I've been very happy with standard, but no experience with IVF coverage.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Ok, so because IVF isn't a covered service at all, the costs that you pay out of pocket can't count toward your OOP Max? Is that right?

That is correct because IVF is not a covered benefit so anything you pay for IVF is completely you cost and DOES NOT count towards OOP max!

I don't know that that's true. I've only done IUIs with Kaiser but it seemed like they counted towards the OOP max with Kaiser standard. My last baby was just born though so it's been a year. I also didn't incur the same costs like ivf would.

IUI --> Covered by Kaiser (at 50% per PP) = counts toward OOP max

IVF --> NOT covered by Kaiser = does not count toward OOP max

Anonymous wrote:

Anonymous wrote:Ok, so because IVF isn't a covered service at all, the costs that you pay out of pocket can't count toward your OOP Max? Is that right?

That is correct because IVF is not a covered benefit so anything you pay for IVF is completely you cost and DOES NOT count towards OOP max!

I don't know that that's true. I've only done IUIs with Kaiser but it seemed like they counted towards the OOP max with Kaiser standard. My last baby was just born though so it's been a year. I also didn't incur the same costs like ivf would.

Anonymous wrote:Ok, so because IVF isn't a covered service at all, the costs that you pay out of pocket can't count toward your OOP Max? Is that right?

That is correct because IVF is not a covered benefit so anything you pay for IVF is completely you cost and DOES NOT count towards OOP max!

Ok, so because IVF isn't a covered service at all, the costs that you pay out of pocket can't count toward your OOP Max? Is that right?

They only cover 50% of IUI cost everything else is excluded

this is whats excluded

These exclusions apply to fertile as well as
infertile individuals or couples:
• Assisted reproductive technology (ART)
procedures, including related services and
supplies, such as
- in vitro fertilization (IVF) and
- embryo transfer, gamete intra- fallopian
transfer (GIFT) and zygote intra-fallopian
transfer (ZIFT)
• Any charges associated with donor eggs,
donor sperm or donor embryos
• Any charges associated with
cryopreservation, thawing, and storage of
frozen sperm, eggs, and embryos
• Ovum transplants
• Infertility services when either member of
the family has been voluntarily, surgically
sterilized
• Services to reverse voluntary, surgically
induced infertility
• Services related to surrogate arrangement

For Feds with Kaiser- which plan do you have? It seems like also the out of pocket max is less for the high plan so that is the way to go. Does that mean even for IVF the most we would pay is the max of your cost-sharing total $2,250 per person up to $4,500 per family enrollment (High Option) or $3,500 per person up to $7,000 per family enrollment (Standard Option) or $4,000 per person up to $8,000 per family enrollment (Basic Option) in any calendar year? Am I thinking about this correctly??

It seems that fertility is not an exempted service...
However, cost-sharing for the following services do not count toward your catastrophic protection out-of-pocket maximum, and you must continue to pay cost-sharing for these services:
• Dental services, except accidental injury dental benefit services
• Eyeglass lenses and frames and contact lenses for adults
• Routine eye exams for members age 19 and older
• Travel benefit

Thank you!!