PLEASE NOTE: This information will be incorporated into the Employee Health, Life and Disability Benefit Program (EHLD) 2019 Summary Plan Description when available. If the content of this communication or any representations made by any person regarding Caterpillar’s employee benefit plans and programs conflict with or are inconsistent with the provisions of the governing documents, the provisions of the plan documents are controlling. To the fullest extent permitted by law, Caterpillar has reserved the right to amend, modify, suspend, replace or terminate any of its plans, policies or programs, in whole or in part, at any time and for any reason, by appropriate company action.

Enrollment in the Fertility Solutions Program is mandatory to receive benefits under the Plan.

COVERED SERVICES

Infertility Services and Fertility Solutions (FS) Program

Therapeutic services for the treatment of infertility when provided by or under the direction of a Physician. The Plan pays Benefits for infertility when provided by a Designated Provider participating in the Fertility Solutions (FS) program. Designated Provider is defined in Glossary Section.

Note: Services must be received by a Designated Provider.

Benefits under this section are limited to the following procedures:

• Ovulation induction and controlled ovarian stimulation
• Insemination procedures: Artificial Insemination (AI) and Intrauterine Insemination (IUI)
• Assisted Reproductive Technologies (ART): in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), Intra Cytoplasmic Sperm Injection (ICSI)
• Testicular Sperm Aspiration/Microsurgical Epididymal Sperm Aspiration (TESA/MESA) - male factor associated surgical procedures for retrieval of sperm
• Cryopreservation - embryo’s (storage is limited to 12 months) 
  Note: Long-term storage costs (anything longer than 12 months) are not covered under the Plan.
• Pre-implantation Genetic Diagnosis (PGD) for diagnosis of genetic disorders only
• Embryo transportation related network disruption

To be eligible for Benefits, the Covered Person must:

• Have failed to achieve a Pregnancy after a year of regular, unprotected intercourse if the woman is under age 35, or after six months, if the woman is over age 35
• Have failed to achieve Pregnancy following twelve cycles (under age 35) or six cycles (age 35 or over) of donor insemination
• Have failed to achieve Pregnancy due to impotence/sexual dysfunction
• Have infertility that is not related to voluntary sterilization
• Be under age 44, if female and using own oocytes (eggs)
• Be under age 50, if female and using donor oocytes (eggs) 
  Note: For treatment initiated prior to pertinent birthday, services will be covered to completion of initiated cycle.
• Have diagnosis of a male factor causing infertility (e.g. treatment of sperm abnormalities including the surgical recovery of sperm)
• Not a Child Dependent

There are separate medical and prescription drug lifetime maximum Benefits:

• Medical Benefits are limited to $15,000 per Covered Person during the entire period you are covered under the Plan.
• Prescription Drug Benefits are limited to $10,000 per Covered Person during the entire period you are covered under the Plan.

Fertility Solutions (FS) Program

The Plan pays Benefits for the infertility services described above when provided by Designated Providers participating in the Fertility Solutions (FS) program. The Fertility Solutions (FS) provides education, counseling, infertility management and access to a national Network of premier infertility treatment clinics.

Covered Persons who do not live within a 60 mile radius of an FS Designated Provider will need to contact a FS case manager to determine a Network facility prior to starting treatment. For infertility services and supplies to be considered Covered Health Services, contact FS and enroll with a nurse consultant prior to receiving services. 

You or a covered Dependent may:

• Be referred to FS by the Claims Administrator.
• Call the telephone number on your ID card.
• Call FS directly at 1-866-774-4626.

Exclusions:

Reproduction

1.      The following infertility treatment-related services:

• Long-term storage (greater than 12 months) of reproductive materials such as sperm, eggs, embryos, ovarian tissue, and testicular tissue
• Donor services and Non-medical costs of oocyte or sperm donation (e.g., donor agency fees)
• Embryo or oocyte accumulation defined as a fresh oocyte retrieval prior to the depletion of previously banked frozen embryos or oocytes
• Natural cycle insemination in the absence of sexual dysfunction or documented cervical trauma
• All costs associated with surrogate motherhood; non-medical costs associated with a gestational carrier
• Ovulation predictor kits

2.      Surrogate parenting, donor oocytes (eggs), donor sperm and host uterus.

3.      Artificial reproductive treatments done for genetic or eugenic (selective breeding) purposes;

4.      The reversal of voluntary sterilization.

5.      Health services and associated expenses for surgical, non-surgical or drug-induced Pregnancy termination. This exclusion does not apply to treatment of a molar Pregnancy, ectopic Pregnancy, or missed abortion (commonly known as a miscarriage).

6.      Contraceptive supplies and services.

Glossary:

Designated Provider - a provider and/or facility that:

• Has entered into an agreement with the Claims Administrator, or with an organization contracting on the Claims Administrator's behalf, to provide Covered Health Services for the treatment of specific diseases or conditions; or
• The Claims Administrator has identified through the Claims Administrator's designation programs as a Designated Provider. Such designation may apply to specific treatments, conditions and/or procedures.

A Designated Provider may or may not be located within your geographic area. Not all Network Hospitals or Network Physicians are Designated Providers.

You can find out if your provider is a Designated Provider by contacting the Claims Administrator at www.myuhc.com or the telephone number on your ID card.