Last Updated on March 23, 2020
Knowing which insurance company covers IVF is an important question for people looking into the infertility treatment option. Since it is a costly procedure, with the cost of one IVF cycle averaging $12,000-$15,000 in the US, getting in touch with the right health insurance provider can really help manage the expenses involved. And it usually involves more than just one cycler to work.
Most health insurance companies use their own definitions and standards for determining infertility and the resulting level of coverage. They also reserve the right to revise policies as clinical information changes. That’s why coverage policy for the same fertility treatment can vary significantly from one insurance provider to the next. These companies also impose limits on treatment such as the maximum number of IVF cycles or attempts.
Here are 5 top insurance companies that cover IVF and what you can hope to get from them:
1. Blue Cross Blue Shield IVF Coverage
225 North Michigan Ave.
Chicago, IL 60601
1310 G Street, NW
Washington, DC 20005
The Blue Cross Blue Shield Association (BCBSA) stands out as one of the most recognized insurance providers in the U.S. and worldwide. The company covers all aspects of healthcare including infertility treatments such as IVF and IUI for its policyholders.
For IVF services, BCBSA gives coverage to members if only specified in the member contract. The number of services covered are linked to the procedure such as ovulation stimulation and monitoring, oocyte retrieval, and lab studies. Members may also be covered for assessing and transferring embryo as well as any radiology or ultrasound services.
Other services that are received as part of an IVF procedure get the same benefits as the procedure itself. These can include coverage for medication, lab work, and pathology. Associated surgical procedures and radiology services are also included.
In cases where mechanically assisted fertilization such as Zona drilling is involved, Blue Cross Blue Shield members get covered for the procedure as well. Others such as intracytoplasmic sperm injection (ICSI) are also covered.
Some cases of IVF treatment may also use additional associated procedures that get coverage such as:
- Microscopic epididymal sperm aspiration (MESA)
- Testicular sperm extraction (TESE)
- Testicular sperm aspiration (TESA)
However, modifications to the IVF procedure do not get covered under most Blue Cross Blue Shield standard plans. These include procedures such as GIFT, ZIFT, PROST, TEST and TET. Charges associated with embryo cryopreservation, thawing or storage don’t get covered under the standard plan either, unless stated in the member’s benefit booklet.
This makes it very important to thoroughly go through the Blue Cross Blue Shield member’s benefit booklet to verify how much coverage you are eligible for.
2. United Healthcare IVF coverage
1-866-414-1959 / TTY 711 for general information
1-877-844-4999 / TTY 711 for technical issues
Like other insurance providers for IVF and IUI, United Healthcare also provides specific infertility coverage based on their specific benefit plan. This means that you will have to check your member specific plan for inclusions and exclusions. If you live or work in a state with an infertility mandate, refer to the mandate as well.
For instance, Arkansas will cover IVF for up to $15,000 while Connecticut mandate provides coverage for two IVF cycles and New York covers 3 IVF cycles. But others like Ohio, despite having an infertility mandate, provide no coverage for IVF treatment.
United Healthcare benefit eligibility requires females to be under the age of 44, unable to conceive for one year if under the age of 35, and for six months if 35 or older. Also, infertility should not be the result of voluntary sterilization or filed reversal of voluntary sterilization.
United Healthcare defines Assisted Reproductive Technologies (ART) as procedures that involve the manipulation of sperm, eggs and embryos to achieve pregnancy. When a member’s plan includes benefits for fertility, IVF that isn’t an ART is not covered. This can include elective fertility preservation, and embryo banking or accumulation. In other cases, where a member’s plan doesn’t include benefits for infertility, IVF doesn’t get covered regardless of the reason for treatment.
3. Cigna IVF coverage
Cigna Corporate Headquarters
900 Cottage Grove Road
Bloomfield, CT 06002
1 (800) 997-1654
Cigna requires a couple to establish infertility based on certain definitions after which it offers coverage for certain treatments. But then the patient needs a plan that covers them.
To be eligible for coverage, Cigna defines infertility as the incapability of heterosexual partners to acquire pregnancy after twelve months of unprotected sexual intercourse. Where the female partner is 35 or older, and unable to conceive after six months, infertility is established. Single women or otherwise, trying to become pregnant after 6 trials of artificial insemination that is medically supervised for over 12 months also qualify. And single women or otherwise, above 35 unable to become pregame after at least three trials of medically supervised artificial insemination over a six-month period can receive an infertility diagnosis.
