Reply to Kaiser - Infertility Services DO count toward OOP Max

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[quote=Anonymous]A few more answers from Kaiser:

Q)  What is the basis for Kaiser’s determination that it will only cover 50% of the cost from the brochures?  There doesn’t seem to be anything in the brochures that would support that, given the language I pointed out.

A)  Per the brochure, which you refer to within your original email:  The 2016 High Option plan, according to publication RI-73-047, covers infertility drugs.  According to Section 5(a), under page 33, it says to see “Section 5(f), Prescription Drug benefits, for coverage of fertility drugs,” and Section 5(f), under page 65, states that “fertility drugs for covered infertility treatments” are covered at “50% of [Kaiser’s] allowance.”    
(This would then indicate the 50 % cost share that is the remaining patient responsibility.)

Q)  Does that mean that fertility drugs do not count towards the out-of-pocket maximum?;

A)  Fertility drug costs DO count toward the out-of-pocket-max.

Q)  Does that mean that even if I reach the OOP max under the plan (be it because of services or because of fertility drugs), that I will always be responsible for 50% of the cost of the fertility drugs?

A)  No, once your out-of-pocket max is reached, all applicable services which apply to the catastrophic max are covered by the health plan.  
  
This seems to indicate to me that fertility drugs will be covered at 100% after you reach your out-of-pocket maximum, but I sent an additional question to confirm.  I hope this helps everyone.[/quote]

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