| HMO | Infertility Services |
| Aetna US Healthcare | Covers: Diagnosis and treatment of infertility for subscriber, his/her covered spouse, and/or other covered dependent. Services must be rendered in a provider’s office or hospital.
Cost Sharing: Copayment applies. Excludes: Infertility injectable medications and drugs related to the treatment of infertility. Also excludes charges for freezing and storage of cryopreserved embryos, charges for storage of sperm, donor costs (eggs and sperm) and costs for ovulation predictor kits. Reversal of voluntary sterilization and related follow-up care are also excluded. |
| Blue Cross Blue Shield | Covers: 50% of medically necessary artificial insemination and prescription drugs used for the treatment of infertility. Infertility services and prescription drugs are limited to a combined $10,000 lifetime amount per Member.
Excludes: Other means of artificial conception. |
| CIGNA / Healthsource | Excludes: Diagnosis or treatment of infertility, unless covered through a supplemental policy. An office visit will be covered if infertility is a secondary or incidental diagnosis and no treatment of diagnosis testing for infertility was performed. |
| Doctors Health Plan | Excludes: Treatment for infertility, including artificial insemination, and reversals of vasectomies and tubal ligations. |
| Generations | Covers: Diagnostic services to establish the cause of infertility.
Excludes: Reversal or surgical sterilization, drug therapy, in-vitro fertilization, embryo transplants, the GIFT program, artificial insemination, tuboplasty and other treatments to induce pregnancy. |
| Optimum Choice | Covers: In vivo fertilization, infertility studies, including testing, medical advice, instruction and treatment to cover any physical abnormality or illness discovered as a cause of infertility, in accordance with medical practice.
Limits: Artificial insemination is covered for a maximum of six (6) cycles. Cost Sharing: Copays may apply. Excludes: Drugs whose primary purpose is the treatment of infertility, except clomiphene citrate (CLOMID). Also excludes in vitro fertilization, embryo transplants, harvesting of ovum or ova, and costs associated with donor sperm and the storage of sperm used for artificial insemination. Excludes reversals of voluntary sterilization. |
| PARTNERS | Covers: Diagnostic and treatment for problems of fertility and infertility.
Excludes: Artificial conception procedures, including but not limited to, artificial insemination and in-vitro fertilization, reversal of voluntary sterilization. |
| Coventry/Principal Health Care of the Carolinas | Covers: Diagnosis and surgical treatment of involuntary infertility. Coverage includes X-rays, laboratory procedures and medication needed to evaluate fertility status.
Excludes: Artificial insemination with donor semen, in vitro fertilization, and embryo transport procedures. Drug therapy for infertility such as Pergonal, Clomid, and other similar drugs is also excluded. Also excludes any medical services, prescription drugs, medicine, supplies, or procedures related to reversal of voluntarily induced sterilization. |
| QualChoice | Excluded: Unless purchased under rider.
With the purchase of a rider, covers: The initial diagnostic workup to confirm a diagnosis of infertility. Excludes: Services for treatment of infertility, such as artificial insemination, in-vitro fertilization, fertility drugs, sonograms or other fertility procedures. |
| The Wellness Plan of North Carolina, Inc. | Covers: Diagnosis of infertility and medically necessary artificial insemination for up to 3 attempts per lifetime.
Limits: Artificial insemination is covered with the inability of a heterosexual couple to achieve conception after one year of unprotected sexual intercourse, or the inability of that couple to sustain a successful pregnancy. Excludes: Other infertility services and treatment. |
| United HealthCare | Covers: Infertility testing and initial diagnosis with prior approval.
Limits: Limited to $1,500 lifetime maximum. Cost Sharing: Copayment applies. Excludes: Health services related to the treatment of infertility, including artificial insemination or fertilization methods such as in vivo fertilization, in vitro fertilization, embryo transfer, zygote intra fallopian transfer (ZIFT), gamete intra fallopian transfer (GIFT) and similar procedures. Also excludes hospital, professional and diagnostic services and medication that are incidental to such insemination or fertilization methods. Reversal of sterilization is also excluded. |
| WellPath | Covers: Diagnostic testing to determine the cause of infertility.
Cost Sharing: Copayment applies. Excludes: Health services related to the treatment of infertility. |