Infertility services for your High Option health 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. If you’re ready to seek medical help on your journey to becoming a parent, the High Option plan covers a range of services to diagnosis and treat infertility.

When to see a healthcare provider for infertility

People under the age of 35 who aren’t pregnant after one year of trying should consider seeing a healthcare provider. If you’re over 35 years of age, you may want to seek evaluation after six months of trying. Your chances of getting pregnant decrease with age.

APWU Health Plan infertility services for the 2023 plan year

High Option members pay (after the calendar year deductible)

Diagnosis and treatment of infertility, except as shown in Not covered

Limited benefits: We pay a maximum of $2,500 for medical and $2,500 for prescription drugs each calendar year per person to diagnose and treat infertility. See Section 5(f), Prescription drug benefits

PPO: 15% of the Plan allowance and all charges after we pay $2,500 in a calendar year

Non-PPO: 40% of the Plan allowance and all charges after we pay $2,500 in a calendar year

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:
    • Artificial insemination (all procedures) (AI)
    • In vitro fertilization (IVF)
    • Embryo transfer and gamete intra-fallopian transfer (GIFT) and zygote intra-fallopian transfer (ZIFT)
    • Intravaginal insemination (IVI)
    • Intracervical insemination (ICI)
    • Intrauterine insemination (IUI)
  • Services and supplies related to ART procedures
  • Cost of donor sperm
  • Cost of donor egg

All charges

Infertility is the condition of an individual who is unable to conceive or produce conception during a period of 1 year if the female is age 35 or younger or during a period of 6 months if the female is over the age of 35.