Fertility Treatment Coverage & Your Extended Health Plan

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Your Extended Health Plan and Fertility Treatment

Some employers and provinces provide benefits that cover specific fertility treatments — from tax deductions to full coverage. It is always important to understand your insurance coverage and what is involved.

Fertility Medical Procedures

  • Many medical procedures involved in fertility treatment are covered by private insurance, particularly those that OHIP does not cover.
  • Please review your private plan, if you have one, to see if it covers fertility procedures, or partially reimburses them, for example: Non -Funded IVF and IUI cycles, and Intracytoplasmic Sperm Injection (ICSI).
  • Before you begin fertility treatment, please ask your insurance company to provide you with written proof or an explanation of what your specific coverage includes. It will be helpful if you know what is covered in advance of your treatment.
  • If full coverage is unavailable, you may be eligible for partial coverage or coverage during certain stages of a procedure or treatment. For example, you plan may cover ultrasounds, blood work, and specific tests.
  • Talk to your HR provider about the possibility of ‘flex’ benefits. This type of coverage may be used for non-OHIP expenses.
  • Check with your employer to see if you are eligible to upgrade your insurance for a set monthly fee. However, before you begin paying an additional fee, please ensure that the insurance you are paying extra for covers some of the treatment costs and that it’s worthwhile for you.
  • You can also check if you have something called a Health Spending Account with your insurance.

Fertility Medication

Most treatments require special fertility medications. Every person is different, and the medication you will need will be specific to you. Costs for fertility medications will vary. You may have full coverage, partial coverage, or no coverage for medication, depending on your extended health plan. If you do have prescription coverage, this does not mean you’re automatically covered for fertility medications — that’s why it’s important to check to make sure what your plan provides.
  • Prior to starting treatment, request a written explanation from your insurance provider outlining exactly what is and what is not covered by your fertility treatment coverage.
  • In the case of a denied claim, you have the option to appeal. When denied, make sure to request the reason for denial and the exact part of the policy that states or supports it. Resubmissions are common.
  • Your insurance company may need preauthorization regarding your medications. Your TRIO team can provide you with a letter for your insurance provider that outlines the medications that are part of your treatment and include the DINs (Drug Identification Numbers).
  • Always check with your insurance plan to determine if there are total amount limits, total treatment cycle limits, yearly limits, or lifetime limits. Do this before you submit a claim, especially for your medications.
  • If you discover you have a yearly coverage limit, you may want to wait until the end of the year to submit your claims. This means the balance could potentially be claimed in the following year.
  • If your insurance is limited by treatment cycle limits, you can choose to pay out-of-pocket for less expensive treatment options, thereby saving your benefits for pricier treatments.
  • If both partners have different benefits, you may have the option to combine them. Let your TRIO team know what your benefits include and we can help separate the costs to submit them to different plans.

Additional Tips for Insurance Coverage

  • If you are a couple, then you should research your individual benefits and how they apply to fertility treatment and related medications.
  • If possible, check to see if you are fully covered by your insurance before beginning treatment.
  • Call an insurance representative to clarify your coverage and if possible, get a written explanation outlining exactly what is covered.
  • Prior to submitting a claim, determine if your benefits include a yearly limit, lifetime limit, treatment cycle limit, or a total dollar limit.
  • Look at your plan to determine if your benefits cover you for naturopathic treatment that involves preconception care, as well as treatment such as acupuncture. A naturopathic doctor uses natural remedies to improve the health of the egg and sperm prior to conceiving.

Fertility Treatment and Your Income Taxes

Fertility treatments may qualify as deductible medical expenses on your income tax return. This tax credit can help individuals reduce the impact of medical costs for themselves or their dependants. In all cases, please check with your personal accountant for further details and to confirm eligibility.

Allowable fertility medical expenses on your income tax may include: