FEHBP Aetna Basic HMO will get you the discounted rate at SGF. That's about half off a lot of services. Even though the plan doesn't cover it, SGF's contract with Aetna means you're eligible for the reduced rate.

Hi there!

I'm a new fed. My partner and I need to go through IVF and PGD due to a genetic issue. We have already gone through one unsuccessful cycle in NJ and we paid completely out-of-pocket. Needless to say, I was disappointed to see that the options for IVF, etc. with health insurance coverage for federal employees seem limited. I have read about the BlueChoice HMO plans based in MD that do cover IVF after the deductible is met. Which is awesome...we would just pay for a private plan for the financial help. However, we just purchased in DC....are these plans only available to MD residents because of the MD statute? If so, what should we do? Purchase just any home for residence? Move? New to all this, so any help appreciated.

Thanks!

I just moved to MD from VA. My husband is a federal employee. We have Aetna now and have paid for the discount rate with Shady Grove for one IVF cycle. Does anyone know if MD Carefirst Gold will continue to provide IVF coverage in 2018? If so, can I just sign up for secondary coverage with this plan or do both my husband and I need to sign up? And PP-how did you pay for just 4-5 months? Once you sign up in Open Season, don't you have to keep the plan for the entire year? Thanks!

If only I lived in Maryland...

I am a Federal employee. got the Maryland carefirst HMO gold (as secondary insurance from marketplace) which was 370/month premium during open season. I paid for ~4-5 months, and only had to pay copay and deductible of ~1000$ for IVF cycle. cryopreservation was OOP (~1500$). After all, I paid <5000 for everything.

Anonymous wrote:Anyone have any sense of whether there will be any changes to the federal insurance health plans and whether they'll reinstate any of the IVF benefits?

I doubt once they take it away that insurance plans will add it back in but here's hoping, right?

Anyone have any sense of whether there will be any changes to the federal insurance health plans and whether they'll reinstate any of the IVF benefits?

I posted in December -- I'm a Fed, and was also expecting to switch from BCBS to Aetna to begin IVF this year but we were caught unaware by the coverage changes.

We looked into switching to Aetna to get the discounted SG rate; or keeping my plan but switching my wife to a Maryland health exchange plan (though we were unable to get good information from Carefirst about coverage).

We did all the math, and in the end we decided to just keep our existing BCBS coverage and pay out-of-pocket for the SG multi-cycle plan. It would have been cheaper to switch plans if we end up with a single cycle but we felt that there was a good chance we could need two cycles and/or extras like ICSI, PGS, FETs. Plus we would have lost some of our existing providers with Aetna.

The whole process (and the decision by Fed plans to drop coverage) was stressful, and I wish everyone best of luck with whatever they're doing. We're into our first cycle now so fingers crossed!

If you already have AETNA, they will automatically give you the $7,500 rate for a fresh cycle of IVF once they verify your insurance. If you are a Fed who just switched during open season, it takes a bit longer. Our insurance doesn't go into effect until Jan 7 or 8, I think. And Shady Grove requires payment about three weeks before an IVF cycle. So your start date may be postponed.

Anonymous wrote:

Anonymous wrote:I'm planning to keep my Aetna hmo - SG is saying they will still provide us with the Aetna negotiated rate next year, so that's a savings of a few thousand off the whole process. Even just an FET is nearly $3k less.

Is this true? We are trying to work with ShadyGrove - how were you able to negotiate this? We were planning IVF in January.

-Jen

There's no need to negotiate, if you have Aetna that is the price they will give you.

Anonymous wrote:I'm planning to keep my Aetna hmo - SG is saying they will still provide us with the Aetna negotiated rate next year, so that's a savings of a few thousand off the whole process. Even just an FET is nearly $3k less.

Is this true? We are trying to work with ShadyGrove - how were you able to negotiate this? We were planning IVF in January.

