This year your employer may decide to switch insurance plans or give you a choice of a couple of different plans from which to choose. Do your homework first before deciding on a plan that works best for your family, especially if you are seeking medical help for infertility.

The Family Building Act of New Jersey was signed into law in 2001. This Act requires insurance policies to provide coverage for infertility benefits to SOME of those who fall into certain criteria.

Through working with our patients at the Delaware Valley Institute of Fertility & Genetics (DVIF&G) and with the insurance companies, we have found that only about half of our patients have benefited from this new law. Most employer groups either are self-insured, self- funded, a union, or have less than 50 employees and are considered a small group. All of these are exempt from having to provide “this family building act.”

To make an informed decision, follow these tips:

Always call the insurance company yourself. Do not rely on what the benefit booklet says.

Make sure your prescription plan is not carved out. Some companies will provide medical benefits from one company and the prescription plan through a completely different company. If that is the case, you need to call each one to check for what is specifically covered. We have come across some plans that will cover a patient for in vitro fertilization (IVF), but their prescription plans will not cover the drugs needed for this procedure. This makes no sense.

If your company does not provide for infertility benefits, inquire to see if you can add a rider onto your individual plan. Then pay the difference for the rider.

Make sure when checking your infertility coverage that you are specific. Some companies will say yes, you have infertility coverage, only to find out later that you only have diagnostic coverage. What this means is that treatment of infertility is not covered. Be very specific when asking questions.

One more tip for 2006: Most insurance companies will no longer be using your social security number as your I.D. number on your insurance card. The next set of I.D. cards you receive may reflect a new I.D. number. This is for your protection. Finally something that does make sense!

Carla Scott is the practice administrator for the Delaware Valley Institute of Fertility & Genetics (DVIF&G) located in Lawrenceville. An expert in health insurance contract interpretation and negotiation, Ms. Scott has helped countless patients better understand their coverage to receive the care they need. If you have any questions regarding your health plan’s infertility coverage, please call her at 609-895-0088 or visit pull quote to include if there’s room: Do your homework first before deciding on a plan, especially if you are seeking medical help for infertility.

Facebook Comments