QUESTIONS TO ASK ABOUT TREATMENT :

  1. Do I have coverage for the diagnosis AND treatment of infertility?
  2. If yes, are IUI’s (Artificial Inseminations) covered? If so, is there any limit to how many?
  3. If yes, is IVF (in-vitro fertilization) covered? If so, is there any limit to how many? For example, 3 cycle per year of IVF or 3 cycles per lifetime?
  4. Is there a maximum dollar amount to my infertility treatment coverage? For example, $50,000.00 lifetime maximum for treatment?
  5. If there is a dollar maximum, does it include medications?
  6. Is there any age restriction for treatment?
  7. Is pre-authorization required for treatment?
  8. What is my co-pay and deductible obligation for my treatment?
  9. Is there a limit to my out of pocket expense?

 

QUESTIONS TO ASK ABOUT PHARMACY/DRUG COVERAGE:

Since drugs used to treat infertility are considered “specialty drugs,  they are often considered a drug benefit specific to high cost injectable medications.

  1. Are drugs indicated for the treatment of infertility covered under my plan?
  2. Do I need to use a specific pharmacy to have access to infertility drugs?
  3. If I have to use a mail-order pharmacy, is there a local back-up available?
  4. Do medications need pre-authorization?
  5. What is my co-pay and deductible for infertility medications?
  6. Is there a dollar limit or annual/lifetime maximum for medications?

 

It is important you take an active role in understanding your coverage. Understanding your benefits will allow you to maximize the coverage available to you!!