Infertility Coverage for Commercial Plans

Infertility is defined as the failure to become pregnant following: at least one (1) year of regular unprotected sex for female age 35 years or younger or at least six (6) months of regular unprotected sex for female older than 35 years.

The DHHA employer plans and all Elevate Health Plans Exchange and Colorado Option products cover infertility services. Coverage may vary by plan.
 

Infertility treatments follow standard copay, deductible, and co-insurance amounts listed in your member handbook.

No, there is no annual or lifetime limit for infertility benefits.

Yes, prior authorization is needed for all infertility services.

Conceptions is currently the only contracted provider in-network.

Your provider can send a prior authorization request to the plan with a referral to a Conceptions infertility specialist once you are diagnosed with infertility.

Refer to your member handbook for full coverage information. The benefit includes same-sex couples and single people. Any services for partners that are not a DHHA employer plan or Elevate Health Plans Exchange or Colorado Option member will not be covered.

For DHHA employer plan members, covered infertility services include diagnostic testing and treatment for infertility and standard fertility preservation services, including three completed oocyte retrievals with unlimited embryo transfers.

Covered infertility services for Elevate Health Plans (Exchange and Colorado Option) members include diagnostic testing and treatment of involuntary infertility, artificial insemination, and appropriate medical advice and instruction, in accordance with accepted medical practice. 
 

The DHHA employer plans include coverage for preservation services. Preservation may be covered for a person who has a medical condition, expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical treatment that is recognized to cause a risk of impairment to fertility.

Elevate Health Plans Exchange and Colorado Option products do not cover preservation services.

No, this is not a covered benefit.

Your provider will send a prior authorization request form to DHMP. The provider will supply each procedure code(s) and will request a date range. This allows the provider to repeat the procedure within the requested date range if needed.

DHHA employer plan members can find a full list of covered medications in the DHHA Employer Plans Formulary. The formulary will specify if there is a preferred medication and if a medication requires prior authorization. 

Infertility medications are not covered for Elevate Health Plans (Exchange and Colorado Option) members.
 

Prescriptions can be filled at any National Network Pharmacy. MedImpact Direct, King Soopers, Walgreens, Safeway and most large retail pharmacy chains are examples. Specialty medications are sent to MedImpact Specialty Direct at 1-877-391-1103.