Need help expanding your family? Your Adobe Aetna medical plan benefits offer plenty of infertility treatment options, including fertility drugs, surgery, artificial insemination and assisted reproductive technology. No matter what you might need to bring a bundle of joy into your life, Aetna is there to support you along the way. Watch this six-minute fertility benefits video to learn more.
Reviewing Your fertility benefits [PDF] is a great way to get familiar with the fertility benefits and support programs Adobe offers to eligible Aetna medical plan members. To begin the process of accessing Aetna’s fertility benefits, call your Fertility Advocate at 1-866-984-0074 (TTY: 711). Your Fertility Advocate will:
- Be your single point of contact to help you understand your benefits and options and coordinate your care.
- Help you find the right in-network doctors and facilities.
- Work with you to fill out a patient registration form, which will help determine which benefits and services you’re eligible to receive. You can also complete the form on your own and fax it to 860-607-7476. Find the form by logging in to health.aetna.com and clicking “Forms.”
Please note: Fertility Advocates are available Monday–Friday, 5 am–1:30 pm PT. If the Fertility Advocate is assisting another member when you call or has left for the day, you can leave a confidential voicemail. Please provide a preferred phone number and time that you’d like a call back within the next business day.
Before authorizing any treatment, your doctor will need to get approval—or precertification—from Aetna. After Aetna reviews the treatment plan and medical information submitted by your doctor, Aetna clinical reviewers will decide if your case meets clinically approved medical guidelines for the proposed services. This process also allows your doctor to obtain and share information with you about how your plan will cover the specific services in your treatment plan, so you know what to expect before you incur expenses. In-network providers will manage this process on your behalf. If your provider is not in network, you may be required to obtain precertification for your services.
When you use an in-network provider, Aetna covers these precertified fertility services at 90% (HealthSave) or 80% (HealthSave Basic) after you meet your deductible. (lifetime maximums may apply):
- Artificial insemination (AI)
- Ovulation induction (OI)
- Assisted reproductive technology (ART)
- In vitro fertilization (IVF)
- Gamete/zygote intrafallopian transfer (GIFT/ZIFT)
- Frozen embryo transfer (FET)
- Intracytoplasmic sperm injection (ICSI) or ovum microsurgery
- Testis biopsy, gonadal tissue, percutaneous epididymal sperm aspiration (PESA)
- Freezing and storage of sperm, eggs and embryos (any or all of the ART cycles covered under the plan can be used for elective fertility preservation)
- If you’re using a gestational carrier, some services may be covered, including fertilization, culture and semen analysis
Adobe’s health care plans offer consistent access to care and resources, independent of the state where you live. The Aetna medical plans cover fertility services and will reimburse travel expenses (subject to IRS limits), for an employee or covered dependent, to a state that can provide these services if traveling 100 miles or more. Review Your fertility benefits [PDF] to learn more. For even more details about what’s covered, refer to your medical plan’s booklet and schedule of benefits.
After you meet your Aetna medical plan’s annual deductible, you’ll pay a copay for each prescription ($15 for generics, $45 for brand-name drugs and $65 for other brand-name drugs). The plan pays up to $60,000 per lifetime for fertility treatment drugs.*
Many fertility medications are specialty medications. They often need special storage and handling, and they need to be delivered quickly. You may be required to fill these through CVS Specialty Pharmacy. Skilled nurses and pharmacists offer extra support to you with these types of medications.
* Note: The lifetime limit for fertility treatment drugs recently increased (formerly $20,000), with a retroactive effective date of January 1, 2019. If you experienced an out-of-pocket expense in 2019 due to having reached the former lifetime cap, you can submit your receipt with a claim form for reimbursement.
In-network versus out-of-network providers
In-network doctors and other care providers have negotiated rates with Aetna. That means you pay less for many services. In addition, your deductible is lower, and the plan pays a larger share of expenses after the deductible. In-network providers also file claims for you and take care of any precertification requirements. Two less steps for you to worry about.
To find an in-network provider, log in to health.aetna.com and click “Find Care.” On the search tool homepage, enter “infertility treatment” in the “Find what you need by name” box. Your Aetna fertility advocate can also help you find an in-network provider.
If you use an out-of-network doctor, you can ask your doctor to call Aetna at 800-575-5999 to start the precertification process. You may need to call Aetna yourself if your doctor doesn’t provide this service.