Infertility services

Infertility is when a person is unable to achieve pregnancy after:

  • One year of egg-sperm contact efforts when the person attempting conception is under age 35, OR
  • Six months of egg-sperm contact efforts when the person attempting conception is age 35 or older

Egg-sperm contact can be from sexual intercourse or artificial insemination (intrauterine, intracervical or intravaginal). Infertility may also be caused by a problem with the reproductive tract that makes egg-sperm contact ineffective. This explanation applies to all individuals regardless of sexual orientation or the presence/availability of a reproductive partner.

To learn more about infertility coverage, limitations and exclusions, please refer to the Official Plan Brochure.

You can also refer to our Clinical Policy Bulletins (CPBs) for more information.

Healthy Pregnancy Program

Our Healthy Pregnancy Program provides tools and support for every stage. You can get trusted information and guidance about family planning, maternity support and postpartum care.

With this program, you’ll also have access to: 

  • Nurses who are trained in obstetrics and high-risk pregnancy
  • Behavioral health support, including referrals to resources to help with stress, depression and anxiety
  • Postpartum depression screening and support
  • Resources and educational materials through our Maternity Support Program
  • Genetic counseling and testing
  • Preeclampsia prevention — If you’re identified as high-risk, you’ll get helpful information about the risk factors and the benefits of aspirin therapy.
  • On-on-one support from a fertility advocate to help you with your infertility journey, fertility preservation, same-sex conception needs and more. They’ll also provide support and guidance during fertility treatment and if you become pregnant. To reach a fertility advocate, call 1-833-415-1709 (TTY: 711).

We’re here for you 

Our experienced maternity nurses and professionals are here to help no matter where you are in your pregnancy journey. The maternity program is optional and available at no cost to you. Your treatment plan is still in the hands of you and your doctor. Call 1-855-282-6344 (TTY: 711) between 8 AM and 9 PM ET with questions or to enroll.

The Centers for Disease Control and Prevention (CDC) HEAR HER™ Campaign seeks to prevent pregnancy-related deaths by sharing potentially life-saving messages about urgent warning signs. For more information on the HEAR HER Campaign visit CDC.

Our Healthy Pregnancy Program also provides you and your partner 24/7 access to Maven’s digital health platform and quality providers via unlimited video appointments, messaging and classes.

Your Maven membership includes support on adoption, surrogacy, fertility, maternity and postpartum care:

  • A personal care advocate who serves as a trusted guide to help you navigate the Maven platform and connect you with providers throughout your journey
  • Unlimited video chat and messaging with doctors, nurses, and coaches across 35+ specialties, including fertility, mental health, doulas, sleep coaches, pediatrics and more
  • Provider-led virtual classes and vetted articles tailored to your journey
  • Counseling and expert guidance via Maven Adoption and surrogacy coaches through different adoption and surrogacy pathways and key considerations in the process

You can find more information in the Official Plan Brochure.

Contraceptive coverage

Under The Affordable Care Act, coverage of certain preventive services, including contraceptives, must be provided at no cost. For a list of no cost contraceptives, click here or go to Section 5(f) of your official plan brochure for additional details. If you or your prescriber believes that a non-formulary contraceptive is medically necessary, please follow the below process.

Contraceptive process:

  • Reviews can be initiated by the member, pharmacist or provider
  • Members should call Express Scripts at 1-800-841-2734
  • Providers can also initiate through an electronic prior authorization

Processing Time for Contraceptive Exception Requests – Exception requests for contraceptive coverage will be processed within 24 hours of receiving complete information.

If the contraceptive is over-the-counter (OTC) and has a National Drug Code (NDC), present your Foreign Service Benefit Plan (FSBP) ID card and the prescription from your provider at the pharmacy.

If you purchase an OTC contraceptive that does not have an NDC, you must file a claim for reimbursement. See Section 7. Filing a Claim for Covered Services in the FSBP Plan Brochure for additional information.

For information about contraceptive resources and reproductive rights visit the Office of Personnel Management (OPM) and the Department of Health and Human Services (HHS) websites. If you need help with contraceptive coverage or other reproductive health, email OPM at Contraception@opm.gov