The University of Utah Employee Health Care Plan covers fertility assistance and treatment as described here.
- Lifetime Maximum: $10,000 medical / $3,000 prescription drug
- Regular deductible, coinsurance and copay amounts apply based on where you receive services
A Claimant who is receiving treatment that may affect future fertility may receive an additional $7,500 per Claimant Lifetime for fertility preservation services for a total of $17,500 for medical services per Claimant Lifetime.
Frequently Asked Questions:
Some diagnostic testing may be a standard benefit and covered as a medical benefit already (not using funds from the fertility benefit). However, if the service is billed with an infertility diagnosis and is a type of service that would indicate it is related to infertility treatment, the claim would count towards your fertility benefit (for example, an ultrasound for diagnostic testing could be billed to the medical benefit and after fertility treatment has started an ultrasound outside of a standard package bundle would count towards your fertility benefit).
Yes, as long as the male is covered under the health plan. Any services provided for a male will be billed under his health coverage and not the female's coverage.
No. Surrogacy services are not covered.
Genetic testing is covered as a medical benefit and may require a prior authorization. Cryopreservation is covered under the fertility benefit (you may be required to pay for the service and then request reimbursement). The plan does not cover the harvesting of embryos/egg/sperm from a donor not covered by the health plan and does not cover the purchase of embryos, eggs, or sperm.
Eligibility for reimbursement will be determined based on the benefits available on the date the services were incurred. Complete Regence’s online reimbursement form.
Yes. An employee may choose to apply their benefit toward payment of new or current storage fees. The employee may need to pay the fees and then request reimbursement.
Reversals are not a covered medical or fertility benefit.
No. Employees can use the fertility benefit at any time they are ready. The larger fertility preservation benefit will require the provider to provide certification that the individual will be going through treatment that will affect their future fertility.
No. The benefit may be used any way the individual wishes to use it. Individuals are encouraged to consult with their physician to determine the best treatment options for them.
No. The only restrictions are that the individual receiving the treatment be covered by the health plan.
The benefit will cover each individual enrolled in the health plan.
The plan does not have any age limits. Check with your provider's office to see if they have limits.
Yes, while an individual has dual coverage under a University employee health plan that includes the fertility benefit, the individual will have $20,000 for medical services provided to them and $6,000 for prescription medications prescribed to them.
The lifetime maximum is per covered individual.
No. The benefit is a lifetime maximum for enrollment in any of the University's plans (including the academic campus plan and the hospitals and clinics plan).
Employees who transfer between UUHC and academic campus will not have a new lifetime benefit. The lifetime benefit is for all employment through the University of Utah.
No. Two individuals may not share their benefit to allow the other to have more than their individual medical and prescription drug maximums. Services billed or medications prescribed to an individual will apply that that individual's maximum.
There is no requirement of an infertility diagnosis. The benefit will be paid based on the service provided and amount billed by the provider. Any services or medications that could be covered as a medical benefit (are not billed with an infertility diagnosis or are a fertility-related treatment) will be covered as a medical benefit and will not count against the lifetime maximum fertility benefit.
Some providers will bill Regence for services and Regence will pay the provider for eligible services. Other providers may require you to pay up front and then request reimbursement for eligible expenses from the health plan. Individuals are encouraged to discuss treatment costs with the clinic's financial counselor. Payment by the plan will be made based on the amount billed by the provider for covered medical services or medications prescribed to an individual enrolled in the health plan.
Payment for any amounts over the health plan's lifetime maximum must be paid by the individual.
Regence is tracking the amount used for medical-related fertility benefits and the plans' pharmacy benefit manager (Regence for academic campus and UUHP for UUHC employees) is tracking the amount used for fertility-related prescription medications.