This article is for assisted reproductive technology providers and reproductive endocrinologists caring for our Federal Employee Program members
Since announcing 2024 changes to our Federal Employee Program (FEP) members’ benefits for 2024, we’d like to share additional details about FEP infertility benefits, which differ from our commercial members’ benefits.
Members with Standard Option, Basic Option, and FEP Blue Focus plans all have reproductive care coverage, with some differences among the plans.
Here are some highlights for members who meet a definition of infertility.
| Members of these FEP plans | Benefit |
|---|---|
|
Standard Option
Basic Option FEP Blue Focus |
Prior
authorization is required for coverage of:
*Medications associated with artificial insemination are also covered with prior approval and when members use either their medical or pharmacy drug program benefits. ** Medications associated with IVF services are also covered with prior approval and only when purchased through the pharmacy drug program. |
| Standard Option |
Authorized assisted reproductive technology (ART) outpatient procedures and services:
|
- All related donor expenses including, but not limited to, the cost of donor sperm or oocytes
- Fallopian tube ligations and vasectomy reversals
- Services determined to be not medically necessary
- Other services, supplies, or drugs provided to individuals not enrolled in this Plan, including surrogates
Follow your standard authorization process by using Authorization Manager to submit an authorization request to us. Please remember that you’re required to use Authorization Manager to review authorization requirements, request authorizations, upload clinical documentation to an existing case, check existing case status, and view/print the decision letter.
For Federal Employee Program members living outside of Massachusetts: Fax completed prior authorization form to 1-888-282-1315.
Where you submit claims depends on where the service is being rendered and where the authorization has been requested. For members receiving services in Massachusetts or who have an authorization for care that will be rendered in Massachusetts, please submit claims to Blue Cross Blue Shield of Massachusetts.
If the Blue Cross Blue Shield of Massachusetts member is receiving services (or has an authorization for care) in another state, please submit to the local Blue Plan.
For coverage information, refer to the member plan brochures below. Search using keywords "reproductive services" or "infertility."
Standard and
Basic Option member brochure FEP Blue Focus member brochure
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