Fed employee insurance plans, DC area -- IVF coverage and age restrictions

[Anonymous]

I live in MD and can find 3 plans that seem to cover IVF at 50%. See below for details. I'm trying to figure out if any of them have age restrictions and whether I would qualify, given that we've been trying 2 1/2 years, but I had a miscarriage last summer (does that restart the clock?). We're unexplained.

The 3 that seem to cover IVF (in MD)

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Kaiser (50%, up to $100,000 plus 50% of fertility drugs)
• Up to three in vitro fertilization procedures per live
birth if:
- your oocytes are fertilized with your spouse’s
sperm; and
- you have been unable to become pregnant
through a less costly infertility treatment for
which coverage is available under the Plan; and
- you and your spouse have a history of infertility
of at least 2 years duration; or
- the infertility is associated with endometriosis,
exposure in utero to diethylstilbestrol,
commonly known as DES, blockage of, or
surgical removal of, one or both fallopian tubes
(lateral or bilateral salpingectomy), or abnormal
male factors, including oligospermia,
Not covered:
These exclusions apply to fertile as well as infertile
individuals and couples:
• Assisted reproductive technology (ART)
procedures, including related services and supplies,
such as:
- embryo transfer, gamete intra-fallopian transfer
(GIFT) and zygote intra-fallopian transfer
(ZIFT)
• Sperm and eggs (from a donor) and embryos
(whether from a member or from a donor), and
services related to their procurement and storage,
including freezing
• Ovum transplants
• Infertility services when either member of the
family has been voluntarily, surgically sterilized
• Services to reverse voluntary, surgically induced
infertility
• Services related to surrogate arrangements
• Intracytoplasmic sperm injection (ICSI)
• Preimplantation Genetic Diagnosis (PGD )


MD-IPA (50%)
Artificial insemination is limited to (6) cycles per lifetime.
• In-vitro fertilization is covered for married members when the following
criteria is met:
- your oocytes are fertilized with your spouse’s sperm
- you and your spouse have a history of infertility of at least 2 years, or
- your infertility is associated with endometriosis, or exposure in-utero to
diethylstilbestrol (DES), or blockage of, or surgical removal of one or
both fallopian tubes (not due to voluntary sterilization), or abnormal
male factors, including oligospermia, contributing to the infertility
- you have been unable to attain a successful pregnancy through a less
costly treatment that is covered by the Plan
In-vitro fertilization is limited to three (3) in-vitro attempts per live birth and a
maximum lifetime benefit of $100,000, except drugs (an attempt is counted
toward this limit when injectable medications are started).
Note: We cover injectable and oral fertility drugs for covered in-vitro
fertilization services. We cover Clomid (clomiphene) for other infertility
services. When covered, all infertility drugs are covered under the
prescription drug benefit.
Not covered:
• Assisted reproductive technology (ART) procedures, unless specifically
listed as covered. For example:
- embryo transplant, gamete intra-fallopian transfer (GIFT) and zygote
intra-fallopian transfer (ZIFT) , sex selection, surrogacy, host uterus,
gene therapy, cryopreservation, and pre-implantation genetic diagnosis
are not covered
• Services and supplies related to ART procedures
• Cost of donor sperm and related costs
• Cost of donor egg and related costs
• Infertility services after voluntary sterilization or reversal of voluntary
sterilization of either partner.

Aetna Open Access (50%)
Infertility is defined as the inability to conceive after 12
months of unprotected intravaginal sexual relations (or
12 cycles of artificial insemination) for women under
age 35, and 6 months of unprotected intravaginal sexual
relations (or 6 cycles of artificial insemination) for
women age 35 and over.
Diagnosis and treatment of infertility, such as:
• Artificial insemination:
- intravaginal insemination (IVI)
- intracervical insemination (ICI)
- intrauterine insemination (IUI)
Note: Coverage is only for 6 cycles (per lifetime).
Infertility services must be authorized. You must contact
the Infertility Case Manager at 1-800/575-5999. You
must use our select network of participating Plan
infertility providers.
• Fertility drugs
Note: We cover oral fertility drugs under the
prescription drug benefit.
In vitro fertilization is a covered benefit when the
following criteria are met:
• You and your spouse have a history of infertility of at
least 2 years duration,
• Your oocytes are fertilized with your spouse’s sperm,
and
• Your infertility is associated with endometriosis,
exposure in-utero to diethylstilbestrol (DES),
blockage of, or surgical removal of, one or both
fallopian tubes, or abnormal male factors, including
oligospermia contributing to the infertility, and
• You have been unable to attain a successful
pregnancy through a less costly treatment that is
covered by the Plan.
Note: In vitro fertilization is limited to three attempts
per live birth, a maximum lifetime benefit of $100,000.
This includes the cost of fertility drugs. We cover oral
fertility drugs under the prescription drug benefit.
Injectable fertility drugs are covered only for in vitro
fertilization.
Not covered:
• Infertility services for couples in which either partner
has had a previous sterilization procedure, with or
without surgical reversal, and for females who have
undergone a hysterectomy.
• Infertility treatment when the FSH level is 19 mIU/ml
or greater on day 3 of menstrual cycle
• Cost of donor sperm and donor eggs
• Assisted Reproductive Technology (ART) procedures
not shown, such as embryo transfer (frozen), GIFT,
ZIFT, sex selection, surrogacy, gene therapy,
gestational carriers, cryopreservation, and any other
services and supplies related to the non-covered ART
procedures
• Charges associated with care of the donor, such as
those required for donor egg retrievals or transfers
• Charges associated with cryopreservation
• Charges associated with a gestational carrier program
or for the member or the gestational carrier
• Home ovulation prediction kits

[Anonymous]

Looks like Coventry covers 50% as well.

Diagnosis and treatment of infertility such as:
• Artificial insemination:
- intravaginal insemination (IVI)
- intracervical insemination (ICI)
- intrauterine insemination (IUI)
• Invitrofertilization - Limited to three attempts per
live birth and a maximum plan lifetime benefit of
$100,000
• Fertility drugs
Note: We cover injectible fertility drugs under
medical benefits and oral fertility drugs under the
prescription drug benefit.

Not covered:
• Assisted reproductive technology (ART)
procedures, such as:
- Intracytoplasmic sperm injection (ICSI), unless
authorized as part of an approved IVF procedure
- in vivo fertilization in vivo fertilization including
but not limited to all forms of artificial
insemination procedures, such as Artificial
Insemination Donor (AID), Artificial Insemination
Homologous/ Husband (AIH) and Interuterine
Insemination (IUI); and cryopreservation and
storage of sperm, eggs and embryos.
• Cost of donor egg
• Cost of donor sperm

[Anonymous]

I'm 41 and used MD IPA successfully this year.

[Anonymous]

Successfully in that they allowed you to do IVF or that you got pregnant (hope it's both?). Who's your RE?

[Anonymous]

FWW, I've just been looking too. MD IPA and Kaiser use Shady Grove, but a lot of people seem to be happy with MD-IPA, and all our docs take it, so that's our choice.

[Anonymous]

14:32 poster here. We were successful in both aspects. We used Dr. Greenhouse at Shady Grove. He works at their Annandale and Fair Oaks offices.

[Anonymous]

MD IPA is pretty inexpensive and a great plan for IVF. I highly recommend Dr. Nancy Durso at Metro Fertility Care. Her phone number is [phone].

[Anonymous]

I used MDIPA in 2008. I'm 43. They approved IVF right away (skipping IUI), with ICSI. Meds cost about $150 per cycle.