In the absence of an infertility diagnosis, IVF is not considered medically necessary.
Once infertility has been established, Cigna will offer coverage for specific treatments if the member owns a plan which covers them. Living in a state with an infertility mandate will help the case.
In the treatment of unexplained infertility ART procedures like IVF are pursued. IVF with embryo transfer that involves an IVF cycle resulting in embryo implantation is regarded as an IVF attempt as per coverage policy. Additional embryo implantations are considered subsequent IVF attempts. An embryo that fails in producing a pregnancy is considered a failed IVF attempt.
Cigna Infertility services covered include outpatient IVF fertilization up to 3 attempts per live birth.
4. Aetna IVF coverage
151 Farmington Avenue<br>
Hartford, CT 06156<br>
1-800-US-AETNA ( 1-800-872-3862 )
Another top insurance company that gives IVF coverage is Aetna. Among their covered fertility services, Aetna offers 3 assisted reproductive technology (ART) cycles per lifetime. This includes IVF, GIFT, ZIFT and FET. The plan covers various procedures that are counted as either one full cycle or one-half cycle.
The starting point for Aetna coverage is to get in touch with a fertility advocate who will assist you in understanding your options and benefits. They will also coordinate your care while helping you maximize your benefits and minimize your out of pocket costs.
Before any treatment starts, your doctor will need to get approval or precertification for the suggested procedure whereupon Aetna decides if your treatment plan meets the guidelines for the proposed services. Working with in-network doctors and care providers lets you pay less for many services but you can also work with an out-of-network doctor is you prefer.
As defined by their plan, ART includes one complete fresh IVF cycle with transfer. This includes retrieving the egg, fertilizing and transferring the embryo. The procedure is counted as one full cycle. Likewise, the plan also covers procedures including one complete GIFT cycle or one complete ZIFT cycle.
Aetna IVF coverage is also extended to one half cycle where one fresh IVF cycle is attempted with egg aspiration. This can be with or without egg retrieval but does not include transfer of embryo.
Fertilization of egg and transfer of a fresh embryo is counted as one half cycle and so is a single cryopreserved embryo transfer.
5. Emblemhealth IVF coverage
55 Water St New York, NY 10041
Emblemhealth provides large group expansion of IVF coverage for new groups effective on or after January 1, 2020. Existing groups who have renewed their policies in 2020 can also benefit from the same.
This coverage extends to cover three IVF treatments per lifetime for infertility. Emblemheath defines “infertility” as a condition that incapacitates one person to conceive or impregnate another after a period of 12 months of unprotected sex. For women older than 35, this applies after six months of regular, unprotected sexual intercourse.
Emblemhealth defines “cycle” as the time when all treatment starts with preparatory medications for ovarian stimulation or when medications get administered for endometrial preparation to undergo IVF using a frozen embryo transfer.
Once both these parameters have been met, Emblemhealth will cover 3 IVF cycles per lifetime. Coverage for treatment related prescription drugs is limited to medications approved by the FDA for use in diagnosis and treatment of infertility. Advanced fertility services linked with IVF include sperm storage costs and embryo cryopreservation and storage.
Like other insurance providers, Emblemhealth also requires treating physicians to submit clinical evidence verifying that the patient meets the criteria for treatment.
Emblemhealth IVF protocol for patients below 35 years of age establishes SET for the first IVF treatment cycle. If no top-quality embryos are present after thawing, the 2 or more embryos of any quality may be transferred for the subsequent IVF cycles. Second and subsequent IVF treatment cycles need to be SEET or SET involving single thawed elective embryo transfer if the patient has one or more frozen embryos.
For members between 35-38 years of age, the first IVF treatment cycle involves SET but subsequent cycles don’t have to be SET or SEET. Members above 38 don’t need to attempt a SET or SEET.
It’s easy to see that navigating infertility insurance is not easy. Every provider has their own definitions and criteria to abide by in addition to state mandates that address infertility issues very differently. The best recommendation is to become very familiar with your insurance provider to learn what is covered and what is not. You can always choose to switch providers if you see a better one, but make sure to check benefits first. Since plans differ, you may easily lose or gain benefits when switching.