Feds - what's the best insurance for IVF?

[Anonymous]

Anonymous wrote:Hmmm, I thought someone had said (on this thread or one of the others, I don't know) that this was OPM's call, not the individual insurers. And that makes way more sense to me than all of the insurance companies making the same decision independently. Does anyone know for sure how this works?

I'm 13:17 and I work with insurance companies in the private sector. In my 20 years of working with insurance I have seen carriers remove coverage for non-mandates (e.g. lasik was covered by many plans in the 90s), but coverage was revoked across all plans and employers. And these plans that were impacted for Federal employees are the self insured plans that allow OPM even more flexibility with plan design.

I asked our broker about this change and if we would see the same impact to plans for the private sector. He said nothing has been brought up by the carriers and all of his companies that renew on 1/1 that had IVF coverage still have it. None of the big carriers said a word about having to remove the coverage. That is why I doubt the message that OPM is selling.

[Anonymous]

Anonymous wrote:^^ Thanks for following up, the OPM message sounds fishy to me. When a carrier is paying out more than they are taking in on claims, they increase pricing. It seems very odd that all Federal carriers have decided to remove IVF, on their on volition, but are not doing that with private sectors plans. The carrier would have just told OPM, plans,are now going up $200 per month for your elected coverages (which IVF is an election an employer makes outside of state mandates). The employer then negotiates with the carrier and makes cost changes such as higher co-pays, deductibles, or removes optional coverage. Maybe OPM said we will pay X more per month and if non-mandated programs have to be removed so be it.

I hope you are able to determine the truth and find a resolution.

Interesting. I wonder if I should put in a FOIA request for this information...

Thanks for the input. I'm going to look into a FOIA request now.

[Anonymous]

Anonymous wrote:

Thanks for the input. I'm going to look into a FOIA request now.

Oh god, as someone who has had to answer FOIAs before...don't count on a quick or enlightening answer!

[Anonymous]

Anonymous wrote:

Anonymous wrote:^^ Thanks for following up, the OPM message sounds fishy to me. When a carrier is paying out more than they are taking in on claims, they increase pricing. It seems very odd that all Federal carriers have decided to remove IVF, on their on volition, but are not doing that with private sectors plans. The carrier would have just told OPM, plans,are now going up $200 per month for your elected coverages (which IVF is an election an employer makes outside of state mandates). The employer then negotiates with the carrier and makes cost changes such as higher co-pays, deductibles, or removes optional coverage. Maybe OPM said we will pay X more per month and if non-mandated programs have to be removed so be it.

I hope you are able to determine the truth and find a resolution.

Interesting. I wonder if I should put in a FOIA request for this information...

Thanks for the input. I'm going to look into a FOIA request now.

Oh that's a good avenue! Would decision like that be subject to FOIA? If the carrier did remove it unilaterally, there would be a letter from them or,it would have been stated in the renewal documents. The "why" may not have been stated.

[Anonymous]

If anyone wants to contact the plans, I found a contact list from OPM for each plan. Here it is:

https://www.opm.gov/retirement-services/publications-forms/benefits-administration-letters/2013/13-403a5.pdf

[Anonymous]

Anonymous wrote:^^ Thanks for following up, the OPM message sounds fishy to me. When a carrier is paying out more than they are taking in on claims, they increase pricing. It seems very odd that all Federal carriers have decided to remove IVF, on their on volition, but are not doing that with private sectors plans. The carrier would have just told OPM, plans,are now going up $200 per month for your elected coverages (which IVF is an election an employer makes outside of state mandates). The employer then negotiates with the carrier and makes cost changes such as higher co-pays, deductibles, or removes optional coverage. Maybe OPM said we will pay X more per month and if non-mandated programs have to be removed so be it.

I hope you are able to determine the truth and find a resolution.

NP here. Not many plans offered the IVF coverage to begin with. It was only something like three plans in the FEHB market. So it's not unrealistic that those three plans decided to stop offering the coverage because increasing their rates made their plans less attractive to the general FEHB population and only seemed to attract people looking to sign on for 1 year to get the IVF coverage and then drop and switch to another plan.

I highly doubt OPM told them not to offer the coverage.

The thing about FEHB is that there are a lot of plans offered. The plans that have the best coverage and rates combined are the ones that get the most subscribers, and the more people they have who sign on, the stronger they are. The plans that have been offering the IVF coverage had significantly higher rates than other plans, which made them less popular with the general population. They were only popular with the population of people who wanted the IVF coverage (and thus cost them more money), and even then, a lot of those people (as seen here in DCUM threads) would switch to more affordable/better plans the next year once they were done with the IVF.

Some of the private plans not on the FEHB market HAVE to offer IVF because the state they operate in mandates it (like Maryland). My guess is they would drop that coverage if they could. FEHB plans aren't subject to state mandates, so that doesn't apply.

I think all of the conspiracy theory nonsense about OPM playing a role in the dropping of IVF coverage in FEHB plans is just that -- a conspiracy theory that has no basis in reality.

Of course, OPM could mandate that ALL plans cover IVF, but then we will definitely see ALL plans increase their rates because, so all of the people who would choose MDIPA one year for IVF and then switch to BCBS for the better rates/easier coverage (not an HMO) the next year won't be able to play that game. All the rates will be comparable to the once high MDIPA rates.

It's worth noting that MDIPA actually lowered their rates the year they dropped the IVF coverage.

