Infertility Treatment. Inpatient/outpatient/in a doctor’s office Three (3) infertility treatment cycles will be covered per plan year with a total of eight (8) infertility treatment cycles covered in a member’s lifetime. 20% - After Deductible 20% - After Deductible
Infertility Treatment. LSNYC will self-insure infertility treatments up to an annual maximum of $25,000 and a lifetime maximum of $50,000 per person.
Infertility Treatment. Advanced reproduction technologies and fertility treatments will be covered after the deductible is met on an in-network basis at 90% of the NNF and on an out-of-network basis at 60% of the MAA. (Amend the following sections of the VMEP: Sections 6.2.2 and 9.19.)
Infertility Treatment. We will cover the Reasonable and Customary Charges for infertility treatment incurred on OPD Treatment or Day Care Treatment or an In-patient Hospitalization by the Insured Person during the Policy Period up to the limit specified in the Policy Schedule or Certificate of Insurance.
Infertility Treatment. We will pay the Reasonable and Customary charges upto the limits mentioned in the Policy Schedule/Certificate of Insurance for In-patient treatment or Day Care treatment of the Insured person in respect of any infertility treatment provided that:
(a) The Benefit will not pay for any OPD treatment The payment under this benefit is within the Basic Sum Insured or the Maternity Sum Insured, subject to limits specified, if any Permanent Exclusion 5(m) of the Policy Wordings stands deleted to the extent of this Benefit only.
Infertility Treatment. We will reimburse the expenses upto the limit specified in Policy Schedule/Certificate of Insurance for the following diagnostic tests and treatments to increase fertility, as well as treatments to prevent future miscarriages, investigation into miscarriage and assisted reproduction and related complications: • Diagnostic investigations, consultations and tests including invasive procedures such as hysterosalpingogram, laparoscopy or hysteroscopy • Laboratory work • Prescribed drug treatment but not limited to ovulation stimulation • Invitro fertilization (IVF) • Intracytoplasmatic sperm injection (ICSI) • Gamete intrafallopian transfer (GIFT) • Zygote intrafallopian transfer (ZIFT) • Artificial insemination (AI) Further, We will only pay the benefits as long as: • The woman is aged under 40 and man under 50 at the time of treatment (first stimulation day in each treatment cycle or first cycle day in case of insemination without hormone stimulation) • The Insured persons sterile condition is due to organic causes and can only be overcome with the aid of reproductive help and • Both the man and woman benefiting from the treatment are insured with Us and are eligible for treatment as per their selected policy benefits Part D – Exclusions I.7, I.27 and III.10 of the Policy Wordings shall stand deleted to the extent of this Benefit only. This cover is also available as a fixed benefit option upto the sum insured specified in the Policy Schedule/ Certificate of Insurance or under the special conditions of the Policy Schedule/ Certificate of Insurance & subject to admissible claim as per the policy conditions applicable to this section including specific exclusion and to any other condition applicable to this policy. In respect to process claims, documents specified under Documentation section is necessary to evaluate the claim. All terms & conditions applicable to this cover remains same as mentioned in coverage, specific exclusion, General exclusion applicable to this section.
Infertility Treatment. Advanced reproduction technologies and fertility treatments will be covered on an in-network basis at 90% of the NNF. (Amend the following section of the VMEP: Section 5.1.3.)
Infertility Treatment. This is NOT a covered expense under this Program; however, diagnostic testing to determine the cause of infertility is a covered expense, and will be covered at the applicable percentages after the deductible is met. Services, treatment and procedures rendered for the specific purpose of making conception possible. This is NOT a covered expense under this Program.
Infertility Treatment. We cover diagnostic and exploratory procedures to determine infertility, including surgical procedures to correct diagnosed diseases or conditions. Limitations Procedures such as IVF, GIFT and ZIFT, which are not essential to the protection of an individual’s life, are not covered.
Infertility Treatment. LSNYC will self-insure infertility treatments up to an annual maximum of $25,000 and a lifetime maximum of $50,000 per person. The lifetime limit of $50,000 is a combined maximum reimbursement for Infertility expenses and Adoption and Surrogacy expenses under Section 5.9 below. LGBTQ members will be reimbursed for infertility treatment without requiring an infertility diagnosis. To be reimbursed, you must first apply to your group health plan and, if coverage is denied, you must appeal that denial through the internal appeals processes described in the Summary Plan Descriptions of your group plan and receive denial of those appeals or lack of decision within 60 days. If a reimbursement request is denied, the Claims Submission Agent (currently USI) will provide written notice to the covered member of their rights to appeal under ERISA and via the Union grievance process within 30 days after the Claims Submission Agent receives your claim. A bargaining unit member can choose to appeal through either or both processes. The notice of denial will provide the specific reason(s) for the denial, the employee’s right to review their application, an optional HIPAA form to allow notification to the union and Employer, and information on how to appeal the denial through both processes. If a HIPAA waiver is signed, LSNYC will provide notice to the Union and the Employer of any denial and the reason for such denial, including a copy of the denial notice provided to the member.
