From what I've researched, many insurance have a standard plan with slight variations for state. Federal BLue Cross Blue Shield does not cover IVF or IUI or anything of the sort. They do cover the meds, and accupuncture if you are interested. I also looked at other plans available to me, that might cover part of the costs, but the deductibles were higher, and you also have to consider the other benefits they apply. I have a friend who has a totally different insurance in MD, non goverment, and three IUI's were covered but not the meds. Honestly, each one is confusing and it isn't easy. The best thing to do is create a spreadsheet comparison.

I could be wrong, but I don't think it matters if you live in DC MD or VA-- the state law requirements for insurance coverage don't apply to the federal government. Of course, different companies can offer different benefits, but I think the benefits from any one company will not vary from DC to MD to VA (at least within the DC metro area).

I have BC/BS as a state employee and they covered 100% of my IVF treatments. I only paid co-pays

i have BC/BS for federal employees, which does not cover IUI or IVF. thankfully, i didn't need either of them to get pregnant this time, but i did see an RE and was really impressed with the amount of money i did NOT have to pay out of pocket with BC/BS. i think i had about $9000 worth of work all told, and I paid about $500 total over 6 months of treatment. My round of Clomid only cost $3!!!

federal aetna has great coverage. they will cover 50% of their negotiated rate for three cycles per live birth, up to $100,000 lifetime benefit. we ended up paying about $5000 a cycle for IVF, ICSI and all medications at SGF. they have a special case management center just for infertility so you are always speaking to nurses that know about the specific benefits, tests, etc.

I am a federal employee living on VA. In 2007, Aetna (and the less expensive of the two fed plans they offer) covered 50% of most IVF expenses at SGF.

OP here--thank you all for your suggestions!

We are Maryland residents so I think we'll look in depth at MAMSI and MDIPA since they seem to have the best IVF coverage. And I will get some more info from Resolve, too.

Wishing you all the best.

previous poster again:
When we were using Mamsi, they covered 50% of infertility testing ordered by the fertility clinic and 50% of all preliminary visits we had there. I got around this some by having tests ordered by my PCP and they were paid in full.
IUI is not paid for at all.
IVF with any associated procedures like ICSI were paid for at 50% as well. The only thing related to IVF that is not covered is freezing and storage of embryos (which you may or may not chose to do).
To have IVF paid for at 50% we had to be married, be TTC for at least a year (based on our word to the RE), and to have some sort of documented infertility. We had horrible male factor infertility which was clearly evident on my husband's SA results so proving that we are infertile was not an issue at all. I don't know how difficult it would be to get improved with infertility of unknown cause.

We have the federal Mamsi plan and did IVF with Shady Grove in fall of 2006.
We paid about $3800 out of pocket for IVF/ICSI (including all ultrasounds, etc until 7 weeks of pregnancy) which was half of Mamsi's negotiated rate with Shady Grove.
Remember, an insurance company's negotiated rate (of which you will pay a perecentage under the federal plans) is lower than the rate paid by private pay patients.

Your clinic should be able to give you a very good estimate on what a cycle will cost under a particular federal plan. Shady Grove is so used to quoting figures to federal employees that when I called recently about the cost of a FET, the front desk person was able to give a rough figure immediately (which was about $1500).


Good luck!

An important note is there is infertility coverage that is mandated by law in MD but not in VA. You can read about this on the RESOLVE site. I live in VA and have Federal Blue Cross. They cover the meds ok, usually just a copay amount. They do NOT cover ANY costs associated with IUI, IVF or anything similar. So out of pocket for IVF you are looking at a least $12k. That was my cost for IVF and ICSI which you would probably have to do. And there are copays for the multiple doctor visits, and some of the testing/prework I still owe a couple hundred dollars.

It will all be worth it if I can get pregnant next cycle. Don't know, but we have no more money after that.

You should also look into maxing our your FSA contributions to pay pre-tax. If you get the 4% raise they are expecting to give, and put in $5,000, you won't feel that pain so much.

I am a fed employee and have GEHA insurance. It covered the diagnosis of intertility but no treatments whatsoever. Good luck with your treatments!

You really have to study the brochures closely and see what makes sense for you. MDIPA, for example, covers 50% of infertility treatments, up to a certain limit (this is more typical of the HMOs on the Fed Plan), while BC/BS covers infertility testing, diagnosis, drugs, surgery under their regular coverage, but provides 0 for the actual ART. So determining the best plan is pretty tough. If, for example the doc comes up with endometriosis as the answer to your infertility problem and recommends surgery to cure it, the 50% plan that covers ART isn't as good a deal as the BC/BS coverage for your specific circumstances.

My husband is a federal employee and we've done IVF under both the Kaiser Plan (a number of years ago) and the MD IPA plan. They were pretty equivalent for medical coverage of IVF, but MD IPA has a cap on the out of pocket expenses for each medication, so it is the better deal. We did not have too much trouble getting either to cover IVF, but I have a well documented history of infertility. Both Kaiser and MD IPA covered 50% of IVF expenses (although some specialized procedures are not covered) up to 3 cycles per a live birth.

I am on the Fed plan and looked into this a couple of years ago and wish I remembered more.

I think MD/IPA covers IVF under some circumstances. I don't think Aetna and Blue Cross cover IVF, although they do cover IUI. All have caps. Check into how much coverage each has for meds. I recall the BCBS coverage was good.

More details here ..

https://www.opm.gov/insure/08/planinfo/dc.asp

I was wondering if anyone who is on a federal employee health plan could share their experiences with getting infertility treatment and medications covered (or not covered as the case may be...).

My husband and I are both on his company's plan presently, which has been good about covering tests to diagnose us (MFI with low sperm count, 1% morphology, 50% motility) but has a lifetime maximum of $5K coverage for IUI and IVF (medications also draw down the $5K), which obviously doesn't cover much. We were thinking we'd try an IUI or possibly two this fall while still on his plan and then since I'm a federal employee, switch to a new plan.

I've browsed through some of the plan info on the OPM website but I'd be VERY grateful if anyone could weigh in with their experiences with federal health plans and IVF coverage.

~Judy