Fertility Insurance Coverage
Navigating fertility treatment costs and insurance coverage can be complex—but you don’t have to do it alone. Our experienced financial educators are here to help you understand your insurance benefits and minimize your out-of-pocket expenses as you plan your fertility journey.
Request an AppointmentHow Our Financial Team Supports You
At RSC, we know the financial aspect of fertility care is a significant consideration. Our financial counselors:
- Explain treatment costs and your insurance coverage before starting a cycle
- Specialize in infertility coverage and insurance benefits
- Act as your advocate, asking the right questions to uncover all possible benefits
- Offer a Predetermination of Benefits Program to review your coverage for both treatments and fertility medications
- Handle claim filing and accept assignment of benefit payments when possible to reduce upfront costs
Insurance Plans and Fertility Benefit Administrators We Work With
RSC is contracted with the following insurance providers:
- AETNA
- Blue Cross
- Blue Shield
- Cigna
- Hills Physicians Medical Group
- John Muir Health
- Progyny (fertility benefit management)
- Sutter Medical
- Sutter East Bay
- Tricare
- TriWest
- UnitedHealthcare (UHC)
- UMR
Important: Benefits vary based on your specific plan. Participation does not guarantee coverage. Always check with your insurance provider for the most accurate information about your individual benefits.
Fertility Benefit Administrators We Accept
In addition to traditional insurance plans, RSC partners with several fertility benefit administrators—third-party companies that specialize in managing fertility treatment benefits offered by your employer.
Patients who use these programs may receive:
- Negotiated preferred rates
- Streamlined claims processing
- Exclusive coverage for fertility treatments and medications
We proudly work with the following fertility benefit administrators:
- Maven Clinic
- Progyny
- Optum
- WINFertility
- Stork Club
Some of these programs may require employees to enroll directly with the fertility benefit provider to access covered services. We recommend contacting your HR department to verify your eligibility and enrollment process. You can also speak with your Financial Educator for assistance.
FAQs: Fertility Insurance and You
Here’s what you need to know:
- Some plans cover diagnostic testing and insemination (IUI)
- IVF coverage is limited in many California plans
- Pharmaceutical (medication) benefits may differ from treatment coverage
- Annual or lifetime maximum benefits often apply
There are three main types of health insurance plans that may include infertility benefits:
1. Private Indemnity Plans
- Choose your provider freely
- Reimbursement ranges from 50% to 100%
- Possible annual or lifetime maximum benefits
- May require deductible or co-insurance
2. PPO (Preferred Provider Organization)
- Use in-network providers for better coverage
- Preauthorization may be required
- Coverage typically 50-80% after deductible
- Possible annual or lifetime fertility benefit caps
3. HMO (Health Maintenance Organization)
- Care must be authorized by your primary care provider or HMO specialist
- Co-pays generally range from $5–$20 per visit
- IVF and other advanced treatments may not be covered
- HMO plans through an Independent Practice Association (IPA) may require additional pre-authorization and have 50% cost-sharing
Here are expert tips from our financial counseling team:
- Understand both your plan and your partner’s coverage
- Call member services (number on the back of your insurance card)
- Request a detailed plan description or contract
- Clarify exclusions like IVF, IUI, medications, and diagnostic tests
- Look for annual or lifetime caps on infertility benefits
- Be your own advocate—ask detailed questions
- Know that “infertility excluded” often means no coverage for either testing or treatment
Before beginning treatment, our team can help you verify your fertility insurance coverage. We:
- Contact your insurer to gather coverage details
- Estimate out-of-pocket costs
- Explain covered services and exclusions
- Help you plan financially for your treatment cycle
Start with Confidence: Schedule a Financial Consultation
At RSC, our goal is to make fertility care as accessible and affordable as possible. Connect with our financial team early in your journey so you can focus on building your family—without unnecessary financial surprises.
