Fertility Benefit - Frequently Asked Questions

  1. What is the Fertility Benefit?
    Effective January 1, 2019, eligible participants may receive certain therapeutic services for the treatment of infertility under the Fertility Benefit. The Fertility Benefit is provided through Optum's Fertility Solutions Program.

  2. What is the Fertility Solutions Program?
    The Fertility Solutions Program is designed to help eligible participants who may be struggling with infertility. The nurse consultants and specialists with the Fertility Solutions Program team will help to facilitate care, provide education and guidance and help coordinate access to infertility services through their Centers of Excellence (COE) qualified providers/facilities.

  3. Who is eligible for the Fertility Benefit?
    Caterpillar active employees and their spouses who are enrolled in the Caterpillar Inc. Employee Health, Life and Disability Benefit Program (the "Plan") may be eligible for the Fertility Benefit if they meet certain requirements. To confirm if you are eligible for services under the Fertility Benefit, call the number on the back of your medical ID card. Dependent children are not eligible for the Fertility Benefit.

  4. How do I learn more about the Fertility Benefit?
    If you have questions about the Fertility Benefit, covered/non-covered services or how to enroll in the Fertility Solutions Program, call the number on the back of your medical ID card after January 1, 2019, to be connected to a Fertility Solutions Program specialist. The contact numbers are also included below for your convenience:
         - UnitedHealthcare: 866-228-4215
         - Blue Cross Blue Shield: 844-228-2227

    To contact the Fertility Solutions Program directly, call 866-774-4626.

  5. What types of services are covered by the Fertility Benefit?
    Covered services may include, but are not limited to:
         - In vitro fertilization, gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT), and any related prescription medication treatment
         - Artificial insemination and Intrauterine Insemination (IUI)
         - Ovulation induction and controlled ovarian stimulation

  6. What types of services are not covered under the Fertility Benefit?
    Some infertility treatment-related services, including, but not limited to, the following services are not covered under the Fertility Benefit:
         - 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
         - Surrogate parenting, donor oocytes (eggs), donor sperm and host uterus
         - The reversal of voluntary sterilization

  7. Am I required to enroll in the Fertility Solutions Program?
    Yes, you must enroll in the Fertility Solutions Program for your claims to be covered. To enroll, call the number on the back of your medical ID card and ask to be directed to a Fertility Solutions Program specialist, or call the Fertility Solutions Program directly at 866-774-4626. You must contact the Fertility Solutions Program and speak with a nurse consultant before receiving services under the Fertility Benefit.

  8. I'm currently in the middle of infertility treatments. What should I do?
    Contact the Fertility Solutions Program to discuss your situation and possible next steps.

  9. What if I choose not to enroll in the Fertility Solutions Program?
    Infertility services will not be covered under the Fertility Benefit if you do not enroll with the Fertility Solutions Program.

  10. How will infertility claims be processed?
    Covered expenses under the Fertility Benefit will be subject to the Plan's deductible and coinsurance amounts, as described in the Benefit Summaries or the Summary Plan Description. For copies of these documents, contact the Caterpillar Benefits Center at 877-228-4010.

  11. What is a Centers of Excellence (COE) provider?
    A COE provider is an infertility facility or provider qualified by the Fertility Solutions Program (and in-network with your carrier) based on an extensive evaluation process of meeting best-practice evaluation criteria that includes:

         - High pregnancy rates and low incidence of multiple births
         - A proven track record of successful clinical outcomes
         - Comprehensive reproductive services
         - Superior physician credentials and experience
         - Exceptional facility operations and staffing
         - Industry accreditation and affiliations

    When a participant calls to enroll in the Fertility Solutions Program, leading infertility COE nurse consultants provide education to help participants make informed decisions. Timely and appropriate referral to pregnancy management programs is also conducted, if applicable.

  12. What does "in-network" mean?
    "In-network" refers to providers or health care facilities that are part of the Plan's network of providers with which is has negotiated a discounted rate. Participants usually pay less when using an in-network provider.

  13. Where do I get a list of COE providers?
    When you call to enroll in the Fertility Solutions Program, a specialist will discuss your needs and the available COE providers in your area.

  14. What if my doctor is not a COE provider?
    You are required to use a COE provider to receive covered services under the Fertility Benefit. Call the number on the back of your medical ID card and ask to be connected to a Fertility Solutions Program specialist to discuss the COE providers that may be available in your area.

  15. What if there isn't a COE provider or facility near me?
    You are still required to enroll in the Fertility Solutions Program. The nurse consultants will work with you to find a COE provider to meet your needs. If there are no COE providers within 60 miles of your home ZIP code, the Fertility Solutions Program may approve a network gap exception to cover a non-network provider. Call the Fertility Solutions Program to discuss a network gap exception.

  16. Is there a dollar limit on services under the Fertility Benefit?
    Yes, there is both a medical and a prescription drug lifetime maximum dollar limit. The medical lifetime maximum dollar limit is $15,000. The prescription drug lifetime maximum dollar limit is $10,000. If you have questions about these limits, or to find out how much you have accumulated toward your lifetime maximums, call the number on the back of your medical ID card.

  17. If I receive prescription drugs related to infertility treatment from my provider through the Medical Benefit under the Plan, does it apply to my medical or pharmacy lifetime maximum dollar limit under the Fertility Benefit?
    If you receive prescription drugs related to infertility treatment through your Medical Benefit, it will apply to the medical lifetime maximum dollar limit under the Fertility Benefit. If you receive prescription drugs related to infertility treatment through the Pharmacy Benefit, it will apply to your pharmacy lifetime maximum dollar limit under the Fertility Benefit. Note: All infertility services will be subject to applicable deductible and coinsurance amounts under the Plan.

  18. How do I determine if a prescription drug is covered under the Fertility Benefit?
    The Fertility Solutions Program specialists will work with you to determine if a prescription drug is covered under the Fertility Benefit.

  19. What if I have been covered by my spouse's non-Caterpillar plan, and its requirement was to use the Fertility Solutions Program, as well? Do I need to re-enroll?
    Yes, you will need to re-enroll in the Fertility Solutions Program. However, you may request that the nurse consultant you previously used continue as your nurse consultant for the Fertility Benefit under the Plan.

  20. If a participant is in the middle of treatment (often called "transition of care") with a non-COE provider on January 1, 2019, can they continue care with that provider?
    Yes, the participant may continue care as long as they are at an in-network provider. Middle of treatment is determined as having already started the fertility process (i.e., taking infertility medication).

  21. If a participant is in between treatment with a non-COE provider on January 1, 2019, can they start the next cycle treatment with that provider?
    No, the participant must start the next cycle of treatment with a COE provider to be covered under the Fertility Benefit.

  22. How does the Fertility Benefit impact my Plan's maximum out-of-pocket?
    Call your carrier at the number on the back of your medical ID card for a full explanation of how benefits are allocated under the Plan.

 

Your rights to the Fertility Benefit are governed by the Plan. These FAQs are being provided solely for informational purposes. If these FAQs are inconsistent with the Plan document or Summary Plan Description in any way, the Plan document or Summary Plan Description will control.