IVF Maternity and Cycle Medical Plan
Plan Description
Providing choices in insurance coverage for an IVF pregnancy and complications that may arise during the IVF synchronization cycle with you, or the egg donor and surrogate.
Maternity Medical Plan Summary of Benefits
| Plan Maximum | $500,000 in negotiated coverage. (negotiated coverage is the amount of the claim after PPO Network discounts are applied.) |
| Coverage | One fetus or two fetus' pregnancy and birth. |
| Hospital Expenses | All medically necessary expenses due to pregnancy while in hospital. |
| Hospitalization In Patient Bed Rest | $50,000 (Maximum amount In-Patient Bed Rest, OBGYN ordered hospitalization, Company preauthorization required). |
| In-Network Payment Percentages | 100% |
| Out of network Payment Percentages | Coverage is 100% up to the plan maximum of $500,000 in negotiated rates. Clients may be balanced billed for any charges over the negotiated amount. Charges for balance bills do not apply toward any policy maximum. |
| OB Physician Services | All medically necessary treatment due to pregnancy while in hospital. |
| Ambulance Services | To and from hospital within 100 miles in the same geographic area. |
| Home Health Care | All medically necessary expenses due to pregnancy in accordance to written plan established, approved and followed by a physician. |
| Prescriptions | All medically necessary prescriptions 100% reimbursed by plan. |
| Pregnancy Ultrasounds | Up to 4 ultrasounds per pregnancy, based on medical necessity. |
| Coordination of benefits | The Maternity Plan is always primary. |
Enrollment Fee
Guaranteed fixed premium until you reach a successful pregnancy up to 26 weeks. Including multiple cycles. New Life is proud to provide our risk free policy for Maternity Coverage.
Comprehensive Plan Premium and Deductible
| Medical Plan Choices | Platinum Comprehensive |
| Premium | $14,750.00 |
| Cycle Premium |
Zero Complication only coverage. $500,000 combined single limit for egg donor and recipient. |
| Deductible: At age of expected date of delivery. |
$15,000 Singleton, $30,000Two Fetus', Age 34 and under. $25,000 Singleton, $37,500 Two Fetus', Age 35 and over. |
| Funding of Deductible | Amount due in full at 6 week ultrasound. |
| Refund of Claims Fund Account Deductible Deposit |
Any unused amount will be refunded back to you once all the claims are paid and your account is closed (6 months after the delivery). If the deductible deposit is depleted then the insurance will start to pay claims. At any time you may request a ledger on your account by contacting our claims administration company; New Life Agency Claims Division |
| Maternity Limit |
US $500,000 negotiated rate. US $50,000 in-patient hospital bedrest. |
| Refund of Premium | 100% refund of Maternity Plan premium if pregnancy is not medically confirmed less any premiums for EDR,EDO,RO certificates Issued. |
| Credit | None. |
| Coverage Term | The maternity policy remains in effect for 18 months from the six week ultrasound of pregnancy. |
Maternity Medical Plan Premium and Deductible
| Medical Plan Choices | Platinum | Gold | Silver |
| Premium | $9,950 | $5,950 | $3,950 |
| Deductible: Age at expected date of delivery. | $15,000 Singleton $30,000 Two Fetus. Age 34 and under $25,000 Singleton $37,500 Two Fetus. Age 35 and over | $30,000 Singleton $40,000 Two Fetus. Age 34 and under $40,000 Singleton $47,500 Two Fetus. Age 35 and over | $45,000 Singleton $60,000 Two Fetus Age 34 and under $55,000 Singleton $67,500 Two Fetus. Age 35 and over |
| Funding of Deductible | Amount due in full at 6 week ultrasound. | 6 months of deductible payments at $3000.00 each. Initial payment due at 6 week ultrasound. | |
| Maternity Limit |
US $500,000 negotiated rate US $50,000 in-patient hospital bedrest | ||
| Refund of Premium | 100% refund of Maternity Plan premium if pregnancy is not medically confirmed less $1050.00 broker/administration fee. (Less $1,500.00 on Back Up plans)* | ||
| Credit | 90% credit to another policy if loss of pregnancy occurs prior to transfer to the OB. | ||
| Coverage Term | The maternity policy remains in effect for 18 months from the six week ultrasound of pregnancy. | ||
*Ask your policy coordinator about Major Medical Back Up Plans
Cycle Medical Plan Summary Of Benefits
| Premium | $395 Per Cycle. Deductible: Zero. |
| Plan Maximum | $500,000 combined single limit for egg donor and recipient. |
| Coverage | Complications only. |
| Paralysis | $200,000 Combined single limit for egg donor and recipient. |
| Death Benefit | $200,000 Combined single limit for egg donor and recipient. |
Why Do You Need The IVF Maternity and Cycle Medical Plan?
