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Important note for New York members
Find fertility coverage exceptions for your state on our clinical policy bulletins page.
Call the Member Services number on the back of your insurance card. Member services can also tell you if you have a specific provider network.
Yes. In-Network Infertility providers are responsible for treatment authorizations. If you are doing treatment with an infertility specialist, you may contact Member Services to confirm whether your provider is In-Network for your plan. If you are treating with an Out-of-Network provider, the member would be responsible for obtaining precertification.
If you have questions regarding copays, deductibles, claims or appeals call the Member Services telephone number on the back of your insurance card.
Once there is a plan for infertility treatment using ovulation induction with injectable fertility medications, artificial insemination, or assisted reproductive technology (ART), your provider will submit precertification to the National Infertility Unit (NIU) using the online Provider Portal: www.availity.com, or by contacting NIU at phone number: 1-800-575-5999. Your provider will submit the treatment plan, along with any pertinent clinical information using the precertification request forms to the NIU. The NIU will use the clinical information submitted by your provider’s office to determine if you are eligible to access the applicable infertility benefit.
Precertification request forms are located here:
The National Infertility Unit (NIU) has nurses and care coordinators with expertise in infertility management. The NIU has been managing women’s precertification needs for Infertility and Pre-implantation Genetic Diagnostic (PGD) testing for over 20 years. NIU staff help members and providers with the precertification process, and to understand infertility benefits. Our NIU staff work with all aspects of Infertility.
If you need help finding an in-network infertility doctor, use our provider search tool. Search for a “Reproductive Endocrinologist” in your area. Aetna has an Institute of Excellence (IOE) infertility network, which is a limited network of providers that offer high-quality, high-value infertility care.
Check with your plan to confirm if you need to use an IOE for infertility services.
Due to Health Insurance Portability and Accountability Act (HIPAA), we need your verbal or written permission to speak with anyone other than you about your care. This includes partners or family members calling for you. Release forms are available on your member website. Or you can call the Member Services number on your insurance card.
If you have questions regarding copays, deductibles, out-of-pocket limits, claims, or appeals; please contact the Member Services telephone number on the back of your insurance card.
Check your employer’s plan document for information on your infertility coverage. Plan benefit documents are available through your secure Member Portal at www.aetna.com. You can also read our Clinical Policy Bulletin on infertility. Clinical policy bulletins are not a guarantee of coverage. They provide information on the services and procedures we consider medically necessary, or experimental and unproven.
If you are registered in the National Infertility Unit, your physician should let us know when you become pregnant. If your plan includes the Aetna Maternity Program, contact them at 1-800-272-3531(TTY: 711). They can answer questions and help you to have a healthy pregnancy.
If your doctor recommends IVF to freeze eggs prior to a planned medical treatment that could cause you to become infertile, your provider will submit the precertification request for a Fertility Preservation IVF cycle. The National Infertility Unit will review your benefits plan to determine if there is coverage for an Iatrogenic Fertility Preservation IVF cycle, review clinical information submitted by your provider, and determine whether applicable medical necessity criteria are met.
Your provider will submit the precertification request for pre-implantation genetic diagnosis (PGD), as well as the IVF cycle (as applicable). The National Infertility Unit will review your benefits plan to determine if there is coverage for pre-implantation genetic diagnosis (PGD), as well as the IVF cycle (as applicable), review clinical information submitted by your provider, and determine whether applicable medical necessity criteria are met.
Beginning 1/1/2019 for plans with cycle limits, an ART cycle is defined as:
|One complete fresh IVF cycle with transfer (egg retrieval, fertilization, and transfer of embryo)||One full cycle|
|One fresh IVF cycle attempted egg aspiration (with or without egg retrieval) but without transfer of embryo||One-half cycle|
|Fertilization of egg and transfer of embryo||One-half cycle|
|One cryopreserved (frozen) embryo transfer||One-half cycle|
|One complete GIFT cycle||One full cycle|
|One complete ZIFT cycle||One full cycle|
To find out how many “cycles” have been pre-certified of your cycle count maximum limit, you may contact the National Infertility Unit at 1-800-575-5999.
If your Infertility benefit has a dollar limit maximum, please contact the Member Services number on the back of your insurance card. Member Services can tell you what dollar amount has been paid out based on claims that have been submitted, and what dollar amount remains on the dollar limit maximum.
Compliance with the federal parity law is the responsibility of self funded plan sponsors and Aetna cannot provide legal advice in this regard. Plan sponsors should seek their own separate counsel for legal guidance on application of the federal parity requirements. Aetna’s interpretation and approach to federal parity compliance will apply to those Plans as they migrate to Aetna operational platforms. Any questions about Aetna's approach to Federal Mental Health Parity may be referred to your Aetna sales or account representative.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
Health benefits and health insurance plans contain exclusions and limitations.