Advanced Reproductive Technology
Benefits through Aetna offer participants three advanced reproductive technology (ART) cycles, as well as lifetime prescription drug benefit of $20,000. Infertility drug coverage is also available. The plan does not cover social preservation of egg freezing. Available coverage includes but is not limited to:
In virto fertilization (IVF)
Zygote intrafallopian transfer (ZIFT)
Gamete intrafallopian transfer (GIFT)
Cryopreserved embryo transfers
Effective 1/1/2025, Artificial Insemination (AI) will be covered under basic fertility benefits with a diagnosis and treatment of underlying medical condition.
Frequently Asked Questions
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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.
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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.
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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.
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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.
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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 the 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.