What is Infertility?

Infertility means not getting pregnant after trying without birth control for a certain amount of time.

  • Age 35 or younger, trying for 1 year
  • Over age 35, trying for 6 months 

 

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Young mother holding her baby outdoors.

Infertility Services Are Covered on These Plans

  • DHHA Employer Plans
  • Elevate Health Plans Exchange
  • Colorado Option 

Prior Approval Is Needed

You must get approval before starting care. This is called prior authorization. Your doctor will send a request form to DHMP and refer you to an in-network Conceptions infertility specialist after you are diagnosed. The request includes the services you need and a date range so care can be repeated if needed. Coverage may be different based on your plan. You will still pay your usual copays, deductibles, and coinsurance. Check your member handbook for details.

What’s Covered

Coverage depends on your plan. Check your member handbook for full details.
These benefits are available to same-sex couples and single people with a diagnosis of infertility. Services for partners who are not members of a DHHA employer plan, an Elevate Health Plans Exchange or Colorado Option plan are not covered.

  • DHHA Employer Plans may cover:
    • Testing and treatment for infertility
    • Fertility preservation when medically needed
    • Up to 3 egg retrievals and unlimited embryo transfers
  • Elevate Health Plans (Exchange and Colorado Option) may cover:
    • Testing and treatment for infertility
    • Artificial insemination
    • Medical advice and guidance for care

For More Information

Review your plan Summary of Benefits and Handbook, found on your plan details page and consult the the FAQ section below for more information. If you still have questions, please contact us—we’re here to help.

DHHA Employer Plans Plan Details
Elevate Health Plans Exchange/CO Option Plan Details

Frequently Asked Questions

No. There is no yearly or lifetime dollar limit.

DHHA employer plans
Yes, if you have a medical condition or treatment that may affect your ability to have children. 

Elevate Health Plans
No, preservation services are not covered.

No, this is not a covered benefit.

DHHA employer plans
Yes. Check the DHHA Employer Plans Formulary to see which drugs are covered and if approval is needed. 

Elevate Health Plans
No, fertility medications are not covered.

You can fill prescriptions at most major pharmacies, including MedImpact Direct, King Soopers, Walgreens, and Safeway. Some specialty drugs are sent to MedImpact Specialty Direct at 1-877-391-1103.

DHHA Employer Plan Pharmacy
Elevate Health Plans Exchange/CO Option Pharmacy

  • Reversing voluntary sterilization
  • Experimental treatments
  • Gamete Intrafallopian Transfer (GIFT) procedures
  • Surrogacy
  • Sperm collection
  • Preparation or storage is not covered unless you have a medical condition or are getting treatment (like surgery or chemotherapy) that could affect your ability to have children
  • Services for people who are not plan members

You must get prior authorization before care. Your doctor will send a request. We review each request to make sure the service is needed. It usually takes 10 to 15 days to get a decision.

Your cost depends on your plan and the type of care you receive. This may include copays, deductibles and coinsurance.