A Fertility Assessment before the holidays? An IUI? These options can become more convenient utilizing your savings as well as, perhaps, holiday time off to accommodate them. As with everything else during this busy time, it is important to book early in order to beat the end of the year rush.
Open enrollment is another issue. Many plans including the Affordable Health Care Act (ACA) have limited open enrollment periods at the beginning of the new year. Often times, employee plans offer an option as well to change or add coverage at this time of the year.
As one of only a small group of mandated states for fertility coverage, Illinois has provided resources in the past for those patients going through diagnosis and treatment. This mandate requires Illinois based companies to provide at least some coverage for their employees.
“Reproductive Medicine Institute (www.reproductive medicineinstitute.com) has a rich offering of plans available to patients,” says Lee Jones, Billing Manager for RMI. “Patients have so many things on their minds when navigating infertility, we try to offer as many financial benefits as possible through the utilization of the maximum amount of insurance plans.”
Shweta Nayak MD and a Reproductive Endocrinologist and Infertility Specialist (REI) with Reproductive Medicine Institute (https://www.reproductivemedicineinstitute.com/about-us/physicians/shweta-nayak-md) confers. “Infertility treatments involve a number of details such as timing of medications, tests and procedures. Not least of these is taking full advantage of the best coverage available to you, whether through an employer or a state run program.”
Along with the questions that patients have in the process of trying to get pregnant, there are a number of concerns regarding the financing of such, and where insurance plays a part.
Q: I live in Illinois, which is a federally mandated state for fertility coverage. Is my employer required to offer benefits even if it’s a small company?
A: Illinois IS one of the mandated states for fertility coverage but the company must be:
*An Illinois corporation (or in the case of an HMO, the company may be outside of Illinois maintains an established network of Illinois providers)
*Have 25 or more employees
*Not be self insured or funded by trust
*Patients are limited to a certain number of cycles (IVF) and must have been actively trying to conceive for one year or more without success.
Furthermore, since August of 2018, Illinois law requires insurance to pay for fertility preservation in the instance of cancer treatment.
Q: Does the Affordable Care Act (ACA) follow this mandate as well?
A: In Illinois (and other mandated states), the answer is Yes.
Q: If I am starting a new job in March, can I sign up for or take advantage of my employer’s insurance plan at that time?
A: Many companies have an open enrollment period for current employees who may want to switch from one policy to another. However, if you are starting a new job outside of that open enrollment period, you should speak with your Human Resources representative to determine whether there is a waiting period to enroll and/or if new hires are accepted into the insurance plan outside of the usual open enrollment period.
In the case of insurance provided through the Affordable Care Act (ACA), the open enrollment period for 2019 closes on December 15, 2018, with coverage beginning January 1, 2019. The only opportunity to enroll after that is if you qualify for a special enrollment plan. Please contact the State of Illinois (https://www.healthcare.gov/blog/when-is-2019-open-enrollment/) for more details.
Q: Other than insurance or self pay, are there other opportunities to finance my fertility treatments?
A: Reproductive Medicine Institute has partnered with WINFertility Quality Discount Treatment Program for patients who have no infertility insurance coverage or who have exhausted their benefits and seek an efficient, economical way to obtain and pay for advanced fertility treatment.
The WINFertility Program includes both advanced medical treatment and fertility medications in a single, discounted ‘bundled’ price for each cycle.
We also participate in the Progyny Fertility Benefits members program. You can request additional information from your employer.
For patients who do not have insurance coverage, Reproductive Medicine Institute offers a special IVF cycle discounted rate.
“At RMI, we pride ourselves on individualized care,” says Dr. Nayak. “Our goal is to ‘meet’ our patients wherever they are in the process, whether it be physical, psychological or financial.”