For 2025, federal employees will see expanded options for fertility benefits under the Federal Employees Health Benefits (FEHB) Program, particularly regarding in-vitro fertilization (IVF) coverage. This follows a major update in 2024, where infertility services were expanded to include all methods of artificial insemination and fertility drugs for up to three IVF cycles annually. In 2025, the improvements continue, offering more plan options with comprehensive IVF coverage.
Key Changes for 2025 IVF Coverage
Two National PPO Plans: Federal employees will now have two national PPO plans offering extensive IVF coverage: BCBS Standard and GEHA High.
BCBS Standard provides IVF coverage with a $25,000 annual limit. Members are responsible for 15% coinsurance after meeting the deductible. However, fertility drug costs do not count toward the $25,000 limit.
GEHA High offers the same $25,000 annual IVF limit, with 20% coinsurance after the deductible, making it slightly more expensive than BCBS Standard in terms of member costs. However, GEHA High premiums are typically lower for self-plus-one and self & family plans compared to BCBS Standard, which may offer a more affordable option for some families.
Increased Local Plan Options: In addition to the national plans, 45 FEHB plans will offer IVF coverage that exceeds the minimum required by the Office of Personnel Management (OPM). This is a significant increase from previous years, providing federal employees more choices.
IVF Costs and Out-of-Pocket Expenses:
Despite the expanded coverage, the cost of IVF remains high. A single IVF cycle can range from $15,000 to $30,000. After deductibles and coinsurance, federal employees may still face significant out-of-pocket expenses, potentially totaling thousands of dollars. For families planning to use IVF, contributing to a Flexible Spending Account (FSA) could help mitigate some of these costs. The 2024 FSA contribution limit is $3,200, which can be used to cover out-of-pocket IVF expenses.
Breakdown of IVF Coverage by Plan
Nationwide Plans Offering IVF Coverage
BCBS Standard – 15% coinsurance, limited to $25K annually.
GEHA High – 20% coinsurance, limited to $25K annually (new in 2025).
D.C. Area Plans
Aetna Open Access High – 50% coinsurance, limited to $5K annually (new in 2025).
Standard & BlueValue Plus – 50% coinsurance, limited to 3 attempts per live birth, $45K annually (new in 2025).
BlueChoice Advantage HDHP – 50% coinsurance, deductible applies, limited to 3 attempts per live birth, $45K annually (new in 2025).
High, Standard, and Prosper – 50% coinsurance, limited to 3 attempts per live birth, $50K annually (new in 2025).
Sentara Health Plans – 20% coinsurance, limited to 3 cycles per year.
Plans in Other States
California: Western Health Advantage and Sharp Health Plan – 50% coinsurance (new in 2025).
Colorado: Kaiser High/Standard/Prosper – 50% coinsurance, $50K annually (new in 2025).
Hawaii: HMSA and Kaiser – Coinsurance ranging from 20% to 30%, one IVF procedure per lifetime.
Illinois/Indiana/Iowa: Health Alliance HMO – 25% coinsurance, deductible applies.
New York: Independent Health – Coinsurance ranges from $40-$50 copay, up to 3 cycles per lifetime (new in 2025).
U.S. Territories
Guam/Northern Mariana Islands: Calvos Selectcare – Coinsurance or copay depending on plan type.
Puerto Rico/U.S. Virgin Islands: Triple S Salud – $7.50 copay, limited to $15K annually.
Important Considerations
Pre-Authorization: Most plans require pre-authorization for IVF services, and families should review their specific plan’s brochure for full details.
Costs for Multiple Cycles: Even with expanded coverage, out-of-pocket costs can still be substantial, and coinsurance rates vary significantly. Families should carefully evaluate the coverage and costs associated with their chosen plan to determine the best option for IVF treatment.
Fertility Drugs: Fertility drug coverage often does not count toward the IVF procedure limit, but costs can still add up, especially with the high expense of IVF cycles.
For federal employees exploring IVF options, the year 2025 offers expanded benefits with multiple plans to consider. Families should compare coverage details, premiums, and coinsurance costs before making their plan selection.
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