This brochure version is for internal use only.
 

 

2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Reproductive Services

 

Note: We state whether or not the calendar year deductible applies for each benefit listed in this section.

Benefit Description

Reproductive Services
Diagnosis of infertility, limited to:
 
  • Diagnostic services
     
  • Laboratory tests
     
  • Diagnostic tests
     
  • Agents, drugs, and/or supplies administered or obtained in connection with your care
     
  • We cover one year of sperm and egg storage for individuals facing iatrogenic infertility, once per lifetime. We provide the benefits seen here when billed by a facility. See page 21  for prior approval requirements. See Section 10 for our definition of iatrogenic infertility.
     
Note: See Section 5(a) for covered labs, diagnostic tests, and X-rays.


You Pay
Preferred: 30% of the Plan allowance (deductible applies)

Non-preferred (Participating/Non-participating): You pay all charges

Note: When care is provided by a Non-preferred laboratory and/or radiologist, as stated on page 18 for an exception, you pay:
 
  • Participating laboratories or radiologists: 30% of the Plan allowance (deductible applies)
     
  • Non-participating laboratories or radiologists: 30% of the Plan allowance, plus any difference between our allowance and the billed amount (deductible applies)

 

Benefit Description

Not covered: The services listed below are not covered as treatments for infertility or as alternatives to conventional conception:
 
  • Assisted reproductive technology (ART) and assisted insemination procedures, including but not limited to:
     
    • Artificial insemination (AI)
       
    • In vitro fertilization (IVF)
       
    • Embryo transfer and gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT)
       
    • Intravaginal insemination (IVI)
       
    • Intracervical insemination (ICI)
       
    • Intracytoplasmic sperm injection (ICSI)
       
    • Intrauterine insemination (IUI)
       
  • Services, procedures, and/or supplies that are related to ART and assisted insemination procedures
     
  • Cryopreservation or storage of sperm (sperm banking), eggs, or embryos except as described above
     
  • Preimplantation diagnosis, testing, and/or screening, including the testing or screening of eggs, sperm, or embryos
     
  • Drugs used in conjunction with ART and assisted insemination procedures
     
  • Drugs to treat infertility
     
  • Services, supplies, or drugs provided to individuals not enrolled in this Plan


You Pay
All charges