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Act Now: Use Open Enrollment To Address Fertility Coverage Blog Feature

Act Now: Use Open Enrollment To Address Fertility Coverage

Infertility | Fertility Treatment | IUI | featured | Featured Story | IVF | Fertility Testing | affording fertility

Trying to conceive and received a diagnosis of infertility? That means new deadlines and a new set of tasks to accomplish. It can feel overwhelming, but it gets a lot better when you follow a to-do list that identifies dates to mark on the calendar and helps you gather the information you need and questions to ask about fertility issues.

Today, focus on open enrollment. DEADLINE is: Dec 15, 2018

Until Dec. 15, you have the opportunity to assess the insurance programs your employer offers and choose the one that best suits your needs. If your current policy does not cover infertility treatment, another one offered by your employer might.

You will have to wait another year if you miss the deadline to switch, so if you think moving your policy to another insurance company might benefit you, start the process now. The information you find may lead to other, more affordable fertility treatment choices, that can be instituted before the end of the year.

Understand Your Current Insurance Plan

Insurance policies may contain jargon, abbreviations and unnecessarily long sentences, but the single best way to understand them is to read through them yourself first. Take careful notes on any areas you don’t understand so you can discuss them with your employer’s benefits officer or go straight to the insurance company. Keep asking questions until you understand all the nuances of the benefit.

Patient K.P. : Learned how to talk with her insurance provider

“I was in CONSTANT contact with my insurance company to make sure that several procedures I had were coded correctly. They were regular medical procedures, but if they were coded as infertility tests, it would have eaten away at my lifetime maximum. RMA of Connecticut helped a lot, but you have to be your own best advocate!”

If fertility treatment coverage is the most important benefit for you to review, go directly to that section. If the treatment is not included in the policy, start examining the other insurance options offered by your company.

Take advantage of all the help your employer and the insurance providers offer. Insurance companies often send representatives to your business for one-to-one sessions. There may be webinars or documents online that explain the process. Make time to take advantage of all of these ways to educate yourself.

5 Questions to Answer

When comparing your current plan to other options, look for the standard offerings, which differ between insurance companies.

  1. Deductibles for procedures and prescribed medicines are the amount you pay whenever you visit a doctor or buy a prescription. They can vary widely and need to be factored in when you make a decision.
  2. The insurance company formulary lists all the medicines covered by the policy. You want it to include any drugs associated with infertility testing or fertility enhancement. If you’re not sure of what those medications might be, speak to us here at RMA of Connecticut for help.
  3. Out-of-network doctor visits often cost more than treatment by in-network doctors who agree to charge set fees for procedures. (If there are no doctors in network in your geographical area, exceptions are often made, but ask to be sure.)
  4. The lifetime maximum is the limit your policy will pay for treatment. . Understanding which tests and procedures are included towards meeting this lifetime maximum is critical to planning your care
  5. Cost of the premium is also a consideration, although a higher annual premium might be worth the expense if the plan includes lower deductibles than other policies or coverage for infertility treatment.


Patient L.M.: Learned that reading the fine print is important:

“The policy might say that fertility treatment is “unlimited,” but that means only when “medically necessary.” You can make a case about whether or not a procedure is medically necessary. I worked very closely with my doctors to submit documents. Otherwise, your treatments can be limited.”

Do this work now.

Entering your request for a change of policies will only be honored until Dec. 15. Missing the deadline means you will have to wait another 11 months to make a switch, which might also mean delaying family building for that time period. (Life changes, such as marriage, divorce or changing jobs are allowed outside the open enrollment period.)

Once you have settled on the right plan, examine your present situation, particularly regarding the annual deductible. If you have met that limit, consider getting infertility diagnostic tests before the end of the year. The results can be used next year to further your fertility treatment schedule.

Spend down your accounts before year-end

Check your medical spending account and decide how much to spend before the end of the year. With a Flexible Spending Account or Health Reimbursement Account, (HRA) you may be able to roll over up to $500 into the next year. You will lose amounts above that.

Other types of plans, such as Health Savings Accounts, usually don’t have end-of-year spending deadlines, but it’s worth checking to make sure.

Keep track of insurance, savings accounts, and spending. It will become easier – even routine – when you create your own calendar for checklists and update it. Soon, you will be more confident in your knowledge and decision-making regarding affording fertility treatment

While you need to understand and take charge of your benefits, you are not in this alone. Reproductive Medicine Associates of Connecticut provides a team of compassionate professionals available to help you.