Common use of Infertility Services Clause in Contracts

Infertility Services. Benefits include: • Diagnosis and treatment of infertility. • Artificial insemination and intrauterine insemination, subject to the following conditions: ▪ Have a history of the inability to conceive after one year of unprotected vaginal intercourse. ▪ A fertility examination resulted in a Physician’s recommendation advising artificial insemination or intrauterine insemination. Charges for collection of the Covered Person’s sperm is not included unless the spouse is also a Covered Person. • In vitro fertilization procedures performed on an outpatient basis, subject to the following conditions and limitations: ▪ For a married Covered Person whose spouse is of the opposite sex, the oocytes of the Covered Person must be fertilized with the sperm of the Covered Person’s spouse unless: ♦ The Covered Person’s spouse is unable to produce and deliver functional sperm; and ♦ The inability to produce and deliver functional sperm is not the result of a vasectomy or another method of voluntary sterilization. ▪ The married Covered Person and spouse must have experienced involuntary infertility that: ♦ Is demonstrated by a history of: 🢒 For a Covered Person whose spouse is of the opposite sex, sexual intercourse failing to result in pregnancy for a duration of at least one year; or 🢒 For a Covered Person whose spouse is of the same sex, 3 attempts of artificial insemination over the course of one year failing to result in pregnancy; or ♦ Is associated with any of the following medical conditions: 🢒 Endometriosis; 🢒 Exposure in utero to diethylstilbestrol (DES); 🢒 Blockage of, or surgical removal of, one or both fallopian tubes (lateral or bilateral salpingectomy); or 🢒 Abnormal male factors, including oligospermia, contributing to the infertility. ▪ The unmarried Covered Person: ♦ Has had 3 attempts of artificial insemination over the course of one year failing to result in pregnancy; or ♦ Is associated with any of the following medical conditions: 🢒 Endometriosis; 🢒 Exposure in utero to diethylstilbestrol (DES); 🢒 Blockage of, or surgical removal of, one or both fallopian tubes (lateral or bilateral salpingectomy); or 🢒 Abnormal male factors, including oligospermia, contributing to the infertility. ▪ The Covered Person has not been able to attain a successful pregnancy through a less costly infertility treatment that is a Covered Health Care Service. ▪ The in vitro fertilization procedures must be performed at a medical facility that conforms to applicable guidelines or minimum standards issued by the American College of Obstetricians and Gynecologists or the American Society for Reproductive Medicine.