Dealing with Infertility

What to Know before You Seek Treatment

Nothing is more frustrating for couples than wanting to have a baby and being unable to conceive. Feelings of stress and helplessness are common in both men and women. Your TRICARE Prime benefit covers health care procedures related to diagnosing and correcting an underlying medical condition that is causing infertility.

What’s Covered

For men, hypothalamic disease, pituitary disease, disorders of sperm transport, disorders of sperm motility or function and/or sexual dysfunction may cause infertility. Under your TRICARE Prime benefit, infertility testing and treatment, including correction of the physical cause of infertility, is covered. Diagnostic services may include semen analysis, hormone evaluation, chromosomal studies, immunologic studies, special and sperm function tests and/or bacteriologic investigation. Therapy may include, but is not limited to, hormonal treatment, surgery, antibiotics, administration of HCG and/or radiation therapy, depending upon the cause.

For women, services and supplies required to diagnose and treat illness or injury involving the female genital system are covered. Infertility testing and treatment, including correcting the physical cause of infertility, are included under this provision. This does not include artificial insemination, which is excluded from coverage.

Artificial Reproduction Technologies Are Not Covered

One of the primary things to know is that TRICARE cannot cover any form of artificial reproductive technologies, but can, in general, cover treatment of underlying medical condition. See the chart for some examples of covered and not covered procedures.

Other Non-Covered Procedures

Reversal of a prior surgical sterilization procedure is not covered. Services and supplies related to artificial insemination (including semen donors and semen banks), in-vitro fertilization, gamete intrafallopian transfer and all other noncoital reproductive technologies are also not covered.

If you choose to seek non-covered infertility treatment from a civilian provider, you will be responsible for the total cost of that care. (Note: The status of the provider does not change the coverage status of a non-covered infertility treatment.)

To Help You Cope

The Military OneSource employee support program, which may include free counseling services outside of the military system, has a toll-free hot line number at 1-800-655-4545 and a Web site at www.militaryonesource.com. These resources provide a wealth of information to help with day–to–day life issues and emotional well-being.

Questions?

If you have questions about infertility benefits, contact TriWest at 1-888-TRIWEST.