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.
- Benefit Systems & Services
- Blue Cross Blue Shield of Illinois PPO/POS/Idemnity
- Cigna HMO- Referral Not Required (WIN Fertility)
- Cigna PPO
- Community Health Alliance
- Community Health Alliance-South Bend
- Community Healthcare System (hospital employees)
- Encore Health Network (The Healthcare Group, LLC)
- First Health/Personal Care
- Great West (Formerly known as One Health Plan of Illinois)
- Health Dynamics
- Health Select-South Bend
- HMO ILLINOIS (WIN Fertility)
- 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, Cigna HMO)
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.