Archived Policies - OBGYN
Assisted Reproductive Technologies
The diagnosis and treatment of infertility may be eligible for coverage and may include, but is not limited to:
Services that are not eligible for coverage include:
The following immunologic therapeutic approaches have been used to avoid recurrent spontaneous abortion but to date have not been documented to be effective and should continue to be considered investigational:
ASSISTED REPRODUCTIVE TECHNOLOGIES (ART) refer to an array of interventions designed to establish a viable pregnancy for those couples who have been diagnosed with infertility. Infertility is defined as the inability to achieve pregnancy after one year of unprotected sexual intercourse despite purposeful attempts at impregnation or the inability to sustain a successful pregnancy. The inability to sustain a successful pregnancy after the loss of three or more consecutive pregnancies, is sometimes referred to as Recurrent Spontaneous Abortion or RSA.
Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.
ACOG, Technical Bulletin, Number 125-February 1989, Infertility.
ACOG, Technical Bulletin, Number 140-March 1990, New Reproductive Technologies.
ACOG, Technical Bulletin, Number 142-June 1990, Male Infertility.
ACOG Technical Bulletin, Number 212 - September 1995, Early Pregnancy Loss.
TEC Assessment Program, Volume 10, No. 18, September 1995, Paternal or Fetal Antigen Immunotherapy for Recurrent Fetal Loss.
West's Smith-Hurd Illinois Compiled Statutes Annotated, Chapter 215, Insurance Act 5, Illinois Insurance Code, Article XX, Accident and Health Insurance, Copr. West Group 1998, Infertility Coverage.
Texas Insurance Code, Article 3:51-6, 3A, In Vitro Fertilization.
|Title:||Effective Date:||End Date:|
|Reproductive Technologies or Techniques and Related Services||10-01-2018||12-31-2018|
|Reproductive Technologies or Techniques and Related Services||10-01-2016||09-30-2018|
|Reproductive Technologies or Techniques and Related Services||11-01-2015||09-30-2016|
|Reproductive Technologies or Techniques and Related Services||07-01-2014||10-31-2015|
|Assisted Reproductive Technologies (ART) and Related Services||05-15-2010||06-30-2014|
|Assisted Reproductive Technologies and Related Services||01-01-2007||05-14-2010|
|Assisted Reproductive Technologies||07-01-1999||12-31-2006|