Assisted Reproductive Services
Who is eligible?
- A subscriber, spouse or Domestic Partner who has been enrolled in a GatorCare plan or continuously employed by a participating Employer Group for at least two years, AND
- Has a current diagnosis of infertility characterized as:
- Failure to achieve clinical pregnancy after 12 months or more of regular unprotected sexual intercourse, OR
- Inability to reproduce as an individual or with their partner, with the intention of resulting conception in that Subscriber, spouse or Domestic Partner, AND is
- Enrolled in Prime, Prime Plus, Premium, GatorCare OOA, Healthy Rewards HRA
What is covered?
- Intrauterine Insemination (IUI), In Vitro Fertilization (IVF) and Frozen Embryo Transfer (FET)
- All laboratory and radiology procedures ordered and performed by UF Health Reproductive Medicine providers at Springhill
- Fertility interventions will be determined by the treating physician based on medical, sexual and reproductive history, age, physical findings and diagnostic testing using evidence-based guidelines from the Society of Assisted Reproductive Technology (SART)
- Preferred formulary self-administered medications prescribed by a UF Health Reproductive Medicine provider and dispensed by the UF Health OP pharmacies in Gainesville and/or Jacksonville
How is it covered?
- Medical benefits are subject to 30% coinsurance; CYD is waived
- Medications are subject to the annual Rx deductible and applicable Tier coinsurance
- Lifetime maximum benefit of $30,000 for combined medical and pharmacy
- Annual Maximum Out of Pocket responsibility of $5,000 for combined medical and pharmacy; Does not apply towards the member’s Annual Out of Pocket Maximum
- Prior Authorization is required
What is not covered?
- Services received from non UF Health providers
- Services incident to or resulting from procedures for a surrogate mother
- Services for collection, purchase or storage of sperm/oocytes/frozen embryos from donors other than the Subscriber, enrolled spouse or enrolled Domestic Partner
- Any services not specifically listed as a covered service
- Fertility preservation for delayed childbearing