Infertility Services. Freezing, storage and thawing of embryos, sperm, or other tissues, for future use, unless the freezing, storage and thawing is needed due to potential iatrogenic infertility as described in Infertility Services in Section 3. • Reversal of voluntary sterilization or infertility treatment for a person that previously had a voluntary sterilization procedure. • Fees associated with finding an egg or sperm donor, related storage, donor stipend, or shipping charges. • Services related to surrogate parenting, when the surrogate is not a member of this
Infertility Services. This plan covers the following services, in accordance with R.I. General Law §27-20-20. • Services for the diagnosis and treatment of infertility if you are:
Infertility Services. Benefits are available for the diagnosis of infertility. Benefits are limited to the following:
1. Infertility counseling; and
Infertility Services. This plan covers services, in accordance with R.I. General Law §27-20-20, for the diagnosis and treatment of infertility if you are: a presumably healthy individual; and unable to conceive or sustain a pregnancy during a one (1) year period. Infertility prescription drug coverage is based on the route of administration and site of service. For information about prescription drugs see Prescription Drugs and Diabetic Equipment or Supplies in Section 3 and the Summary of Pharmacy Benefits.
Infertility Services. This plan covers the following services, in accordance with R.I. General Law §27-20-20. • Services for the diagnosis of infertility. • Services for the treatment of infertility if a member is unable to conceive or sustain a pregnancy during a: ▪ one (1) year period for a member under age 35; ▪ six (6) month period for a member age 35 or older. • Some services for the treatment of infertility may have additional eligibility criteria, as listed in our medical policy for infertility services. Please contact our Customer Service Department for additional information. • Standard fertility preservation services for members not in active infertility treatment when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility. Iatrogenic infertility means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes. ▪ Prescription drugs for the treatment of infertility. Coverage is based on the route of administration and site of service. For information about prescription drugs see Prescription Drugs and Diabetic Equipment or Supplies and the Summary of Pharmacy Benefits. This plan covers infusion therapy and related administration services.
Infertility Services. Freezing and storage of embryos, or other tissues, for future use. • Reversal of voluntary sterilization or infertility treatment for a person that previously had a voluntary sterilization procedure. • Fees associated with finding an egg or sperm donor, related storage, donor stipend, or shipping charges. • Hospital services which are not performed in a hospital. • Medical services of the donor that are not directly related to the organ transplant. ▪ Services related to obtaining, storing, or other services performed for the potential future use of umbilical cord blood. • Noncadaveric small bowel transplants. • Services related to donor searches. • Donor related medical and surgical expenses when the recipient is not covered as a • Services or supplies related to an excluded transplant procedure. • Preimplantation genetic diagnosis, also known as embryo screening. • Amniocentesis or any other service when performed solely to determine gender. • Biological products for allergen immunotherapy and vaccinations. • Blood fractions. • Compound prescription drugs that are not made up of at least one legend drug. • Bulk powders and chemicals used in compound prescriptions that are not FDA approved, are not covered unless listed on our formulary. • Prescription drugs prescribed or dispensed outside of our dispensing guidelines. • Prescription drugs that have not proven effective according to the FDA. • Prescription drugs used for cosmetic purposes. • Prescription drugs purchased from a non-designated pharmacy, if a pharmacy has been designated for you through the Pharmacy Home Assignment program. • Experimental prescription drugs including those placed on notice of opportunity hearing status by the Federal Drug Efficacy Study Implementation (DESI). • Prescription drugs provided to you that are not dispensed by a network pharmacy or covered under your medical plan. • Prescription drugs and diabetic equipment and supplies purchased at a non-network pharmacy unless indicated as covered in the Summary of Pharmacy Benefits. • Prescription drug related medical supplies except for diabetic, regardless of the reason prescribed, the intended use, or medical necessity. Examples include, but are not limited to, alcohol pads, bandages, wraps or pill holders. • Off-label use of prescription drugs except as described in Experimental or Investigational Services in Section 3; • Prescribed weight-loss drugs. • Replacement of prescription drugs resulting from a lost, stolen, broken ...
Infertility Services. Freezing and storage of embryos, or other tissues, for future use. Reversal of voluntary sterilization or infertility treatment for a person that previously had a voluntary sterilization procedure. Fees associated with finding an egg or sperm donor, related storage, donor stipend, or shipping charges.
Infertility Services. Inpatient/outpatient/in a physician’s office. Three (3) in-vitro fertilization cycles will be covered per plan year with a total of eight (8) in-vitro fertilization cycles covered in a member’s lifetime. 20% - After deductible 40% - After deductible Outpatient - facility 0% - After deductible 20% - After deductible In the physician’s office/in your home 0% - After deductible 20% - After deductible
Infertility Services. Covered Services, which may require Preauthorization, include diagnostic counseling, consultations, planning services and treatment for problems of fertility and Infertility, subject to the exclusions in LIMITATIONS AND EXCLUSIONS. Once the Infertility workup and testing have been completed, subsequent workups and testing will require approval of the HMO Medical Director.
Infertility Services. Inpatient/Outpatient /In a Doctor’s Office
