Infertility is a disease defined as when a person is unable to conceive or produce conception after 1 year of egg-sperm contact when the female attempting conception is under 35 years of age, or after 6 months egg-sperm contact when the female attempting conception is 35 years of age or older. Egg-sperm contact can be achieved by frequent sexual intercourse or through monthly cycles of timed sperm insemination (intrauterine, intracervical, or intravaginal). This definition applies to all individuals regardless of sexual orientation or the presence/availability of a reproductive partner. Infertility may also be established by the demonstration of a disease of the reproductive tract such that timed egg-sperm contact would be ineffective.
For detailed coverage, limitations, and exclusions please refer to the Official Plan Brochure.
For a copy of Aetna’s Clinical Policy Bulletin on Infertility, please refer to Aetna Clinical Policy Bulletins (CPBs).
Healthy Pregnancy Program
Our Healthy Pregnancy Program provides trusted information and guidance about family planning, maternity support and postpartum care.
With this program, you will have access to the following resources:
- Nurses who are trained in obstetrics and high-risk pregnancy conditions.
- Behavioral health support, including referrals to resources to deal with stress, depression, and anxiety
- Postpartum depression screening and support
- Resources and educational materials through our Maternity Support Program
- Guided medically appropriate genetic counseling and testing
- Preeclampsia prevention – If you are identified as high-risk, you will receive educational materials about preeclampsia risk factors, and the benefits of aspirin therapy.
- Fertility advocate to help you throughout your infertility journey, fertility preservation, same-sex conception needs, and more. The advocate will also provide support and guidance during fertility treatment and provide support if you become pregnant. For direct access to a fertility advocate, call 1-833-415-1709 (TTY: 711).
No matter where you are on your journey, our nurses and experts are here to support you along the way. Participation in this program is voluntary and available at no cost to you. You and your physician or healthcare provider remain in charge of your treatment plan. If you would like more information or would like to enroll in our Healthy Pregnancy Program, call 1-855-282-6344 (TTY:711) between 8 AM ET and 9 PM ET.
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.
Under The Affordable Care Act, coverage of certain preventive services, including contraceptives, must be provided without member cost share as prescribed by your provider. If your prescriber believes that a non-formulary contraceptive is medically necessary for you, please have your prescriber call Express Scripts Pharmacy at 1-800-841-2734 to request an exception.
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. For additional detail on how to file your claim, see Section 7. Filing a Claim for Covered Services in the FSBP Plan Brochure.
You can learn more about contraception resources and reproductive rights at these websites:
Please contact OPM if you have difficulty accessing contraceptive coverage or other reproductive health by emailing: Contraception@opm.gov.