Can anyone help me in understanding this? I have BCBS and I am trying to make sense of their language and also the legality of it all. So I just checked my insurance coverage document for 2011 and it looks like donor eggs is covered. Does anyone know what exactly is covered when they mean covered. The language says part of a "program". I am not clear on what they think constitutes being part of a "program". Also it looks like they are discriminating if one is not married. Is that legal?
Do you think I should call and ask? I am afraid to alert them to any plans I may have though so I am a little nervous about asking them questions.
3.20 Infertility Services
Inpatient/Outpatient/In a Doctor's Office
In accordance with Rhode Island General Law §27-20-20, this agreement provides coverage
for medically necessary services for the diagnosis and treatment of infertility. We cover donor
gametes if provided through a program. We only cover these services if you are:
married (according to the statutes of the state in which you were married);
unable to conceive or sustain a pregnancy during a one (1) year period; AND
a presumably healthy individual.
Infertility services, including prescription drug coverage, are covered up to the benefit limit and
level of coverage listed in the Summary of Benefits. Infertility prescription drug coverage is
based on the route of administration and site of service. See Section 3.29 - Prescription Drugs
for details and the Summary of Benefits for benefit limits and level of coverage.