Understanding the Connecticut Fertility Mandate Questions for Insurance Companies & Employers May 8, 2006 Financial Services Representatives The Center for Advanced Reproductive Services

About the Mandate Mandate requires an infertility diagnosis Mandate requires an infertility diagnosis Some of what the mandate says is open to the interpretation of individual insurance plans Some of what the mandate says is open to the interpretation of individual insurance plans Definition of ovulation induction (clomid vs. injectibles Definition of ovulation induction (clomid vs. injectibles Definition of IVF cycle Definition of IVF cycle Mandate requires that covered treatments are clinically indicated Mandate requires that covered treatments are clinically indicated Exhausting covered benefits does not mean one will be moved on to the next level of treatment Exhausting covered benefits does not mean one will be moved on to the next level of treatment

The Center for Advanced Reproductive Services Mandate Related Questions Am I covered under the CT mandate passed on 10/1/05? Am I covered under the CT mandate passed on 10/1/05? Is my policy self funded or fully insured? Is my policy self funded or fully insured? When am I eligible to access my infertility benefit under the mandate? When am I eligible to access my infertility benefit under the mandate? Do I need to complete the Disclosure Form (individual plan holders)? Do I need to complete the Disclosure Form (individual plan holders)? If so, where do I send it? If so, where do I send it? Does my partner need to complete one? Does my partner need to complete one? Is there a fertility look back clause associated with my policy? Is there a fertility look back clause associated with my policy?

The Center for Advanced Reproductive Services Mandate Related Questions Confirm eligibility for: Confirm eligibility for: 4 ovulation inductions (how is your plan defining ovulation induction; clomid, injectibles?) 4 ovulation inductions (how is your plan defining ovulation induction; clomid, injectibles?) 3 intrauterine inseminations 3 intrauterine inseminations 2 IVF cycles (How is your plan defining an IVF cycle?) 2 IVF cycles (How is your plan defining an IVF cycle?) –Do FET cycles count toward the 2? –When does the clock start ticking (what constitutes one cycle)? »Start of meds »Completed retrieval »Completed transfer

The Center for Advanced Reproductive Services General Questions for your insurance company (mandate and non-mandate) Do I have infertility benefits Do I have infertility benefits Do I need a referral? Do I need a referral? What is my co-pay for a specialist office visit? What is my co-pay for a specialist office visit? Effective date of my policy Effective date of my policy Renewal date of my policy Renewal date of my policy Is there a deductible or co-insurance? Is there a deductible or co-insurance?

The Center for Advanced Reproductive Services Questions about blood work Is diagnostic blood work covered? Is diagnostic blood work covered? Estradiol, FSH, LH, Hep B&C, HIV Estradiol, FSH, LH, Hep B&C, HIV Is monitoring blood work covered? Is monitoring blood work covered? Estradiol, FSH, LH, Progesterone Estradiol, FSH, LH, Progesterone Is blood work for genetic testing covered? Is blood work for genetic testing covered? Chromosomes; Cystic Fibrosis, Tay Sachs Chromosomes; Cystic Fibrosis, Tay Sachs Am I required to use specific labs? Am I required to use specific labs?

The Center for Advanced Reproductive Services Questions about diagnostic testing procedures Will my new patient visit be covered? Will my new patient visit be covered? Will any of the following be covered?: Will any of the following be covered?: Semen analysis Semen analysis Hysterosalpingogram or Sonohysterogram Hysterosalpingogram or Sonohysterogram Endometrial biopsy Endometrial biopsy Transvaginal ultrasounds Transvaginal ultrasounds –Diagnostic –Monitoring as part of cycle

The Center for Advanced Reproductive Services Questions about IUI treatment Do I have coverage for intrauterine inseminations aka artificial inseminations? Do I have coverage for intrauterine inseminations aka artificial inseminations? Is prior authorization required? Is prior authorization required? Is there: Is there: A maximum number of cycles? Does the maximum include all treatment cycles? A maximum number of cycles? Does the maximum include all treatment cycles? A dollar amount maximum? A dollar amount maximum? Coverage for sperm washing? Coverage for sperm washing?

The Center for Advanced Reproductive Services Questions about IVF Treatment Do I have coverage for In Vitro Fertilization? Do I have coverage for In Vitro Fertilization? Is prior authorization required? Is prior authorization required? Is there: Is there: A maximum number of cycles? Does this maximum include all treatment cycles? A maximum number of cycles? Does this maximum include all treatment cycles? A dollar amount maximum per year or lifetime? A dollar amount maximum per year or lifetime?

The Center for Advanced Reproductive Services Questions about Embryology Lab Procedures Is there coverage for Intracytoplasmic Sperm Injection (ICSI)? CPT codes or Is there coverage for Intracytoplasmic Sperm Injection (ICSI)? CPT codes or Is there coverage for Assisted Hatching? Is there coverage for Assisted Hatching? CPT code Is there coverage for Cryopreservation of embryo(s)? Is there coverage for Cryopreservation of embryo(s)? CPT code Is there coverage for Cryopreservation of sperm? Is there coverage for Cryopreservation of sperm? CPT code 89259

The Center for Advanced Reproductive Services Questions about Medications Do I have a separate pharmacy carrier? Do I have a separate pharmacy carrier? Do I have coverage for oral medications (ie, clomid)? Do I have coverage for oral medications (ie, clomid)? Do I have coverage for injectible medications? Do I have coverage for injectible medications? Bravelle, Follistim, Gonal F Bravelle, Follistim, Gonal F Is prior authorization required for my medications? Is prior authorization required for my medications? Do I need to utilize a specific pharmacy? Do I need to utilize a specific pharmacy?

The Center for Advanced Reproductive Services In Closing If unable to access this information from your insurance company contact your benefits administrator thru your employer If unable to access this information from your insurance company contact your benefits administrator thru your employer Don’t take “no” for an answer or a first response as the final word. Request to speak to a supervisor Don’t take “no” for an answer or a first response as the final word. Request to speak to a supervisor Your doctors office has experienced people to help you obtain information and help you understand it. However, ultimately we cannot guarantee benefits. Benefits are between patients and their insurance company. Your doctors office has experienced people to help you obtain information and help you understand it. However, ultimately we cannot guarantee benefits. Benefits are between patients and their insurance company.

The Center for Advanced Reproductive Services Questions and Answers Thank you!