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Affording Treatment

Fertility Insurance Providers

At Reproductive Medicine Associates of Connecticut, we help you work with your insurance company to determine your level of coverage and your out-of-pocket expenses (when applicable). We also review with you the specific details of your insurance plan for infertility treatment. We encourage you to be your own best advocate by thoroughly understanding your benefits before you begin treatment. Start by reviewing your specific policy requirements for covered and non-covered infertility services and asking questions of your insurer for clarification.

Infertility benefits vary from patient to patient and from provider to provider. Here are some key points about insurance coverage for infertility treatment by major plans to help you know what to expect.

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Basic Requirements

A member is considered infertile if he or she is unable to conceive or produce conception after 1 year of frequent, unprotected heterosexual sexual intercourse, or 6 months of frequent, unprotected heterosexual sexual intercourse if the female partner is over age 35 years. Alternately, a woman without a male partner may be considered infertile if she is unable to conceive or produce conception after at least 12 cycles of donor insemination (6 cycles for women aged 35 or older). However, this definition of infertility may vary due to state mandates and plan customization; please check plan documents.

Preauthorization

A member is considered infertile if he or she is unable to conceive or produce conception after 1 year of frequent, unprotected heterosexual sexual intercourse, or 6 months of frequent, unprotected heterosexual sexual intercourse if the female partner is over age 35 years. Alternately, a woman without a male partner may be considered infertile if she is unable to conceive or produce conception after at least 12 cycles of donor insemination (6 cycles for women aged 35 or older). However, this definition of infertility may vary due to state mandates and plan customization; please check plan documents.

Infertility Medical Policy

Click here to read Aetna's Infertility Medical Policy

Basic Requirements

When a male or female is unable to conceive or produce conception after ≥ 12 months of frequent, unprotected heterosexual sexual intercourse or ≥ 6 months of frequent unprotected heterosexual sexual intercourse if the female partner is > age 35 years. (Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after 6 months).  Women < 35, including single female patients and same sex couples member must have undergone a total of 6 IUI cycles (with at least 2–4 cycles of ovulation induction). Women > 35, including single female patients and same sex couples — member must have undergone a total of 3 (physician-supervised) IUI cycles (with at least 2–3 cycles of ovulation induction).

Preauthorization

All infertility services must be pre-authorized prior to beginning treatment.   Note: It is the member’s responsibility to verify prior authorization was obtained prior to starting treatment.

Infertility Medical Policy

Click here to read GHI's Infertility Medical Policy

Basic Requirements

The inability of opposite-sex partners to achieve conception after at least one year of unprotected intercourse.

The inability of a woman to achieve conception after six trials of medically supervised artificial insemination over a one-year period.

The inability of opposite-sex partners to achieve conception after six months of unprotected intercourse for a woman over the age of 35 years.

Preauthorization

Infertility diagnostic workup must be done prior to starting treatment for any infertility cycle. 

Infertility Medical Policy

Click here to read Cigna's Infertility Medical Policy

Basic Requirements

Infertility is defined as the condition of a presumably healthy individual who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period.  Coverage is limited to individuals under 40 years of age.  Connecticare requires both partners to be under the age of 40 in order to access their infertility benefit. Infertility treatment follows the Connecticut State mandate: 4 cycles of ovulation induction, 3 cycles of intrauterine insemination (IUI), 2 cycles of invitro fertilization (IVF). Religious and self-funded employers are permitted to exclude infertility coverage under the mandate. 

Preauthorization

All infertility services must be pre-authorized prior to beginning treatment.  A 12-month waiting period may apply for members in individual ConnectiCare®Solo plans. Members are no longer eligible for coverage after their 40th birthday.

Infertility Medical Policy

Click here to read ConnectiCare's Infertility Medical Policy

Basic Requirements

The inability to conceive following 1 year of unprotected intercourse or therapeutic donor insemination in cases where the female is ≤ 35 years of age or following 6 months of unprotected intercourse or therapeutic donor insemination for females > 35 years of age.

Preauthorization

Prior to the initial office visit, patients must call Optum(Oxfords managed infertility program) at (877) 512-9340 to register for their initial consultation.  All infertility treatment  must be pre-authorized prior to beginning treatment.  Authorization request can take approximately 5 business days. Authorizations cannot be backdated.

Infertility Medical Policy

Click here to read United Healthcare - Oxford's Infertility Medical Policy

Basic Requirements

Infertility - failure to achieve a successful pregnancy after 12 months or more of appropriate, timed unprotected intercourse or therapeutic donor insemination. Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after 6 months for women over age 35 years.

Preauthorization

Prior notification is required for some United Health Care Plans prior to the initial office visit, patients must call Reproductive Resources Services (United Health Care’s managed infertility program) at (866) 774-4626 to register for their initial consultation.  Infertility diagnostic workup must be done prior to starting treatment for any infertility cycle. 

Infertility Medical Policy

Click here to read United Healthcare's Infertility Medical Policy

The infertility policy for the insurance companies listed below are plan specific:

Basic Requirements:
Varies depending upon your plan, please call your insurance directly for more information.

Preauthorization:
Infertility diagnostic workup must be done prior to starting treatment for any infertility cycle. Prior authorization may be required by your plan, please call your insurance directly for more information.

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Harvard Pilgrim Health Care

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