Questions To Ask Your Insurance Carrier About Your Infertility

Even though New Jersey is one of the 15 states that has passed a mandate with regards to infertility insurance, it does not mean your in-vitro fertilization (IVF) is automatically covered.

Insurance_3Why is this?  Every state’s law is different, and many have exclusions.  For example, if you work for a religious organization, a self-insured employer or a small employer, it is very likely that the employer is exempt from offering the mandated coverage.  Also, several states require insurance companies to offer coverage for infertility treatment, but specifically exclude IVF as treatment.

If you do not live in a mandated state, your plan may cover certain aspects of your fertility treatment, such as the initial diagnosis of infertility.  Navigating the insurance maze is stressful, so find out what your plan covers before you get started.  Here are some helpful questions to ask your insurance provider:

  • How do you define “infertility”?  For some plans to cover IVF, a couple must have been experiencing infertility for five years or longer.
  • What coverage is available for fertility treatment in my plan?
  • Is prior authorization necessary for certain fertility treatments?
  • Do I need to obtain a referral before I see a fertility doctor (reproductive endocrinologist)?
  • Does my insurance policy include coverage for the diagnosis of infertility, such as lab work, office visits and hysterosalpingogram?
  • Does my policy cover fertility drugs?  Are any fertility drugs excluded?
  • If the policy does not cover IVF, does that mean it won’t cove r any of the office visits, lab work or ultrasounds for the non-covered treatment?
  • What is my annual or lifetime maximum benefit for infertility treatment?

Insurance plans can vary greatly in what they cover and what they require for that coverage.  RMANJ participates with several leading insurance plans including: Aetna, Amerihealth, Cigna, Horizon Blue Cross Blue Shield, Oxford Health Plan, United Health Care and Great West.  Here are a few key points for insurance coverage by major plans to help you manage expectation of coverage.  All information provided is for informational purposes only and is not a commitment of coverage.

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