Questions to Ask About Your Coverage
QUESTIONS TO ASK ABOUT TREATMENT :
- Do I have coverage for the diagnosis AND treatment of infertility?
- If yes, are IUI’s (Artificial Inseminations) covered? If so, is there any limit to how many?
- 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?
- Is there a maximum dollar amount to my infertility treatment coverage? For example, $50,000.00 lifetime maximum for treatment?
- If there is a dollar maximum, does it include medications?
- Is there any age restriction for treatment?
- Is pre-authorization required for treatment?
- What is my co-pay and deductible obligation for my treatment?
- 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.
- Are drugs indicated for the treatment of infertility covered under my plan?
- Do I need to use a specific pharmacy to have access to infertility drugs?
- If I have to use a mail-order pharmacy, is there a local back-up available?
- Do medications need pre-authorization?
- What is my co-pay and deductible for infertility medications?
- 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!!