Federal Health Plans & IVF coverage

[Anonymous]

Anonymous wrote:

Anonymous wrote:I just wanted to make sure everyone knew. After much debate during the Federal Government Open Season, we decided to go with Kaiser after confirming that both infertility services and infertility medications count toward the out-of-pocket maximum.

Well, I'm happy to report that it turned out to be true. After paying $2500 to Kaiser's Pharmacy for the first round of meds, I've had to pay ZERO in additional meds or any costs to SG for the actual IVF procedure.

Figured this information would be helpful for anyone considering Kaiser/Aetna/etc. in the upcoming Open Season.

So, to make sure it is clear, while it says that Kaiser covers IVF at 50%, once you reach your out-of-pocket maximum (which under the high option is $2500), Kaiser then covers your IVF expenses at 100%. That's a mighty good deal. So, for 3 IVF procedures in one year, you'll pay a total of $2500.

Is this correct? If so I should've gone with Kaiser! We have coverage but I've had to pay for assisted hatching. Also pgs.

[Anonymous]

Thanks for the info, PP! I do not work for the Federal Government but DH does so I might have to switch during the next open season, provided that they keep the same level of coverage. Aetna looked okay on paper (3 IVFs at 50% following 6 required IUIs) but it turns out they do not cover injectible meds. I just had my second IUI and while that is not going to bankrupt us, I have a feeling IVF is in our future and with Aetna, we were planning to take out a loan.

[Anonymous]

Hi, does anyone know if Kaiser will now cover PGS testing? I know they covered PGD, but not PGS. Hoping that has changed.

[Anonymous]

Anonymous wrote:Hi, does anyone know if Kaiser will now cover PGS testing? I know they covered PGD, but not PGS. Hoping that has changed.

No PGS testing, at least for Fed Kaiser.

[Anonymous]

Still no Kaiser coverage for PGS.

[Anonymous]

Aetna covered ISCI and Assisted Hatching. I didn't need AH after all but I had coverage.
I have been on high dose meds and the costs are incredible ($6000-8000 per cycle!).
One other thing that is a plus with Aetna: if you run out of coverage or have a non-covered service, SG has to give you the Aetna negotiated rate, which is a big discount over SG's rack rate.
Aetna has approved me quickly but my day 3 numbers are fine and we have very severe male factor. I think if your FSH has hit 18, they may deny you coverage.

I have other issues that made me hesitant to switch doctors that I have been working with for almost 8 years and with Kasier you have to switch.

[Anonymous]

Does anyone have any idea if the coverage for kaiser is going to change for next year (2017). We are deciding between doing the shared risk option with SGF or waiting until open enrollment so that I can get on his federal Kaiser plan. But I am worried that we will wait the 4 months and the coverage will have changed. Also, does anyone know if there is a waiting period for fertility treatment with Kaiser once you get on the plan in the new calendar year. Any advice/help would be appreciated. Thanks!

[Anonymous]

No one knows if it will change for 17 plans don't come out for another 4-5 weeks.

[Anonymous]

Does any one have information about IVF coverage outside of the DC/MD/VA area, but still a federal employee? Looking for a new plan in the open season that will cover (even partially) IVF treatments. Thanks

[Anonymous]

Since this is DCUM, keyword "DC" most of us won't be framiliar with out of state plans. Most of the plans that cover IVF are HMO, and are state by state coverage. I would take a look at Aetna, and Kaiser if available, once the brochures come out in about a week.

[Anonymous]

I just heard that Kaiser won't cover IVF for the 2017 season. They will send letters to existing patients, but won't announce it for a while.

[Anonymous]

I heard from my source, that you are wrong. The FEHB brochures go out in about a week, until then stop spreading rumors.

[Anonymous]

Kaiser and Aetna both dropped IVF coverage for 2017

[Anonymous]

my husband and I just started on our journey at SGF only to hear from them that the Fed gov't dropped the infertility treatment option for 2017, so Kaiser will no longer cover treatments. really sucks bc we hadn't planned for that, so looks like we are going to have to postpone our treatment until we save up more money. really really sucks to have to pay for insurance and the ONE time you need it, it fails you. unfortunately, we are not one of those couples that just has $20k laying around.

[Anonymous]

Anonymous wrote:my husband and I just started on our journey at SGF only to hear from them that the Fed gov't dropped the infertility treatment option for 2017, so Kaiser will no longer cover treatments. really sucks bc we hadn't planned for that, so looks like we are going to have to postpone our treatment until we save up more money. really really sucks to have to pay for insurance and the ONE time you need it, it fails you. unfortunately, we are not one of those couples that just has $20k laying around.

Get on a payment plan or take out a loan.