Fertility treatments - does anyone cover this?

cadylou · 01-11-2007, 02:10 PM

I have a client looking for a health plan that will cover fertility treatments. I told her to ask her Dr. which providers they typically see insurance with, and the answer was Aetna, Cigna & BeechStreet (which is just a network of physicians, right?)

My guess is that maybe these firms cover it, but it may only be for group & not individual. Does anyone know?

Any help you can offer would be appreciated.

healthagent · 01-11-2007, 02:14 PM

Check with Blue Cross first. In MD some plans cover fertility.

somarco · 01-11-2007, 03:16 PM

Most (if not all) individual will not cover fertility treatments unless required by law. Group plans will cover if required to do so or if the plan is with a large employer.

Treatment is expensive, usually in the $10k range and the chances of multiple births goes up. The complications associated with triplets (or more) make this a potentially expensive proposition for a carrier.

Some apps ask if you are undergoing, or anticipating fertility treatment. If you answer "yes" they will reject your application even if they are not going to cover the treatment itself.

healthagent · 01-11-2007, 03:50 PM

Very true. If you're looking for individual health insurance and seeking fertility treatment that's a straight decline. High risk of miscarriages. Very high risk of birth defects.

***Melmunch3*** · 01-11-2007, 03:58 PM

Even on a group plan, in a state where it is a mandated requirement, many plans will exclude in vitro. You should really find out more info as to what specific treatments they are looking at.

healthagent · 01-11-2007, 04:42 PM

So health insurance is supposed to cover you if you want help to have kids? Why would that be? Silly me - I thought it was for illness and injury. My wife and I are looking to adopt in the next few years. Maybe health insurance should cover those expenses too.

***Melmunch3*** · 01-11-2007, 04:48 PM

On an individual level, you are completely correct, and that it why it is almost never covered on individual policies. But from the perspective of a large company, these are the sort of benefits that people are interested in. Here in MD, Carefirst will not cover IVF on a small group, defined as less than 50 enrollees. However, IVF is covered at 50%, which can amount to $50,000 or more, on large group plans.
Also, many larger companies will give maternity and paternity leave, for adopting children. True, it isn't a medical issue, but it is a benefit that makes people happier workers.

cadylou · 01-12-2007, 08:42 AM

It won't be covered. My guess is the only reason that the physician she talked with sees Aetna & Cigna would be because they are associated with very large corporate group plans.

I can't find anyone to cover this. The providers I do carry don't want to carry maternity at all, so I knew this would be highly unlikely.

Thanks for the commentary. I appreciate the quick replies.