Any teachers with IF insurance coverage? Or anyone for that matter?
5 Replies
kate_len04 - March 30

I'm doing a quick survey to find out if any school districts, anywhere, offer IF coverage for insurance. We're up for a new contract this year, in Ohio, and I've been working my tail off fighting for coverage. I've been lied to about our carrier not even having a plan (Anthem Blue Cross/Blue Shield), but I know they do because the INCIID website carries a list of "Fertility-friendly employers" and low and behold, many of them have Anthem! I've written letters, made complaints, etc... and I'm not stopping until we have fair coverage like everything else. Does anyone have any other suggestions? I'd like to know if you have coverage, what the coverage is, who the carrier is, and how much you pay each pay period (if you don't mind me asking). I've never been on this site (I frequent another one), but I'm trying to gather some information so I'm more informed. So I'm posting messages everywhere!

THANKS SO MUCH FOR YOUR HELP!!

 

amyjoy - March 31

I am a teach in Illinois and I have IF insurance and it does cover ivf. We pay 10% and my medication has never been more than $40 for the month. I have not done an ivf cycle. yet. We will be doing our 2nd IUI in May. I paid a total (with meds) for an IUI - about $300 from start to finish. We have Blue Cross/Blue Shield. I have a PPO. However, our insurance follows the state mandate in Illinois for IF insurance. I can email you a copy of that if you want. I do not pay my insurance premium, my school district does. But, if I wanted family insurance, it would be around $600 a month! I'm not sure what other info you are looking for, but please email me if you need any furthur info: [email protected]

 

kate_len04 - April 1

Thank you! I'm trying to make sure I get a lot of information to take to my administration. We are also a mandate to cover and I have Anthem PPO. So do you think it's supposed to be covered?

 

amyjoy - April 1

Here is what it is for Illinois (below). I would google info for Ohio's law mandating insurance coverage.

Here's what MY particular insurance covers:
They pay 90%, I pay 10% after a $250 deductible
$10 for office visits
Any preg. complications
Diagnostic testing
IUI
IVF- 4 retrievals per lifetime
Meds- $10 generic, $25 not generic, $40 if not on policy
Donor eggs
Donor Sperm



Illinois Law Mandating Insurance Coverage for Infertility
(Text from Illinois Insurance Website. Revised June 2002.)
Infertility is a condition that strikes hundreds of couples in Illinois. Illinois law requires group insurance plans and health maintenance organizations (HMOs) to provide coverage for infertility. Here are the basic facts about the law.

Who Must Offer the Coverage?

Illinois law requires insurance companies and HMOs to provide coverage for infertility to employee groups of more than 25. The law does not apply to self-insured employers or to trusts or insurance policies written outside Illinois. However, for HMOs, the law does apply in certain situations to contracts written outside of Illinois if the HMO member is a resident of Illinois and the HMO has established a provider network in Illinois. To determine if your HMO provides infertility benefits, you should contact the HMO directly or check your certificate of coverage.

Who is Covered?

To receive infertility coverage, you must:


live in Illinois

be covered by a fully insured Illinois group policy through an employer with more than 25 employees

have been unable to conceive after one year of unprotected sexual intercourse between a male and female or have been unable to sustain a successful pregnancy.

What is Covered?

Illinois requires group insurance and HMO plans to cover the diagnosis and treatment of infertility the same as all other conditions. For example, they may not apply any unique co-payments or deductibles for infertility coverage. Benefits shall include, but not be limited to:


testing

prescription drugs

artificial insemination

in vitro fertilization (IVF)

gamete intrafallopian tube transfer (GIFT)

intracytoplasmic sperm injection (ICSI)

donor sperm and eggs (medical costs)

What are the Limits?

Benefits for advanced procedures such as IVF, GIFT, ZIFT or ICSI are required only if you have been unable to attain or sustain a successful pregnancy through reasonable, less costly medically appropriate infertility treatments for which coverage is available under the policy.

The benefits for advanced procedures required by the law are four completed oocyte retrievals per lifetime of the individual, except that two completed oocyte retrievals are covered after a successful live birth is achieved as a result of an artificial reproductive transfer of oocytes. For example, if a successful live birth takes place as a result of the first completed oocyte retrieval, then two more completed oocyte retrievals for a maximum of three are covered under the law. If a live birth takes place as a result of the fourth completed oocyte retrieval, then two more completed oocyte retrievals for a maximum of six are covered. The maximum number of completed oocyte retrievals that can be covered under the law is six.

One completed oocyte retrieval could result in many IVF, GIFT, ZIFT or ICSI procedures. There is no limit on the number of procedures, including less invasive procedures such as artificial insemination. The only limitations are on the number of completed oocyte retrievals.

NOTE: Once the final covered oocyte retrieval is completed, only one procedure (IVF, GIFT, ZIFT, or ICSI) is covered. After that, the benefit is maxed out and no further benefits are available under the law.

NOTE: Oocyte retrievals are per lifetime of the individual. If you had a completed oocyte retrieval in the past that was paid for by another carrier, or not covered by insurance, it still counts toward your lifetime maximum under the law.

What is Not Covered?

Your group insurance or HMO plan does not have to pay for:


costs incurred for reversing a tubal ligation or vasectomy

costs for medical services rendered to a surrogate for purposes of childbirth; however, medical expenses incurred by a surrogate for infertility related services must be covered

costs of preserving and storing sperm, eggs and embryos

costs for an egg or sperm donor which are not medically necessary; any fees for non-medical services paid to the donor are not covered under the law

experimental treatments

costs for procedures which violate the religious and moral teachings or beliefs of the insurance company or covered group

 

amyjoy - April 1

What other site do you frequent?

 

kate_len04 - April 1

I've been on fertilityneighborhood for a few years or more. I just recently "branched out" to gather my information!

Ohio's rules are very brief. It says that HMOs must offer fertility coverage, but the State does not define "infertility." It just states that it has to be medically necessary. I'm going to call our Dept. of Insurance tomorrow morning for more clarification. I want to know if my employer is required to carry it. Thanks so much for all your info!!!

 

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