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, with the following copays:
Fertility Treatments
In-Network
Out-of-Network
Office Visit
$5 to $40 copay / visit (based on provider and location)
$120 copay / visit
Artificial insemination
$100 copay / service
$200 copay / service
Latrogenic IVF
$500 copay / service
Not Covered
Egg Retrieval
$1,500 copay / service
$3,000 copay / service
Embryo Transfer
$750 copay / service
$1,500 copay / service
Cryopreservation
$500 copay / service
$1,000 copay / service
Storage
$100 copay / year
$200 copay / year
Thawing
$150 copay / service
$300 copay / service
Genetic Testing (PGT)
$500 copay / visit
$1,000 copay / visit
Donor Services (Egg)
$1,200 copay / service
$2,400 copay /service
Donor Services (Sperm)
$300 copay / service
$600 copay / service
Benefits for infertility treatment are limited to a medical lifetime maximum of $20,000 per person and a separate pharmacy lifetime maximum of $20,000.
Infertility treatments are covered as follows:
  • Diagnosis and treatment of an underlying medical condition that causes infertility, when under the direction of a Physician.
  • Routine diagnostic services, including diagnostic lab, x-ray, and ultrasound are included in the Fertility Treatment copay. When the routine diagnostic service is prescribed by a doctor and received on a different date of service and location, the service is $0 copay.
  • Therapeutic services for fertility when provided by or under the direction of a Physician. Benefits under this section are limited to the following procedures:
  • 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.
    • Pre-implementation generic screening (PGS and PGD)
    • Creation of an embryo using donor material
  • The Plan will cover associated donor medical expenses, including collection and preparation of oocyte and/or sperm, and the medications associated with the collection and preparation of oocyte and/or sperm. The Plan will not pay for donor charges associated with compensation, administrative services or any non-medical expenses
  • Cryopreservation of mature oocytes is only covered when medically necessary; contact the Claims Administrator for additional information
  • The Plan will cover the diagnosis and treatment of the male factor causing infertility, including collection and preparation of sperm, and the medications associated with the collection and preparation of sperm.
  • Multiple copays may apply if more than one service is performed during a visit.
  • Fertility Preservation for Iatrogenic Infertility:
Benefits are available for fertility preservation for medical reasons that cause irreversible infertility such as chemotherapy, radiation treatment, and bilateral oophorectomy due to cancer. Services include the following procedures, when provided by or under the care or supervision of a Physician:
    • Collection of sperm.
    • Cryo-preservation of sperm.
    • Ovarian stimulation, retrieval of eggs and fertilization.
    • Oocyte cryopreservation.
    • Embryo cryopreservation.
  • Benefits for medications related to the treatment of fertility preservation are provided as described under your Outpatient Prescription Drug Benefit.
  • Benefits are not available for elective fertility preservation.
Is there a program for help navigating the fertility process?
The 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 Fertility Solutions program, call +1 866 774 4626.
Are contraceptive devices covered under the Plan?
The Plan covers contraceptive devices under the medical plan at:
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:
  • $30 to $210 copay / visit (based on provider and location) for in-network services and $630 copay / visit for out-of-network services.
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:
  • 100% for in-network providers and $0 copay / visit and $60 copay / visit for out-of-network providers.
You must obtain prior authorization before you are admitted to the hospital.
Tubal ligation reversals are not covered.