CommercialCoverageMedium impact
23-1391 Help Members Get the Most from Infertility Treatment Coverage
Health Net·CA · OB-GYN, Endocrinology·Provider News
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Health Net updated their infertility treatment coverage policy effective January 1, 2024, expanding diagnosis criteria to include members without male partners and clarifying that infertility copayments typically don't apply to out-of-pocket maximums. The policy emphasizes establishing treatment plans before beginning infertility procedures and checking Schedule of Benefits for specific coverage limits.
Action Required
Immediately: Billing team must update patient eligibility verification procedures to reflect expanded infertility diagnosis criteria that now includes members without male partners. Verify copayment structures in billing system to ensure infertility procedure copayments are not applied to out-of-pocket maximums unless member's employer group plan specifies otherwise. Update pre-authorization workflows to require treatment plan establishment before infertility procedures and verify coverage limits in member's Schedule of Benefits for advanced reproductive technologies.