I know this is an old thread, but I wondered if anyone has updated information regarding Kaiser OOP maximums and IVF? I know Kaiser stopped covering IVF in 2017, but does that mean the OOP max doesn’t apply to IVF? I plan to discuss with Shady Grove after our third IUI attempt but it would be great to hear from someone that has been through this recently. Thanks!

Yes, federal government plans are exempt from the state mandates. This is why BCBS and all the other plans don't offer IVF coverage--none of them have to.

The plans on the MD state exchange are required to offer IVF coverage at some level because they are state-based plans and must follow the mandate. Some cover more than others. For an individual the coverage is not that expensive.

This is all so interesting and completely confusing. I am the original poster and was told specifically that the IVF coverage was being dropped by Kaiser mid Atlantic. Not the California one. It's so frustrating to wait and see because if no federal insurance is going to cover IVF we just want to move foward with starting the shared risk plan from our clinic. But if there will be some coverage it makes sense to wait and save money. Sigh. It seems like there is a lot of confusion out there as to what is going to happen.

As for the Maryland state mandate, it's my understanding that the federal government is exempt from the mandate. They talk about it here
http://www.resolve.org/about/insurance-coverage-of-infertility-treatments.html
And here
https://www.growingfamilybenefits.com/maryland-infertility-mandate/
And even mention it on shady grove fertility's blog
https://www.shadygrovefertility.com/blog/affording-care/what-you-need-to-know-insurance-coverage-for-fertility-treatment/

I really really hope that you are right though and that everyone that has is now keeps the coverage. I just wish I could get an answer so I could move forward and make a plan for my treatment. So frustrating.

Anonymous wrote:I know some people who work on this procurement year in and year out. You won't know until the official awards are made public, and benefit brochures are distributed. This will probably be around 2nd to 3rd week of October or about a month before Open Season Starts. It really won't affect us much. We got 4 good frosties, so if I am wrong, we will go to Aetna for the FET's, the drug costs for FETS are lower than for an Egg Retrieval. If we do need drugs we will probably go with one of the less expensive routes and not through AETNA's insurance for that. Also, the OP who talked about Kaiser dropping it, might be talking about the plan on the west coast, not the DC Area, they are two separate plans, with two separate submissions.

The interesting thing that I was also told, was the MDIPA may have actually violated Maryland State Law last year, as Maryland State Law requires that if you buy insurance in Maryland, that it has to cover up to 3 attempts of IVF. Since MDIPA sold their plan to NOVA/DC and MD residents, but did not have IVF coverage, they may have broken Maryland's Infertility Coverage Law, which is why it may be coming back. This is also the reason why I highly doubt that Kaiser will drop it on either plan, as Kaiser is sold to DC,VA and MD residents. Could the OOP stuff change? Sure, but I highly doubt coverage is going away completely. There is no law in California that states insurance sold there must cover IVF.

https://www.fertilityauthority.com/costs/insurance-coverage/maryland-infertility-insurance-mandate
https://www.fertilityauthority.com/costs/insurance-coverage/california-infertility-insurance-mandate

But if this is the case why don't other plans like BCBS (fed) cover IVF?

I know some people who work on this procurement year in and year out. You won't know until the official awards are made public, and benefit brochures are distributed. This will probably be around 2nd to 3rd week of October or about a month before Open Season Starts. It really won't affect us much. We got 4 good frosties, so if I am wrong, we will go to Aetna for the FET's, the drug costs for FETS are lower than for an Egg Retrieval. If we do need drugs we will probably go with one of the less expensive routes and not through AETNA's insurance for that. Also, the OP who talked about Kaiser dropping it, might be talking about the plan on the west coast, not the DC Area, they are two separate plans, with two separate submissions.

The interesting thing that I was also told, was the MDIPA may have actually violated Maryland State Law last year, as Maryland State Law requires that if you buy insurance in Maryland, that it has to cover up to 3 attempts of IVF. Since MDIPA sold their plan to NOVA/DC and MD residents, but did not have IVF coverage, they may have broken Maryland's Infertility Coverage Law, which is why it may be coming back. This is also the reason why I highly doubt that Kaiser will drop it on either plan, as Kaiser is sold to DC,VA and MD residents. Could the OOP stuff change? Sure, but I highly doubt coverage is going away completely. There is no law in California that states insurance sold there must cover IVF.

https://www.fertilityauthority.com/costs/insurance-coverage/maryland-infertility-insurance-mandate
https://www.fertilityauthority.com/costs/insurance-coverage/california-infertility-insurance-mandate

Interesting. I really hope you are right! That would be amazing. Can I ask where you heard that? What I was told is that since the brochures haven't been made, they can't give me a final answer and of course the people at Kaiser wouldn't give me much information. I really hope what you heard is what happens. And I hope that for Kaiser the oop max still counts towards infertility. I know it doesn't for Aetna in the 2016 plan year. And it would be great if MDIPA brought it back too. Fingers crossed!

Any idea when we will find out for sure? I'm hoping the brochures come out sooner rather than later.

Interesting because proposals were due a while back so they can't be wavering back and forth, as proposals were due already and submitted. What I heard was that is was dropped from the low plan, but kept in the high plan, and there was about a 10% premium increase. I also have heard MDIPA may be bringing back IVF coverage, also heard AETNA will still be offering it.

The $5300 should have been $5100 (That was the amount covered by our FSA's) The other amount was truly out of pocket with no fsa paying for it.

I wonder if they are planning to drop because a lot of people suddenly came to Kaiser once MD IPA was no longer an option.

Of course this will happen. Another kick in the balls

I know a few people that are involved in negotiating the new plan benefits for every year. I called a Kaiser rep and asked them once I heard this and they said they wouldn't be able to tell me anything for certain until the official plans came out in late October/early November. But of course I panicked because this is a huge deal if they go from covering 50% and having the oop max count towards infertility to nothing. I am kicking myself for not getting on kaisers plan last year.

Again, it's not 100% confirmed that they are dropping the benefit, but it's looking like it will happen. I hope I am wrong.

Anonymous wrote:I haven't been able to get an answer on that either. My husband is on Kaiser and I am not. I am assuming they won't cover IVF for me until I am on it as well, but I haven't been able to get a straight answer either.

I am also really deviated because I have a pretty good source that has told me that Kaiser will be dropping all IVF coverage for 2017. This is extremely devasting news and seems a little crazy that they will just drop all coverage, but I guess that happens. I am still hoping it's not true, but it's a pretty good source.

How did you hear this?

I haven't been able to get an answer on that either. My husband is on Kaiser and I am not. I am assuming they won't cover IVF for me until I am on it as well, but I haven't been able to get a straight answer either.

I am also really deviated because I have a pretty good source that has told me that Kaiser will be dropping all IVF coverage for 2017. This is extremely devasting news and seems a little crazy that they will just drop all coverage, but I guess that happens. I am still hoping it's not true, but it's a pretty good source.

Does anyone know if both you and your husband have to be on Kaiser feds for Kaiser to cover IVF? My husband is on BCBS federal in order to cover some medical procedures and medicines for his children from his previous marriage. I've called Kaiser and had a different answer both times.

Yes, Kaiser covers IVF at 50%, but after you have met the OOP max, it covers all covered costs at 100%. So that's why the 2250 replaces the 2300 and 2750. The rest of the costs listed were not covered costs for PP. It look like in her equation the 4250 is 2250 (OOP max) + 2000 (ICSI). The 5300 is the PGS testing and cryopreservation.

This is the first year that all infertility costs have counted toward the OOP max, and who knows if they'll continue it next year or not. I don't know if it's true for standard vs high.