Insurance

Your employer determines if infertility will be covered in the plans they choose to offer their employees. Insurance coverage for infertility varies from plan to plan so it is important to check with your insurer to see what your plan covers. Some important questions to ask include:

Is infertility treatment covered in my current plan?
Are there restrictions to the infertility benefits?
What are the exclusions?
Do I need a referral? If so, how long is it valid?
Do I need to get a precertification?
Do I have a lifetime maximum benefit? If so, what is the limit?
Will medications be covered?

Be sure to get the name of the person you speak to at your insurance company, along with his/her telephone number and extension. Take notes on what you are told, and ask for a written confirmation of the conversation and benefits.

Participating Insurance Plans

This list is not all-inclusive and can change at any time. Due to the wide array of plans that are available and the ability employers now have in building insurance packages unique to them, we advise you to contact the customer service number on the back of your insurance card to make sure your specific infertility plan is in network with the University of Chicago Physician's Group (UCPG) and the University of Chicago Hospitals (UCH) and confirm that our doctors are included in your plan.

Aetna (after January 1, 2008)
Benefit Systems & Services
Blue Cross Blue Shield of Illinois PPO/POS/Idemnity
Caterpillar
CCN
Cigna HMO- Referral Required
Cigna PPO
Community Health Alliance
Community Healthcare System (hospital employees)
CoreSource
Encore Health Network (The Healthcare Group, LLC)
First Health/Personal Care
Great West (Formerly known as One Health Plan of Illinois)
Health Dynamics
Humana (HMO's and other products) (for certain physicians and sites)
Indiana Health Network
Ingalls Memorial Hospital Employees
Ingalls Provider Group - NAMM
Methodist Hospitals
Midwest Physicians Group
Naperville Health Care Associates
Northwest Community Health Partners - NAMM
Partners National Health Plan of Indiana
Preferred Health Network (PHN)
Preferred Network Access (PNA)
Preferred Plan Inc.
Private Healthcare Systems (for certain physicians and sites)
Pronger Smith Medical
Purdue University Employees
One Health Plan (see Great West)
Sagamore Health Network
Select Health Network
United Healthcare
Unicare Health Plan
University of Chicago Health Plan
WIN Fertility (HMO Illinois)

State Mandates

Determine whether or not you live in a state that has mandates for infertility insurance coverage. There are a handful of states that mandate insurance coverage for infertility to some extent or under certain conditions.

Twelve states currently have infertility insurance mandates. These mandates vary in the level of coverage that health insurance underwriters are required either to offer (otherwise known as a “mandate to offer” or “soft mandate”) or to provide (a “mandate to provide” or “hard mandate”). The Massachusetts and Illinois mandates are hard mandates that compel insurers to provide infertility coverage; the Texas and California mandates are soft mandates that merely compel insurers to offer the coverage to employers. Employers in those states are not obligated to purchase the coverage.

Unfortunately, self-insured groups are not required to follow these mandates. The majority of people with employer-sponsored health insurance policies are "self-insured" and thus the mandates do not apply to the majority of people, even in states with mandates.