MMC Benefits Handbook
Family Planning
Does the Plan cover infertility treatment?
The Plan covers infertility treatments with a benefit cap of $15,000 for medical services at:
Under the $400 Deductible Plan
  • Services billed in-network for an office visit are subject to copay and all other in-network services are subject to 80% coinsurance after the Plan's deductible has been met. Out of network services are covered at 60% of reasonable and customary charges after the Plan's deductible has been met.
Under the $900 Deductible Plan
Under the $1,500 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $2,850 Deductible Plan
  • 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Benefits for infertility treatment are limited to a medical lifetime maximum of $15,000 per person.
Infertility treatments are covered as follows:
  • Assisted reproduction procedures (including facility charges and related expenses) due to infertility
  • Ovulation induction and monitoring
  • Artificial Reproductive Technology (ART)
    • In vitro fertilization
    • Gamete intrafallopian transfer (GIFT)
    • Zygote intrafallopian transfer (ZIFT)
    • Cryopreserved embryo transfers
    • Intracytoplasmic sperm injection (ICSI) or ovum microsurgery.
Artificial insemination is considered an infertility treatment and is limited to the overall infertility medical lifetime maximum of $15,000 per person as noted in the infertility treatment sub-section.
You must obtain preauthorization before receiving infertility treatment.
Prescription drugs related to infertility are covered under the prescription drug benefit and a separate lifetime maximum benefit cap of $15,000 applies for prescription drugs related to infertility.
Is there a program for help navigating the fertility process?
The UHC Fertility Solutions program provides tools and information to help members (not a child dependent) navigate the Infertility process by providing:
  • Access to dedicated Fertility Solutions Nurses to help provide treatment education and counseling
  • Support from the early infertility diagnosis stage to advanced treatment
For more information about the UHC Fertility Solutions program, call +1 866 774 4626.
Are contraceptive devices covered under the Plan?
The Plan covers contraceptive devices at:
Under the $400 Deductible Plan
  • 100% for in-network providers (no deductible) and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $900 Deductible Plan
  • 100% for in-network providers (no deductible) and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $1,500 Deductible Plan
  • 100% for in-network providers (no deductible) and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $2,850 Deductible Plan
  • 100% for in-network providers (no deductible) and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Oral and injectable contraceptives are covered under the prescription drug plan.
Certain contraceptives are covered under the prescription drug plan. To check drug coverage, visit www.express-scripts.com.
Does the Plan cover vasectomy?
The Plan covers vasectomies at:
Under the $400 Deductible Plan
  • Services billed in-network for an office visit are subject to copay and all other in-network services are subject to 80% coinsurance after the Plan's deductible has been met. Out of network services are covered at 60% of reasonable and customary charges after the Plan's deductible has been met.
Under the $900 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $1,500 Deductible Plan
  • 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $2,850 Deductible Plan
  • 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
You must obtain prior authorization before you are admitted to the hospital.
Vasectomy reversals are not covered under the Plan.
Does the Plan cover tubal ligation?
The Plan covers in-patient and outpatient tubal ligation at:
Under the $400 Deductible Plan
  • 100% for in-network providers with no deductible and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $900 Deductible Plan
  • 100% for in-network providers with no deductible and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $1,500 Deductible Plan
  • 100% for in-network providers with no deductible and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $2,850 Deductible Plan
  • 100% for in-network providers with no deductible and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
You must obtain prior authorization before you are admitted to the hospital.
Tubal ligation reversals are not covered.