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Infertility services for the High Option plan

Infertility is a struggle. When you want to start or expand your family but have been unable to conceive within a reasonable period of time, it can affect your emotional health. For members who are ready to seek medical help on the journey to becoming a parent, the High Option covers a range of services to diagnosis and treat infertility.

APWU Health Plan infertility services for the 2024 plan year

High Option members pay (after the calendar year deductible)

Diagnosis and treatment of infertility specific to, except as shown in Not covered, see Section 10, Definitions

  • Artificial insemination (AI):
    • Intravaginal insemination (IVI)
    • Intracervical insemination (ICI)
    • Intrauterine insemination (IUI)
  • Infertility medications, including IVF related drugs. See Section 5(f), Prescription drug benefits

PPO: 15% of the Plan allowance

Non-PPO: 40% of the Plan allowance

Iatrogenic fertility preservation procedures (retrieval of and freezing of eggs or sperm) caused by chemotherapy, pelvic radiotherapy, ovary or testicle removal and other gonadotoxic therapies for the treatment of disease and gender reassignment.

Note: Fertility preservation procedures require prior approval (see Section 3, Other services).

Limited benefits: $12,000 lifetime maximum.

PPO: 15% of the Plan allowance

Non-PPO: 40% of the Plan allowance

Not covered:

  • Infertility services after voluntary sterilization
  • Assisted reproductive technology (ART) procedures, such as:
    • In vitro fertilization (IVF)
    • Embryo transfer and gamete intra-fallopian transfer (GIFT) and zygote intra-fallopian transfer (ZIFT)
  • Services and supplies related to ART procedures
  • Cost of donor sperm
  • Cost of donor egg

All charges

Infertility is defined as: The inability to conceive after 1 year of regular unprotected sexual intercourse for an individual with female reproductive organs under 35 years of age. The inability to conceive after 6 months for an individual with female reproductive organs over age 35 years of age. The inability to conceive after 1 year of artificial insemination (AI) for those under age 35 and 6 months for those over age 35. The diagnosis of a disease or condition of the male or female reproductive tract such that regular unprotected sex or artificial insemination would be ineffective. The inability to carry a pregnancy to delivery.