease, such as cancer. If you already have health insurance, your regular plan probably already provides all the coverage you need.
  • Check to see what protection you have before buying any more insurance.

 

Investigating your Policy

One way to keep costs down is to EXCLUDE coverage for illnesses that insurers believe are non-life-threatening.

Infertility is seen by many companies to be "elective" and nonlife-threatening.

When examining a claim, insurance companies look at WHAT is procedure is being claimed and the WHY it is being performed. The WHAT and the WHY is the basis of a claim's acceptance or denial.

 

The WHAT

CPT Codes: ( Physicians Current Procedural Terminology) A listing (and coding) of procedures and services performed by the physician. These codes are systematic standarized and put forth by the American Medical Society.

 

The WHY

ICD-9 Codes: These codes give the insurance company the diagnosis from the doctor of your condition. 
This gives the insurance company the information about why you are being treated: endometriosis, PID, Blocked Tubes etc.

If insurance companies do not agree with the WHAT (CPT codes) or the WHY (ICD-9) they may deny the claim. Many carriers may cover the cost to diagnose but not to treat.

Knowing how the codes are applied to your insurance may help you not only get something covered but also be sure codes are being properly applied for more efficient payment of the physician or for reimbursement for you.

 

Get Copies of Your Documents

It is as important to get copies of your own records as it is to see a copy of your insurance contract.

Call you physician's office and get copies of all your labs, notes etc. Then call your (or your spouses) benefits office for contract information. If you are insured individually, call your agent.

The policy comes in two forms, a contract (which is usually not provided to you in a group policy, unless you ask, or a summary plan booklet. The booklet is a brief summary of the benefits.

 

Read your Documents

Even your booklet is a "contract" written specifically to spell out not only what IS covered but to exclude what is not covered. Disputes over the policy language have traditionally sided with the insured.

Insurance companies are designed to cover the insured in the event they suffer from an "illness" or "injury".

 

ADA - Recognizes Infertility

In 1990 The American Fertility Society, now the ASRM (American Society for Reproductive Medicine), defined infertility as a disease. then in 1996, Pacourek v. Inland Steel Co., 64 U.S.L.W. 2550 (N.D. Ill. Feb. 16, 1996) reasoned that including the reproductive system in the regulation's list of body systems which can be impaired for purposes of the ADA would have been superflous had the EEOC rulemakers, and Congress before them, not intended infertility to be a disability covered by the Act. The court also found that a major life activity should be characterized in terms of the quality of life, not merely the frequency of the activity

There are numerous physical problems that accompany infertility as a disease process, endometriosis, polycystic ovarian syndrome etc. Being defined as a "disease or illness" may be a step in the direction of coverage instead of exclusion.

 

Exculsions

Review carefully this portion of your insurance booklet or contract. Pay careful attention to the terms and definition of the terms and language of the contract.

If a procedure is no specifically listed in the exclusions area of your policy, it would be fair to assume the procedure is covered and this opens the door to an appeal for a denial of coverage.

 

Denials

In the past, insurance carriers that have denied claims for one of the following four reasons:

1. Infertility is not an illness;

2. Treatment of infertility is not medically necessary;

3. Treatment of infertility is experimental.

4. Excluded Treatment

 

Not Medically Necessary

Traditionally, having a baby is not looked upon as being medically necessary. Most insurers, however, will pay for treatment where an illness or disease contributes to infertility IF treatment is not just for the purpose of getting pregnant.

Because of this, portions of infertility treatments can be broken out and paid for using specific billing codes. Review of the "denied claim" as not medically necessary can often be resubmitted successfully with additional information from the physician.

 

An Experimental Procedure

In the past IVF seemed to fall under this catagory. Today denying coverage as "experimental" is simply not a valid reason.

 

Excluded Procedure

You should examine this area very carefully. Most medical procedures have many different components. There may be sub-areas within the procedure that are not excluded and there fore portions of the procedure might be copied.

Look carefully at the language. IVF may not be a covered procedure but when broken down into the billing codes for egg retrieval, embryo transfer, blood work etc, a number of the services might be covered. IVF and embryo transfer might be excluded but with no mention of GIFT (Gamet Intrafallopian Transfer) which could open the door for coverage for this specific procedure.

 

 

 

 

Pages