We want you to make the most of every opportunity available to you in your quest to have a baby. Our financial counselors are experts navigating the complexities of insurance coverage and will work closely with you to ensure that you are making the most of your insurance coverage.

Finding Clarity

Coverage varies greatly depending on your insurer, your coverage plan, where you live and even where your insurance plan is headquartered. We will help you to discern exactly what is covered, coach you on the right questions to ask and help you every step of the way.

Component: Video Embed Block

Patients and Physicians discuss the costs of IVF, insurance coverage and opting to use payment programs to fund treatment.

Accepted Healthcare Plans

We accept the following Healthcare Plans:

Component: Data Table Block


ProviderPlan
Advocate Health Care PHOs*Humana HMO
Advocate Health Care Centered EPOs**Humana EPO, PPO
Aetna HMO, POS, PPO
Blue Cross/Blue Shield of IllinoisPOS, PPO
Cigna - Great West HealthcareOut-Of-Network
Non State of Illinois
Benefits Only
Coventry/First Health/Personal CareHMO, POS, PPO
HFNPPO
HumanaHMO, POS, PPO
MultiplanPPO
Private Health Care SystemsPOS, PPO
TriCareHMO, PPO
United Health Care/OptumHealthHMO, POS, PPO
Provider Plan
Advocate Health Care PHOs*Humana HMO
Advocate Health Care Centered EPOs**Humana EPO, PPO
Aetna HMO, POS, PPO
Blue Cross/Blue Shield of IllinoisPOS, PPO
Cigna - Great West HealthcareOut-Of-Network
Non State of Illinois
Benefits Only
Coventry/First Health/Personal CareHMO, POS, PPO
HFNPPO
HumanaHMO, POS, PPO
MultiplanPPO
Private Health Care SystemsPOS, PPO
TriCareHMO, PPO
United Health Care/OptumHealthHMO, POS, PPO

* Advocate Health Care PHOs include Christ, Condell, Good Samaritan, Good Shepherd,
Illinois Masonic, Lutheran General, Sherman, South Suburban, and Trinity Hospital
**Advocate Health Care EPOs require a special waiver for coverage

Where to Begin

After consulting with one of our financial counselors, contact your insurance provider to ask questions about your specific coverage. Try to be as detailed as possible, take notes and get a reference number for the call in the event that there is any dispute later. We have compiled two lists of questions to start with:

Fertility Coverage in Illinois

Illinois is one of the few states in the country with a mandate to cover infertility fairly extensively. That does not mean that an Illinois resident will be covered for everything, but you will most likely have more coverage than you would in most other states.

Who is Eligible for Fertility Treatment

In order to qualify for infertility coverage, there are specific criteria that you must meet. First, be sure to verify that the insurance offered by your company is actually Illinois insurance. If your company is headquartered in another state, it’s very likely that your health insurance will instead be based in that state and not Illinois.

Second, according to regulations, your health insurance “must be a fully-insured group policy of accident and health insurance or HMO contract for a group larger than 25.” And then you must personally:

  • Be unable to conceive after one year of unprotected sexual intercourse
  • Be unable to sustain a successful pregnancy
  • Have been diagnosed by a physician as having a medical condition that renders conception impossible through sexual intercourse; or
  • Have undergone one year of medically based and supervised methods of conception, including artificial insemination, which a physician has determined to have failed and are not likely to lead to a successful pregnancy.

What is Covered

According to the law, Illinois group insurance and HMO plans are required to cover the diagnosis and treatment of infertility the same way they would for all other conditions. In other words, there cannot be additional co-payments or deductibles applied only to fertility coverage. Your benefits will likely include:

  • Testing and diagnosis
  • Prescription medications
  • Intrauterine Insemination (IUI)
  • In Vitro Fertilization (IVF)
  • Intracytoplasmic Sperm Injection (ICSI)
  • Donor sperm and eggs (medical costs)
  • Procedures to retrieve oocytes or sperm and to then transfer the oocytes or sperm to the covered recipient

Payment is Your Responsibility

We are happy to contact your insurance company as a courtesy to explore the details of your infertility coverage. But please understand that this is in no way a guarantee of benefits. Due to the complexities of insurance, what the insurance company tells us is occasionally inaccurate. While this occurs rarely, if it does the responsibility for payment will fall to you. However, in such an event, you are highly encouraged to dispute the issue with your carrier. Fertility Centers of Illinois is not responsible for any insurance carrier’s omissions or incorrect information.

The Limitations of Coverage

Certain advanced procedures — like In Vitro Fertilization (IVF), and intra-cytoplasmic sperm injection (ICSI) — are often only covered once you have first tried a number of attempts at pregnancy through less expensive procedures. For example, you may need to try a certain number of Intrauterine Inseminations (IUI) before being allowed to move on to In Vitro Fertilization (IVF). Once your insurance company authorizes you to proceed with IVF, you will likely also be limited to a certain number of attempts in your lifetime — any prior IVFs that were covered by a different insurance carrier may apply to your lifetime limit. You will also find that while some policies do not have annual limits, others only allow for four cycles per year. When considering limits on your benefits, keep in mind that you may want to preserve some of them for the future if you think you may want a second child.

What May not be Covered

Not everything related to your fertility treatment is covered, even under the Illinois State Insurance Mandate. For example, your group insurance or HMO plan may not be required to pay for:

  • Preimplantation Genetic Diagnosis (PGD)
  • Preimplantation Genetic Screening (PGS)
  • Reversing tubal ligation or vasectomy
  • Fees paid to a surrogate or gestational carrier
  • Preserving or storing sperm, eggs or embryos
  • An egg or sperm donor when it has not been deemed medically necessary
  • Non-medical fees paid to an egg or sperm donor
  • Experimental treatments
  • Procedures that violate the religious or moral teachings or beliefs of the insurance company or covered group