IVF pregnancy health care costs in the United States are higher than typical pregnancy and maternity costs. Claims history demonstrates 30% higher claims cost for IVF pregnancies.
The United States health care system is principally funded through private insurance. These insurers are searching for avenues to limit their risk in light of the economic times and the unforeseen costs of Health Care Reform.
Major medical insurance companies may deny IVF pregnancy related claims and some major carriers are updating their booklets to exclude or limit coverage for IVF pregnancies if there are past claims showing complications during pregnancy or delivery from an IVF pregnancy. Therefore, individual or group coverage may be insufficient to cover your maternity liability.
Here are good explanations of why you need the IVF Maternity and Cycle Medical Plan:
1. IVF Procedures and complication.
One in 100 U.S. babies are conceived every year by assisted reproductive procedures. One in 10 U.S. women of reproductive age has consulted a doctor for infertility issues. As 7% of women trying to have a baby fail to conceive after 12 months of unprotected intercourse, the popularity of IVF is dramatically increasing. Claims, procedures and complications arising out of
these staggering numbers inevitably increase as well.
2. Higher risk in IVF pregnancies.
Claims for IVF pregnancies have a 30% higher claims risk ratio. The IVF Maternity and Cycle Medical Plan is specifically designed to manage IVF pregnancy and delivery claims.
3. Women with no insurance.
Women with no insurance or women that are uninsurable due to preexisting conditions or unemployment may apply for coverage.
4. Women who are pregnant and not insured or under insured.
If you are pregnant and uninsured or under insured, you are not alone. Thirteen percent of all pregnant women are uninsured and that number seems to be increasing with the economical challenges we face in today's economy. A pregnancy is not time to waiver or forgo appropriate healthcare. This is important for both you and your baby.
5. Women who's insurance excludes pregnancy or you are under insured.
Maternity insurance is a benefit frequently included in the health benefits provided by corporations. However, it may be an optional benefit with additional expenses to the employee. It is quite possible that you are one of the individuals that has health insurance but either maternity benefits are not included or you are under insured.
4. Large network of medical providers.
The network accesses one of the largest medical provider networks in the nation; offering cost savings based on agreed contracted network service provider rates.
Claims Management and Customer Care
New Life Agency Claims Division is a third party administrator providing customer care and claims handling services to fertility patients, surrogates and egg donors for New Life Agency, Inc.
Claims Cost Control:
Saving fertility patients money is New Life Agency Claims Division's standard. Our standard protocol is to have all claims re-priced through our network, adjudicated, and paid within 30 days providing our clients with the deepest discounts available for their medical expenses.
| Savings Samples | Total Charges | Negotiated rate | Savings |
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Vaginal singleton: No complications | $9,491.62 | $1,235.00 | $8,256.62 |
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C-section singleton: With complications | $40,205.30 | $12,061.59 | $28,143.74 |
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C-Section Two Fetus: No Complications | $11,746.52 | $5,664.70 | $6,081.82 |
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| Use the Network Providers To access the most current list, go to newlifeagency.com network of providers. Call or email New Life Agency Claims Division. care@newlifeagency.com 877.952.5443 |
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Show your ID Card when you check in The doctor's office and hospital admissions department will ask if you have insurance. Just give them your ID card. It has everything they need! |
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Doctors and Hospital Submit Claims All claims will be submitted by doctors and hospital directly to New Life Agency Claims Division. A NEW STANDARD OF CARE... |