All U-M health plans will continue to cover in vitro fertilization, following a three-year pilot program. Additionally, modest coverage expansions have been implemented retroactively to Jan. 1, 2019.
Since 2015, the plans have covered IVF treatments for women through age 42 who are diagnosed with infertility. The benefit includes single embryo transfers for women younger than 35 and double embryo transfers for women ages 35 through 42.
After review of the pilot data, additional evidence-based practices have been included under the IVF benefit.
One addition expands the basis for diagnosing infertility based on specific clinical indicators of diminished ovarian reserve. Another allows for additional embryo transfers based on embryo quality or when prior IVF attempts have failed.
And fertility preservation is now covered when a medical diagnosis or treatment would significantly affect a plan member’s ability to conceive in the future. This coverage includes the retrieval and processing of eggs or sperm and one year of storage.
An evaluation of the three-year pilot, led by James Dupree, assistant professor of urology, provided insight into the design of the benefit and its utilization.
Rich Holcomb, senior director for benefits, health and well-being services, said that compared to other groups, members with lower salaries disproportionately increased their use of IVF.
“This suggests that for many in our community, cost posed a significant barrier to seeking infertility care before we implemented the benefit in 2015,” Holcomb said. “These results really underscore the importance of one of our benefit design principles, which is to provide quality programs at an affordable cost.”
The cost structure and provider network for IVF benefits remains the same. Individuals contribute a coinsurance of 20 percent of the cost, and the plans cover the remaining costs up to a $20,000 lifetime maximum. Procedures are covered when they are performed at the Michigan Medicine Center for Reproductive Medicine.