-Jen

Just to let those of you out there that work for the Federal Government. IVT treatments are no longer covered if you have a Federal Government Plan. I have been with Aetna for over 10 years, and completed an IVF cycle in 2015 for 50% of the cost stemming from Aetna. I took a break for 2016 before we decided to try again. During open season, Keiser said that they cover IVF treatments as well as Aetna, when I spoke to representatives. Now It is 2017, and I received a letter in the mail that states that IVF is no long covered at 50% from Aetna. When I called to talk to a representative, Aetna went as far as to say that no insurance plan as a Federal Government Employee covers IVF for 2017. I called Keiser to verify, since during open season said that they do cover it. Well I just got off the phone with Keiser who apologized for the misinformation I was given, but told me that they did cover it last year, but for 2017 they don't cover it. She said Keiser will only cover IUI or ICI. In my case, neither of these options I can use. For those ladies out there in need of IVF like me it sucks that these insurance companies will pay for something one year and won't the next and to make matters worse leave people oit there in the open with misinformation about what plans there going to get.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:PP here. I know shady grove and many other RE define trying as having unprotected sex. This doesn't mean temping, or using opk, or checking fertile mucus or keeping record of charts. So, if they ask (and no one ever asked me to prove it) they usually just ask how long have you been trying.

Okay, thanks for the info. I also read a certain requirement for IVF in the Blue Choice 3500 HMO plan that "The Member has been unable to attain a successful pregnancy through less costly infertility treatment for which coverage is available under this Agreement;" and I take this to mean that we have to try IUI cycles first since the plan also seems to cover IUI treatments. We've already been doing IUI cycles because the Federal Aetna plan mandated that we had to do 6 IUIs before they approve an IVF cycle and we made it to our 4th cycle when we realized that they were dropping coverage next year.

Does anyone have this plan currently? Do you know if you can go straight to an IVF cycle, or do you have to try IUIs first and if so, how many before they'll let you try an IVF?

Same poster again lol. My coworker is not a candidate for IUI at all, and she is not having any problems getting the ivf covered without "less costly treatments." But, she has a documented workup from her doctor. Hopefully, they don't make you waste time and money having unnecessary medical procedures if you aren't a candidate for them.

Thanks again for the info. We are in the unexplained infertility category right now. We've done 4 IUIs so far and none of them have worked. I can see them making us do IUIs again though since we don't have any diagnosed problems requiring us to go straight to IVF.

I spoke to a Carefirst customer service rep the other day and was advised that even tho the plan says "no cost, no deductible" we would still possibly be subject to a facility charge and/or physician charge, which is only covered (with a copay) after you have met your deductible. We might pick the HealthyBlue HMO 1000 plan just to keep the deductible low and the out-of-pocket maximum low.

Anonymous wrote:

Anonymous wrote:PP here. I know shady grove and many other RE define trying as having unprotected sex. This doesn't mean temping, or using opk, or checking fertile mucus or keeping record of charts. So, if they ask (and no one ever asked me to prove it) they usually just ask how long have you been trying.

Okay, thanks for the info. I also read a certain requirement for IVF in the Blue Choice 3500 HMO plan that "The Member has been unable to attain a successful pregnancy through less costly infertility treatment for which coverage is available under this Agreement;" and I take this to mean that we have to try IUI cycles first since the plan also seems to cover IUI treatments. We've already been doing IUI cycles because the Federal Aetna plan mandated that we had to do 6 IUIs before they approve an IVF cycle and we made it to our 4th cycle when we realized that they were dropping coverage next year.

Does anyone have this plan currently? Do you know if you can go straight to an IVF cycle, or do you have to try IUIs first and if so, how many before they'll let you try an IVF?

Same poster again lol. My coworker is not a candidate for IUI at all, and she is not having any problems getting the ivf covered without "less costly treatments." But, she has a documented workup from her doctor. Hopefully, they don't make you waste time and money having unnecessary medical procedures if you aren't a candidate for them.

Anonymous wrote:PP here. I know shady grove and many other RE define trying as having unprotected sex. This doesn't mean temping, or using opk, or checking fertile mucus or keeping record of charts. So, if they ask (and no one ever asked me to prove it) they usually just ask how long have you been trying.

Okay, thanks for the info. I also read a certain requirement for IVF in the Blue Choice 3500 HMO plan that "The Member has been unable to attain a successful pregnancy through less costly infertility treatment for which coverage is available under this Agreement;" and I take this to mean that we have to try IUI cycles first since the plan also seems to cover IUI treatments. We've already been doing IUI cycles because the Federal Aetna plan mandated that we had to do 6 IUIs before they approve an IVF cycle and we made it to our 4th cycle when we realized that they were dropping coverage next year.

Does anyone have this plan currently? Do you know if you can go straight to an IVF cycle, or do you have to try IUIs first and if so, how many before they'll let you try an IVF?