Fellow KPMG, anyone with aetna pos II plan? It seems like you have a 35,000 lifetime maximum.

I also understand that oral drugs such as letrazole are covered under the prescription plan and you only need to enroll and register in the fertility plan if you need IUI and the more rigorous treatments.

Questions:
1. Does the letrazole count towards the 35 lifetime maximum?

Any other advice or insight would be appreciated.

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I’m at ey but from what I’ve read our plans are very similar. That being said, I still had to enrol even with a timed cycle. However, it only went against the special fertility coverage once we got to IUI and beyond.

Hi! I believe oral medications or monitoring/bloodwork do not fall under the plans limit, only injectable meds and procedures.

That said, the way its set up is really unnecessarily complicated - everything is covered under your major medical coverage, even the injectable medication (not under your pharmacy coverage). They also charge insane rates for the injectable drugs that if you think you might need more than one cycle its worth paying a fifth of the price for oop meds and just using the coverage for procedures. I got quoted like 20k in drugs for a not very aggressive ivf treat cycle, i opted to pay 3000 oop instead and save my limit for procedures

Orals do not count towards the limit but injectable are. I also found the ovidrel is actually more expensive via insurance vs buying it out of pocket. $220 vs $120. So I haven't even been charging my injectibles through insurance

How do you go about buying oop? Do you just say you wont be using your insurance?

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