Infertility Awareness Week is the last week of April. Infertility has changed a great deal within the last ten to fifteen years. In the past, there was little support for those experiencing infertility. There were gaps in the healthcare system. Many were left wondering about infertility.

• What treatment is needed?
• What treatment is available?
• What specialist should I go to?
• Will seeking treatment for infertility cost a lot of money?

Answers to these questions were not readily available or talked about just a few years ago. Infertility treatment has grown tremendously since then, and we are proud to say that the Foreign Service Benefit Plan added many benefits and coverage surrounding treatment for infertility in the last couple of years. In 2023, FSBP was the only fee-for-service plan in the federal program to offer any coverage for artificial insemination and in vitro fertilization (IVF).

What does FSBP cover for Infertility Treatment?

The Plan covers two different infertility treatment levels: Basic Infertility and Advanced Reproductive Technology (ART).

Advanced Reproductive Technology

The following are considered covered treatments for ART:

• Ovulation induction cycle(s) while on an injectable medication to stimulate the ovaries
• Services provided in the setting of ovulation induction such as ultrasounds, laboratory studies, and physician services
• In vitro fertilization (IVF)
• Embryo transfer and gamete intrafallopian transfer (GIFT) and Zygote intrafallopian transfer (ZIFT)
• Intracytoplasmic sperm injection (ICSI)
• Iatrogenic fertility preservation procedures (retrieval of and freezing of eggs or sperm) caused by chemotherapy, pelvic radiotherapy, ovary or testicle removal and other gonadotoxic therapies for the treatment of disease.

The eligibility requirements for ART are as follows:

• You or your partner have not gone through voluntary sterilization with or without reversal.
• You have met the requirement for the number of months trying to conceive through egg and sperm contact.
• Your unmedicated day three (3) Follicle Stimulating Hormone (FSH) level and testing of ovarian responsiveness meet the criteria outlined in Aetna’s Clinical Policy Bulletin (CPB) for Infertility (visit https://fsbphealth.com/ maternal-health-and-pregnancy/ to access the CPB – Infertility).
• You have failed to conceive after a trial of ovulation induction:
  • For women 37 years of age or younger, three cycles of ovulation induction (with or without intrauterine insemination); or
  • For women 38 years of age or older, no trial of ovulation induction is required
• Natural or artificial insemination would not be expected to be effective, and ART would be expected to be the only effective treatment.

Infertility services for Artificial Insemination (AI) will be considered medically necessary for any member unable to conceive, regardless of relationship status or sexual orientation.  The Plan will cover AI as a core medical benefit; members will no longer need to meet a definition or obtain prior authorization.

Coverage for medical services and prescription drugs for both artificial insemination and IVF has no limit on coverage now. Services can be provided by either an in-network or out-of-network provider. Members residing in the U.S. will pay 10% of the Plan allowance for in-network (includes Guam) and 30% of the Plan allowance for out-of-network (includes Guam), and any difference between the plan’s allowance and the billed amount.

ART requires prior authorization, and services must be rendered by an Institute of Excellence (IOE) Infertility provider. For additional information regarding the IOE Infertility Providers, please call 800-593-2354 or visit www.aetnainfertilitycare.com. The plan also covers ovulation induction services under the ART benefits.

Basic Infertility

The following are considered covered treatments for basic infertility:

• Initial diagnostic tests and procedures done only to identify the cause of infertility;
• Medical or surgical procedures done to create or enhance fertility;
• Artificial insemination (AI) and monitoring of ovulation to include:
  • Intravaginal insemination (IVI)
  • Intracervical insemination (ICI)
  • Intrauterine insemination (IUI)

For Basic Infertility, members will not need prior authorization, and services can be rendered by either an in-network or out-of-network provider.

Another benefit we offer is Doula Services. Doula services cover prenatal services, childbirth, and up to three months of post-partum care after delivery.

In 2024, we partnered with Maven to provide additional support for our members. Maven can provide you with a fertility advocate and digital resources to support you through your infertility journey. To learn more about what Maven offers, check out our AFSPA Talks Maven episode. To speak directly with a fertility advocate, call 833-415-1709. You can register for Maven here.

Services Not Covered

• Reversal of voluntary surgical sterilization
• Costs of donor sperm and donor eggs
• Elective fertility preservation, such as egg freezing due to natural aging
• Storage cost
• Costs for obtaining sperm from a person not covered under this Plan
• Infertility treatment when a successful pregnancy could have been obtained through less costly treatment
• Infertility treatment when infertility is due to a natural physiologic process such as age-related ovarian insufficiency (e.g., perimenopause, menopause) as measured by an unmedicated FSH level at or above 19 on cycle day two (2) or three (3) of your menstrual cycle or other abnormal testing results as outlined in Aetna’s Infertility Clinical Policy.
• Injectable infertility medication including but not limited to menotropins, hCG, and GnRH agonists, expect as described in Section 5(f). Prescription Drug Benefit
• Any ART services not prior approved by the Plan
• Coverage for services received by a spouse or person who is not a covered member under the Plan.

All information is taken from pages 46-48 of the 2025 FSBP brochure. For more information about infertility, listen to the AFSPA Talks Infertility Awareness episode from 2023.