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FEP infertility benefits: Authorization and claim submission
April 29, 2024

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.

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What's covered?

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:
  • Artificial insemination*, including:
    • Intracervical insemination (ICI)
    • Intrauterine insemination (IUI)
    • Intravaginal insemination (IVI)
  • In vitro fertilization (IVF)**- up to three annual drug cycles.

*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:
  • Limited to $25,000 paid annually
What's not covered?
  • 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
Requesting authorization

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.

Note: Please refer to the FEP member brochures for coverage information (see Resources section below). These medical policies apply to our commercial members only: Assisted Reproductive Technology Services medical policy 086 and Preimplantation Genetic Testing medical policy 088.

For Federal Employee Program members living outside of Massachusetts: Fax completed prior authorization form to 1-888-282-1315.

Claim submission procedures

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