GatorCare 2022 Infertility Benefit

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