Family Planning Benefits

Family planning is deciding when and how many children to have in one's life. Whether you intend to delay having children or are ready for the journey to conception, the postdoc medical plan has services to help you attain your desires.

Conception Assisted Services

The path to conception is not always easy and affects individuals of every gender and demographic group. No matter your family dynamic, if you need help conceiving a child, the postdoc medical plan offers benefits for you. No diagnosis of infertility is required to access covered services. No minimum follicle-stimulating hormone (FSH) level must be present, and no attempt to conceive through egg and sperm contact is required.

Basic Conception Assisted Covered Services

Covered services include seeing a provider:

To diagnose and evaluate the underlying medical cause of infertility.
To do surgery to treat the underlying medical cause of infertility. Examples are endometriosis surgery or, for men, varicocele surgery.

Comprehensive Conception Assisted Services

Covered services include the following when provided by an in-network Family Planning Specialist:

Ovulation induction cycle(s) using medication to stimulate the ovaries. This may include the use of ultrasound and lab tests.
Artificial insemination includes intrauterine (IUI)/intracervical (ICI) insemination.

Comprehensive Family Planning services may include either dollar or cycle limits. A cycle limit is defined as:

An attempt at ovulation induction while on medication to stimulate the ovaries with or without artificial insemination
An artificial insemination cycle with or without medication to stimulate the ovaries

**Your Plan Limits and Cost Share**
Description	In-Network	Out-of-Network
Maximum number of ovulation induction per lifetime while on medications to stimulate the ovaries	3 50% coinsurance No deductible No copay	Not covered
Maximum number of artificial insemination per lifetime	3 50% coinsurance No deductible No copay	Not covered

The following are not covered comprehensive Conception Assisted Services:

All charges associated with or in support of surrogacy arrangements for you or the surrogate. A surrogate is a female carrying her own genetically related child with the intention of the child being raised by someone else, including the biological father.
Home ovulation prediction kits or home pregnancy tests.
The purchase of donor embryos, donor eggs, or donor sperm.
Obtaining sperm from a person not covered under this plan.
Family Planning treatment when either partner has had voluntary sterilization surgery, with or without surgical reversal, regardless of post-reversal results. This includes tubal ligation, hysterectomy, and vasectomy only if obtained as a form of voluntary sterilization.
Injectable family planning medication, including but not limited to menotropins, hCG, and GnRH agonists.

Advanced Reproductive Technology (ART)

Advanced reproductive technology, also called "assisted reproductive technology," is a more advanced type of Conception Assisted Service.
Covered services include the following when provided by a network ART specialist:

In vitro fertilization (IVF).
Zygote intrafallopian transfer (ZIFT).
Gamete intrafallopian transfer (GIFT).
Cryopreserved (frozen) embryo transfers (FET).
Cryopreservation (freezing) and storing eggs, embryos, sperm, or reproductive tissue for 12 months per cycle.
Thawing of cryopreserved (frozen) eggs, sperm, or reproductive tissue.
Charges associated with your care when you receive a donor egg or embryo in a donor IVF cycle. These services include culture and fertilization of the egg from the donor and transfer of the embryo into you.
Charges associated with your care when using a gestational carrier, including egg retrieval and culture and fertilization of your eggs that will be transferred into a gestational carrier. Services for the gestational carrier, including embryo transfer into the carrier, are not covered.

Premature Ovarian Insufficiency

If your infertility has been diagnosed as premature ovarian insufficiency (POI), as described in our clinical policy bulletin, you are eligible for ART services using donor eggs/embryos through age 45, regardless of FSH level.

ART covered services may include either dollar or cycle limits. For plans with cycle limits, an ART "cycle" is defined as:

Procedure	Cycle Count
One complete fresh IVF cycle with transfer (egg retrieval, fertilization, and transfer of embryo)	One full cycle
One fresh IVF cycle with attempted egg aspiration (with or without egg retrieval) but without the transfer of an 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

**Your Plan Limits and Cost Share**
Description	In-Network	Out-of-Network
Limit per lifetime	$7,000 50% coinsurance No deductible No copay	Not covered

Fertility Preservation

Fertility preservation involves the retrieval of mature eggs/sperm with or without the creation of embryos that are frozen for future use.
Covered services for fertility preservation include:

Cryopreservation of eggs, embryos, and sperm (actual service to freeze what is retrieved from the fertility preservation IVF cycle).
Limited to one cycle per lifetime (as stated above) and thawing and storing up to 1 year of eggs, embryos, and sperm.
Includes iatrogenic and elective fertility preservation.

Family Planning Services Exclusions

The following are not covered services:

The donor's care in a donor egg cycle. This includes, but is not limited to, screening fees, lab test fees, and charges associated with donor care as part of donor egg retrievals or transfers.
A gestational carrier's care, including embryo transfer to the carrier. A gestational carrier is a woman who has a fertilized egg from another woman placed in her uterus and who carries the resulting pregnancy on behalf of another person.
All charges associated with or in support of surrogacy arrangements for you or the surrogate. A surrogate is a female carrying her own genetically related child with the intention of the child being raised by someone else, including the biological father.
Home ovulation prediction kits or home pregnancy tests.
The purchase of donor embryos, donor eggs, or donor sperm.
Obtaining sperm from a person not covered under this plan.
Family Planning treatment when either partner has had voluntary sterilization surgery, with or without surgical reversal, regardless of post-reversal results. This includes tubal ligation, hysterectomy, and vasectomy only if obtained as a form of voluntary sterilization.
Treatment for dependent children, except for fertility preservation, as described above.
Family Planning medication, including but not limited to menotropins, hCG, and GnRH agonists.

Aetna's National Infertility Unit

The National Infertility Unit (NIU) can help determine eligibility for benefits and recertification. They can inform you about our infertility Institutes of Excelence^TM (IOE) facilities. You can call the NIU at 1-800-575-5999.

Your network provider will request approval for all Conception Assisted Services.

Pregnancy Prevention and Termination

Not ready to have children? Female contraception, voluntary sterilization, and abortion services are available.

Female Contraception

Covered as Preventative Care and is at no cost to you when assessed through an in-network provider.

Covered services include:

Counseling services provided by a physician or other provider on contraceptive methods. These will be covered when you get them in a group or individual setting. Limit of 2 per calendar year
Contraceptive devices (including any related services or supplies) when they are prescribed, provided, administered, or removed by a health professional.
Voluntary sterilization, including charges billed separately by the provider for female voluntary sterilization procedures and related services and supplies. This also could include tubal ligation and sterilization implants.

Male Contraception

Although not considered Preventative Services, there is no cost associated with the following when accessed through an in-network provider:

Voluntary sterilization, including charges billed separately by the provider for male voluntary sterilization procedures and related services and supplies.
Prescribed male condoms.

Voluntary Termination of Pregnancy - where permitted by state and local law

For postdocs who must travel to receive abortion services, there are additional benefits as follows:

Scholars who must travel more than 100 miles from their residence to access certain in-network covered services may apply for reimbursement of travel and lodging expenses of up to a $5,000 maximum annually.
Please note that anyone accessing certain services must attest that there were no service providers within 100 miles of their residence.
Reimbursement of expenses requires the submission of receipts.
The Internal Revenue Service limits lodging reimbursement to $50/day, $100 maximum (member plus companion).

Postdocs should contact SHCA Member Care Services at 855-345-7422 for assistance with the reimbursement process.