Open Enrollment: 15 Questions You Must Ask About Fertility Benefits

Fertility Benefits for Open Enrollment. It’s Open Enrollment time again—the one time each year when people can review their health insurance benefits and make important changes, depending on their personal health needs. Well, that’s what we are supposed to do. Instead, many ignore Open Enrollment, assuming their health coverage is just fine.

What about fertility benefits? Is this covered under your employer’s plan?

If you are among the 7.4 million adults that have been diagnosed with infertility or if you are an older woman, LGBTQ or a single man or women who desire a family, fertility benefits are essential to make having a baby affordable. And most people don’t know if they have fertility benefits until they start to ask questions. The 2018 Open Enrollment Period runs from November 1, 2017 to December 15, 2017. You need to act quickly if there are changes to be made to your policy. Here’s some guidance on questions to ask your HR, employer or health insurer during Open Enrollment to know exactly what your fertility benefits cover.

Ask Specific Questions About Fertility Benefits

Health insurance policies are confusing and difficult to understand. While some policies pay for procedures to treat infertility, they may not pay for procedures to help you get pregnant such as Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF). Some policies may approve oral fertility drugs but not injectable fertility drugs. And other policies may not cover fertility treatments unless you have an infertility diagnosis, which limits many people who want families and cannot do so naturally.

Talk with your health insurance representative

While your HR representative may have some answers about fertility benefits, you really must open your policy and talk with the Health Insurance representative to understand the benefits fully.  Even then, you still won’t know what specific coverage you have until you sign in at a fertility clinic and they begin the very detailed pre-authorization process.

Become knowledgeable about fertility benefits

So, grab a cup of tea, dial the number, and get answers to the following questions:
  1. Is the initial consultation covered by my policy? Depending on your plan, you may have to pay a deductible and come up with a co-payment. Find out how much this will be.
  2. Are diagnostic tests covered? While some infertility tests may be covered, others may not be. Ask for the specific tests so you are aware ahead of time what you might have to spend.
  3. Do I need a referral to see a fertility doctor? Oftentimes a Primary Care Physician (PCP) must refer a patient to the fertility center or to a fertility doctor. Knowing this ahead of time will allow you to make the necessary appointment with your PCP. 
  4. Will my health insurance carrier have to preauthorize my first visit at the fertility center? Here’s where you might learn more about what is and isn’t covered under your plan. Once this is preauthorized, you will begin your appointments.
  5. Is preauthorization necessary for any labs? Usually, labs are covered but make certain in your case or you’ll be spending more than you might have out-of-pocket.
  6. Is pre-authorization needed for radiology or sonograms? Radiology can get pricey. Make sure this is covered in your initial phone call to the health insurance rep.
  7. Does my fertility benefit cover fertility drugs and injectable medications? Ask if there are limits to this coverage. If you need to take more drugs for a longer period of time, be sure your policy will cover this. Some policies cover fertility drugs but not injectables.
  8. Does the insurance cover fertility treatment? This is a big one. So often policies will pay for a diagnosis of infertility and then pay nothing toward the treatment. For single men and women and those who are LGBTQ, they may not be infertile at all—but still need the fertility benefit to have a family using sperm or egg donation, IVF or surrogates.
  9. Is IUI covered? Intrauterine insemination (IUI) is a relatively low-tech assisted reproductive technology (ART) that deposits washed sperm into the uterus through the cervix. Make sure it’s covered in case your doctor recommends this.
  10. Is IVF covered? In vitro fertilization (IVF) is a method of assisted reproduction that involves surgically removing an egg from the ovary and combining it with prepared sperm in the laboratory to permit fertilization. IVF is becoming the gold standard in helping people have families. While costly, IVF has a great success rate and should be a paid option for you. Ask ahead how many cycles the insurer will cover.
  11. Is there a maximum benefit amount? Is it a dollar amount or a number of cycles? Is it annual or lifetime? What counts toward the max—diagnostic testing, medications, or just treatments?
  12. What are the deductibles, co-pays, and/or co-insurance? Here’s where the out-of-pocket payments come from. Make sure you understand fully your responsibility for paying the bill and have set this money aside.
  13. Does the policy cover testing and treatment for male factor infertility? If you have a male partner, check your partner’s insurance to see if he is covered for his testing and treatment for male factor infertility, if treatment should be necessary for him.
  14. Does the policy cover same-sex couples or domestic partners? If you are a same-sex couple, be sure and find out what coverage each of your policies provides and whether you have coverage for domestic partners or same-sex spouses. This kind of coverage varies by state and by policy.
  15. Can they explain the fine print? Be sure and ask if egg freezing, preimplantation genetic diagnosis (PGD) or intracellular sperm injection (ICSI) are recommended, so you know in advance if your insurance covers those procedures.

Limited Coverage? How WINFertility Can Help You Have a Family

Nearly 25% of all IVF cycles performed in the US is by a WINFertility Network practice. WINFertility provides patients with the most direct route to the most effective fertility treatment, at a single, discounted, bundled price that is up to 40% less than fee-for-service treatment, genetic testing, and retail medication rates. There are no hidden requirements or criteria and patients pay only for the individual treatment cycles and medications they receive…never for multiple cycles they may not need. Each patient has a designated FertilityCoach® Nurse to advise, explain and monitor progress throughout their treatment process. WINFertility has developed evidence-based treatment protocols for IUI, IVF and Third Party Reproduction, delivered by a contracted, credentialed network of leading-edge fertility specialists. Medical treatment, genetic testing, and medications are included in the single, discounted, bundled price for Program participants. There are no age or medical criteria required to enroll in the Program. If treatment is indicated by a participating provider and the patient has no infertility insurance coverage, she can enroll in the WINFertility Program. Typical patient savings per treatment cycle can range from $5,000 to $10,000 or more, depending on treatments and medication doses required. Contact Us Today > Or Give us a call Toll-Free at 855-705-4483 (Monday – Friday 8:30 AM – 7:30 PM EST) and see what WINFertility can do to help you have a family.

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