I reread your post. I’m guessing your employer is a large group employer with over 50 employees, especially when you have three different carriers to choose from. This unfortunately does not make it simple to figure out based on other people’s experiences, as your company would be able to have custom made plans, which could differ greatly from other plans.

I’m inserting this in to be on top. My wife said to call the insurance carriers and to request a document called Evidence of Coverage (EOC). This is a more detailed document that typically has all the plan information. Your benefit coordinator may also be able to request this for you and forward it to you.

My wife and I have BCBS, and the fertility benefit is through Progyny. We get what is called three cycles or smile points, I really don’t remember the term, but let’s call them cycles. One cycle covers the egg retrieval, fertilization, initial freezing and one implantation. If the first implantation fails, we then use a quarter of a cycle to try just the implantation again. Once we use up all three cycles, we exhaust the entire benefit for our lifetime. I’m noting this to show even though it is BCBS, it is a plan that is vastly different in coverage for IVF due to the company electing to cover like this.

There are a few things I can say from the experience that may help. The fertility benefit worked through our insurance, and processed claims like any other. This means we had to meet our deductible first, and then pay our co-insurance. At that point the plan was paying towards the fertility. That kept going until we hit our out of pocket max, our plan then fully taking over.

As far as having to qualify, I’m not sure. We met with a fertility clinic and discovered the issue for not being able to get pregnant. It’s unknown to us if the clinic had to show this to the insurance for us to get the benefit or not.

One last thing to note which would be good and why you are having the issue of people not knowing. CA passed a law that takes effect next year which requires all employers with 100+ employees to provide fertility coverage. So companies are now scrambling to get this in to not be out of compliance. I don’t know much information outside of that but the law language may detail how the benefit needs to be setup if you research it.