Kaiser Fed - date of IVF coverage end in Dec?

[Anonymous]

I posted this at the end of the other Kaiser coverage thread, but with 100 remarks before it, I am wondering if someone with actual knowledge might not see it. I'm trying to figure out the timing of my last cycle, so it's a pretty urgent issue for me. Of course I will call Kaiser member services today, but I have my doubts about being able to get a real answer.

Just got my FEHB Kaiser letter of discontinuation of IVF services for next year. They claim they are only covering IVF through Dec 31, 2016, but the end of the benefit plan year for FEHB 2016 is actually January 9th. Is this a typo given that Kaiser has lots of plans that might run on an actual calendar year (i.e., Jan 1st - Dec 31st)? Or can they really discontinue service before the benefit plan period is technically over?

Has anyone already called and sorted this issue out?

[Anonymous]

I haven't got my letter yet, but am a Kaiser Fed. is there a special number to call about this issue?

[Anonymous]

My letter says to call 1-855-315-1004. Not sure if that's the general member services number or not. I haven't had a chance to call yet.

[Anonymous]

FWIW, my nurse at SG said the latest they will start stims this year is 12/1. So even if your coverage goes slightly into January, I'm not sure it would help. (I don't know which clinic you're at, obviously, or if the others are similar.) I would check with your nurse as well.

[Anonymous]

I don't see how they can legally stop offering coverage before the end of the benefit plan. We anticipated starting stims in the first week of Dec. I'm really surprised that Kaiser can change its services while you're still under the current FEHB plan.

[Anonymous]

OP. I emailed with some Kaiser people on Friday but still didn't get real answers. One of them said that all of the FEHB plans begin new coverage on Jan 1 and end on Dec 31 and it just doesn't show effective until the first pay period in January has passed. My HR confirmed that this was incorrect information and the benefit period does go through the first week of Jan.

I think the PP who noted that SG's stim cutoff date is in early Jan has a great point. This is the deadline that matters most for a stim cycle. If you start in early Dec and make the SG cutoff for the holidays, then you'll still make the Kaiser cutoff. It might really only affect people having an FET between Jan 1 and Jan 7 who get screwed.

[Anonymous]

This came up last year with MDIPA. you have coverage the first week of next year BUT under the terms of the new plan.

[Anonymous]

Anonymous wrote:This came up last year with MDIPA. you have coverage the first week of next year BUT under the terms of the new plan.

+1. This is in the brochure under "when benefits and premiums start."

[Anonymous]

Just piggybacking on this because it's related. I had some refills left for different medications, both infertility and regular (e.g., Synthroid) and I ordered them to get them for free given that I'd met my out-of-pocket max for this go-round. I'm Kaiser fed so benefits are supposed to go through Jan 7th, and I did not renew for the 2017 period. I went to pick up the Rx and even though I got them free last month, they tried to charge me all of my copays for regular meds and 50% for infertility meds. The pharmacists didn't know why this happened and couldn't call on it for me because it was a weekend. It appears that they reset my OOP max met back to $0 after the 31st even though the plan year is not over until the 7th. What gives? Can they do this? Why doesn't what I paid toward my OOP max extend for the last week of my benefit year (Jan 1 through 7th)? Any experience with this?

[Anonymous]

I had the same thing happen on the 3rd. Full co-pay even though I'd met my OOP max for 2016.

[Anonymous]

I'm the PP with this issue. Kaiser pharmacy talked to benefits today and they said they reset the OOP max counter at the start of the calendar year (Jan 1st) even though the benefit period extends through the 7th. Even if this is correctly their policy, it just doesn't seem fair. This means you don't get a full year of the benefits in your benefit period.

[Anonymous]

Kaiser is correct. Ooo max is Jan 1- Dec 31. It is a quirky thing in fehb, but Kaiser is right.

[Anonymous]

Anonymous wrote:Kaiser is correct. Ooo max is Jan 1- Dec 31. It is a quirky thing in fehb, but Kaiser is right.

Since coverage only starts after the first week of Jan this means only 51 weeks for a benefit period ?

[Anonymous]

Yes.