Starting or growing a family is expensive! Everyday costs for family necessities add up quickly. And don’t forget big-picture expenses like buying a larger home or paying for college tuition. For families going through infertility issues, the costs involved with in vitro fertilization (IVF) or intrauterine insemination (IUI) can add additional challenges to an already emotionally difficult experience. And while fertility treatment insurance coverage can lessen the financial impact, the fine print isn’t always easy to navigate. So, how exactly do you tell if your insurance covers IVF or IUI? With “Open Enrollment” underway, now’s a great time to find out.
“Navigating the complexities of fertility coverage can feel like a full-time job! Someone just beginning their journey doesn’t know what they don’t know, so there is a lot of time spent researching, seeking resources, trying to make a myriad of decisions, and often feeling frustrated with the lack of support,” says Holly Singh, who founded Wellhatched after going through this same experience. Focusing on patient education and advocacy, Singh knows just how important it is to have the right information, assuring that there are steps to finding out if you know where to look.
How do I know if my insurance plan covers IVF or IUI?
According to Singh, the best way to find out the details of your fertility insurance coverage is by directly contacting your employer’s human resources team or your insurance company. She adds, “Most fertility clinics have patient and financial coordinators dedicated to explaining the logistics of your IVF coverage. Ask your nurses or the front desk about this! They are incredible resources who are happy to help.”
Human resources or your insurance company should provide you with a copy of your benefits package at the time of enrollment, or upon your request. This will typically include an “Explanation of Benefits” or “Summary Plan Description” outlining coverage details. Singh recommends reviewing it carefully to better understand:
- If fertility treatment (not just diagnosis) coverage is offered
- What the lifetime fertility maximum is
- What requirements (if any) are needed to be eligible [For example, if you’re not the employee, you may need to be a spouse/partner/dependent of the covered employee. Or, you may require a diagnosis of infertility to receive treatment]
- Which services are covered under the benefit
And once you begin any related IVF or IUI treatments, make sure to work closely with your healthcare providers. Monitor what diagnostic codes are used, as they can impact whether your treatments will be covered and/or how they will be applied to your benefits and maximums.
Am I protected by fertility coverage state mandates?
As of June 2022, 20 states have passed fertility coverage laws, but they vary by state, type of insurance plan, and where your employer is located. For more information and to check your state’s laws, visit Resolve.org.
What if I have minimal or no IVF or IUI coverage?
“If the plan doesn’t include coverage for fertility treatments, employers can request add-on plans (also known as ‘Riders’) from their insurance providers. These add-on plans provide coverage for IVF or infertility treatments (and medications, in some cases). But, as the demand for family-building benefits increases, employers are creating innovative solutions. A great example is the S.A.F.E. journey wallet at Affirm, a family-planning lifetime allowance (which includes surrogacy, adoption, fertility, and egg freezing). This benefit is funded by Affirm and provided outside of their insurance providers,” says Singh.
Other roads to IVF/IUI financial solutions include:
- Flexible Spending Accounts (FSA) or Healthcare Savings Accounts (HSA)
- IVF clinical trials
- Medical tax write-offs
- Private fertility financing
The road to getting IVF or IUI financed can be an arduous one. Remember that it’s OK to ask for help, and it’s normal to feel overwhelmed sometimes. Resources are available to help you on your path to becoming a parent — but don’t forget that there are also mental health resources to support your well-being along the way.