Reply to DC Government insurance coverage options for IVF

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[quote=Anonymous][quote=Anonymous][quote=Anonymous]OP here - I've only gotten a response back from UHC so far, but below is what they provided.  It's more flexible coverage (no restrictions on types of services, etc.), but it will be easy to hit the $30,000 limit quickly.  I've heard of people paying for meds out of pocket, then saving the insurance coverage for the actual cycles/services.

From Aetna:

There is a $30,00 lifetime maximum for infertility coverage; and the benefit is based on the dollar limit, not number of cycles. Coverage is at 50% of the eligible expenses/provider’s contracted rate. The plan covers infertility medications, and fertility treatments and medications both count toward the annual out of pocket maximum ($3,500).  Cryopreservation of embryos is covered.

Prior Authorization Requirement
You must obtain prior authorization as soon as possible. If you fail to obtain prior authorization as required, Benefits will be reduced to 50% of Eligible Expenses.
 
 Just to clarify, you said the above is from Aetna but you talked to UHC. So is the above UHC? I really appreciate this info!

Services for the treatment of infertility when provided by or under the direction of a Physician, limited to the following procedures:
?             Ovulation induction.
?             Insemination procedures (artificial insemination (AI) and intrauterine insemination (IUI)).
?             Assisted Reproductive Technologies (ART).
?             Pharmaceutical Products for the treatment of infertility that are administered on an outpatient basis in a Hospital, Alternate Facility, Physician's office, or in a Covered Person's home.

To be eligible for Benefits, the Covered Person must meet all of the following:
?             Have failed to achieve a Pregnancy after a year of regular, unprotected intercourse if the woman is under age 35, or after six months, if the woman is over age 35.
?             Be under age 44, if female.
?             Have infertility that is not related to voluntary sterilization or failed reversal of voluntary sterilization
 
[/quote][/quote]

Sorry I quoted without my question earlier. Just to clarify, you said the above is from Aetna but you also said you talked to UHC. So is the above UHC? I really appreciate this info! Dealing with DC Government HR is a nightmare.[/quote]

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