MMC Benefits Handbook
Family Planning
Does the Plan cover infertility treatment?
The Plan covers infertility treatments with a benefit cap of $20,000 for medical services and a separate benefit cap of $20,000 for pharmacy services at:
Under the $1,600 Deductible Plan
Under the $3,200 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 $20,000 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.
  • Medically necessary fertility preservation and cryopreservation for individuals who are presumed to be fertile but who have planned therapies for the treatment of medical conditions
  • Pre-implantation genetic screening (PGT-A/PGS)
Artificial insemination is considered an infertility treatment and is limited to the overall infertility medical lifetime maximum of $20,000 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 $20,000 applies for prescription drugs related to infertility.
Is there a program for help navigating the fertility process?
Aetna's National Infertility Unit (NIU) is part of Aetna's women's health programs. NIU provides education around fertility treatment options, helps members through the preauthorization process and directs members to quality providers.
You need to enroll in the program once there is a plan for infertility treatment. This includes ovulation induction with injectable infertility medications, artificial insemination or assisted reproductive technology (ART). You do not need to register in the NIU program in order to see a physician to determine why you are having trouble getting pregnant, or to start orally medicated, timed intercourse cycles.
If you plan to start treatment for infertility, log in to Aetna's website to complete the registration form or call +1 800 575 5999.
Are contraceptive devices covered under the Plan?
The Plan covers contraceptive devices under the medical plan at:
Under the $1,600 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 $3,200 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.
Certain contraceptives are covered under the prescription drug plan including oral and injectable contraceptives as well as contraceptive devices.
To check drug coverage, visit www.caremark.com.
Does the Plan cover vasectomy?
The Plan covers vasectomies at:
Under the $1,600 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 $3,200 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 preauthorization 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 $1,600 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 $3,200 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 preauthorization before you are admitted to the hospital.
Tubal ligation reversals are not covered.