[Anonymous]

Anonymous wrote:If anyone wants to contact the plans, I found a contact list from OPM for each plan. Here it is:

https://www.opm.gov/retirement-services/publications-forms/benefits-administration-letters/2013/13-403a5.pdf

Here's a more updated list:

https://www.opm.gov/retirement-services/publications-forms/benefits-administration-letters/2016/16-402a5.pdf

[Anonymous]

Anonymous wrote:

Anonymous wrote:^^ Thanks for following up, the OPM message sounds fishy to me. When a carrier is paying out more than they are taking in on claims, they increase pricing. It seems very odd that all Federal carriers have decided to remove IVF, on their on volition, but are not doing that with private sectors plans. The carrier would have just told OPM, plans,are now going up $200 per month for your elected coverages (which IVF is an election an employer makes outside of state mandates). The employer then negotiates with the carrier and makes cost changes such as higher co-pays, deductibles, or removes optional coverage. Maybe OPM said we will pay X more per month and if non-mandated programs have to be removed so be it.

I hope you are able to determine the truth and find a resolution.

NP here. Not many plans offered the IVF coverage to begin with. It was only something like three plans in the FEHB market. So it's not unrealistic that those three plans decided to stop offering the coverage because increasing their rates made their plans less attractive to the general FEHB population and only seemed to attract people looking to sign on for 1 year to get the IVF coverage and then drop and switch to another plan.

I highly doubt OPM told them not to offer the coverage.

The thing about FEHB is that there are a lot of plans offered. The plans that have the best coverage and rates combined are the ones that get the most subscribers, and the more people they have who sign on, the stronger they are. The plans that have been offering the IVF coverage had significantly higher rates than other plans, which made them less popular with the general population. They were only popular with the population of people who wanted the IVF coverage (and thus cost them more money), and even then, a lot of those people (as seen here in DCUM threads) would switch to more affordable/better plans the next year once they were done with the IVF.

Some of the private plans not on the FEHB market HAVE to offer IVF because the state they operate in mandates it (like Maryland). My guess is they would drop that coverage if they could. FEHB plans aren't subject to state mandates, so that doesn't apply.

I think all of the conspiracy theory nonsense about OPM playing a role in the dropping of IVF coverage in FEHB plans is just that -- a conspiracy theory that has no basis in reality.

Of course, OPM could mandate that ALL plans cover IVF, but then we will definitely see ALL plans increase their rates because, so all of the people who would choose MDIPA one year for IVF and then switch to BCBS for the better rates/easier coverage (not an HMO) the next year won't be able to play that game. All the rates will be comparable to the once high MDIPA rates.

It's worth noting that MDIPA actually lowered their rates the year they dropped the IVF coverage.

Just to clarify, the carriers participating in the FEBH market (e.g. Aetna, BCBS, Kasier, etc) offer infertility to private sector clients regardless of state mandates. Mandates don't drive all the coverage offered by a carrier. The organization is free to pick and chose the coverage it wants. And it will pay accordingly.

[Anonymous]

Anonymous wrote:Hello, federal employee here gearing up for IVF and disappointed to learn about non coverage next year. I'm working with SG, they confirmed to me that they would honor Aetna rates as a previous poster said. I asked if Kaiser had the same sort of thing, and I understand Aetna is the only provider that has the lower rate schedule available with SG (for procedures, not meds). I'm struggling to decide since Kaiser offers IUI coverage still. I'm a MD resident and may drop FEHB coverage all together for a Maryland Heath exchange plan. There is a BCBS HMO plan that would be $270 a month and $6550 max out of pocket, and should cover up to three cycles of IVF. the open season for that plan is 11/1 until 1/31/2017. Anyone else researching this option?

I just started doe this process and this feels like some "Hat Trick". I a FED in Maryland and I have BCBS and it doesn't cover IVF so I am trying to figure this out in time for open season. This thread has been helpful because I knew I wasn't crazy that most of the plans for 2017 don't cover IVF. So SG told me to look at the MD exchange (which I'll start tomorrow). It's jus frustrating that this process is painful and difficult for people who want to have children?

[Anonymous]

So, did we ever come to a decision on the best federal plan for infertility coverage??

[Anonymous]

Here's what I gathered from the various threads:
1. If you are doing IUIs, Kaiser or the local BCBS HMO is your best bet
2. If you are doing IVF and at SG, Aetna may be best: they'll give you the Aetna negotiated rate, which will provide real cost savings.

[Anonymous]

We plan to start on IUIs and, if unsuccessful, move to IVF. My husband has BCBS federal family plan to cover his chidlren from a previous marriage. I have AETNA (Feds). Do you think I'm allowed to keep my plan AND join his family plan so I could be covered for both IUIs and later, if needed, get the SG AETNA negotiated rate. Just not sure if one can be on two FEHB plans at once (different agencies)

[Anonymous]

No you can not be covered by two different plans. You may want to talk to your doctor about the success rates of MIUI for you, and proceed accordingly. You may want to try 3 iuis in one year, then if they don't work switch h to Aetna. But who knows if that negotiated rate will stay.

[Anonymous]

You can be carry two plans at once--last year I joined my husband's Aetna plan through UMBC student insurance, which covered IVF, but still was on FEHB Blue Cross from earlier in the year. One is considered primary, and claims get submitted to that insurance first and then the other. But I don't think you can be on two FEHB plans at once.

[Anonymous]

I'm looking at the AETNA plans, but there's 5 different ones. Which one would be the one that will honor the negotiated rate at SG? 22, F5, J9, JN, or N6?