This is a good deal from Kaiser. Does it cover ICSI so that you can do PGS (no male factor so otherwise not necessary)? With Kaiser you are with Shady Grove. Does SG have any policies on not doing IVF for women over certain ages or who have already done several attempts at another clinic? I am not interested in donor egg and have heard they push this after a couple of failed tries. Do they ever just say, "No, I'm not treating you"? I'm a good responder but have quality issues.

Anonymous wrote:I just wanted to make sure everyone knew. After much debate during the Federal Government Open Season, we decided to go with Kaiser after confirming that both infertility services and infertility medications count toward the out-of-pocket maximum.

Well, I'm happy to report that it turned out to be true. After paying $2500 to Kaiser's Pharmacy for the first round of meds, I've had to pay ZERO in additional meds or any costs to SG for the actual IVF procedure.

Figured this information would be helpful for anyone considering Kaiser/Aetna/etc. in the upcoming Open Season.

So, to make sure it is clear, while it says that Kaiser covers IVF at 50%, once you reach your out-of-pocket maximum (which under the high option is $2500), Kaiser then covers your IVF expenses at 100%. That's a mighty good deal. So, for 3 IVF procedures in one year, you'll pay a total of $2500.

I just wanted to make sure everyone knew. After much debate during the Federal Government Open Season, we decided to go with Kaiser after confirming that both infertility services and infertility medications count toward the out-of-pocket maximum.

Well, I'm happy to report that it turned out to be true. After paying $2500 to Kaiser's Pharmacy for the first round of meds, I've had to pay ZERO in additional meds or any costs to SG for the actual IVF procedure.

Figured this information would be helpful for anyone considering Kaiser/Aetna/etc. in the upcoming Open Season.

BC/BS Federal will cover IUI but not IVF.

Dominion takes Aetna Open Access-it was about 50% coverage.
DF in my opinion, is the better clinic over SG, having been a patient at both. The financial people are very helpful and explain everything upfront, no last minute calls holding up your treatment of blindsiding you during this already incredibly stressful time.

Does anyone know what DC/VA clinics take AETNA Open?

I just spoke with SG, and they said that with the negotiated rate for Kaiser , an IVF cycle would cost me around $1,500-2,500

Aetna Open Access is still covering 1/2 of IVF until you're menopausal unless you are younger than 45 (so until 45 or until menopausal, whichever is later), in which case they will still cover you. I called, spoke to a bunch of people and finally got a straight answer: they are clarifying that infertility is only a medical condition if it's not JUST that you're old.

I did a quick search on the webpage:
https://www.opm.gov/healthcare-insurance/healthcare/plan-information/compare-plans/

Looks like Kaiser covers at 50%:
https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plan-codes/2016/brochures/73-047.pdf

Outside of DC area, I cannot find a plan that covers infertility treatments like IVF or IUI.

Anyone else able to find IVF or IUI covered in any other plan?

There is a potentially major change in the criteria for who qualifies in 2016. This language was not in the brochure last year:
In vitro fertilization is a covered benefit when the following criteria are met:
...snip...
• You and your partner do not have infertility that is due to natural physiologic process such as age related ovarian insufficiency or the result of gender reassignment surgery (female to male or male to female).

I suspect that will hit many on this list, as it did for us. Aetna refuses to tell us how they will medically define "infertility that is due to natural physiologic process." If they use ovarian insuffiency as a guideline, that's one thing but if they use some other diagnostic code or other criteria I don't know about, it's a whole different ball of wax. Has anyone else noticed this and have any insight?

Anonymous wrote:Ok, so I've only found that Kaiser will cover it. Did not see Aetna coverage on any plans.... saw this on all Aetna plan brochures:
Infertility - The Plan will no longer cover artificial insemination. (See pages 58 and 106)

Check pages 34-35 of the Aetna Open Access brochure.

Ok, so I've only found that Kaiser will cover it. Did not see Aetna coverage on any plans.... saw this on all Aetna plan brochures:
Infertility - The Plan will no longer cover artificial insemination. (See pages 58 and 106)

Anonymous wrote:

Anonymous wrote:FYI. NONE of the federal health plans cover IVF for 2016!! In fact, they all explicitly say they do NOT cover IVF or ART.
What can we do?

Aetna and Kaiser do.

Yeah. What are you talking about? Kaiser covers 50%, which still is a lot of money out of pocket, but better than nothing.

Anonymous wrote:FYI. NONE of the federal health plans cover IVF for 2016!! In fact, they all explicitly say they do NOT cover IVF or ART.
What can we do?

Aetna and Kaiser do.

FYI. NONE of the federal health plans cover IVF for 2016!! In fact, they all explicitly say they do NOT cover IVF or ART.
What can we do?

I work in DC and go to Shady Grove (SG) in VA, tried my first IUI under BCBS Basic which really isn't covered. Only Timed Intercourse (TI) along with meds were covered under BCBS. The IUI cost about 1600$. Open enrollement for health insurance is next week and I am considering a few more rounds of IUI before moving towards IVF. Does anyone recommend a good IUI/IVF federal health insurance plan for 2016? I noticed that MDIPA (Open Access) no longer covers any infertility procedures.

The only plans I have identified that have some coverage for 2016 are CareFirst BlueChoice HMO, Kaiser, Aetna HealthFund CDHP and Value Plan Most of Virginia, Aetna Open Access Northern/Central/Richmond Virginia Areas. These were all found directly from the OPM site. There seems to have been changes to IVF coverage for 2016. Any better understand would greatly help. Thanks!