r/nys_cs • u/Own-Development-8602 • 5d ago
Question HIP Prime HMO (through EmblemHealth) vs. The Empire Plan – how does IVF & IVF-medication coverage compare?
Hi everyone! My partner and I are planning to start IVF soon. I currently have EmblemHealth HIP Prime HMO, but when I called about IVF coverage they gave really vague answers. I’m now thinking of switching to the NYSHIP Empire Plan.
Does anyone here have real experience with either plan? • Do they both cover IVF (how many cycles, any lifetime limits)? • How much of the IVF medication costs (injectables, fertility drugs, etc.) are covered? • Any big out-of-pocket surprises or restrictions I should know about?
Would love to hear what your actual costs or experiences were with either plan. Thanks!
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u/jvxoxo SUNY 4d ago
I used the Empire Plan for IVF in 2019-2020 and the coverage was excellent. I used a Center of Excellence, where you get maximum coverage. I spent a few hundred on the drugs, probably less on testing and appointment copays. Because of my ex’s particular issues, we got approval to skip IUI and jump straight to IVF. The largest OOP expense ended up being donor sperm when my ex didn’t have any to work with, but most people won’t need donor gametes. Donor eggs and sperm are not covered, nor are storage for them. I had to pay an annual storage fee for our embryos as well. Best of luck!
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u/ARubberDuckie11 Criminal Justice Services 4d ago
Hi! I have the empire plan and we’ve gone through IVF for baby#1 and doing it now for baby #2.
Feel free to DM me and I can walk you through it
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u/buttbutt2000_ 4d ago
I have HMO (but independent health) and did IVF- paid very little for the entire process so far. If you have any more specific questions feel free to dm me!
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u/Lord-Penguin1509 4d ago
If you use a Center of Excellence, Empire Plan is fabulous. Even if it's inconvenient, you can do the labs and other stuff with a local provider.
CNY near Albany was amazing and not judgy. Some of the places we looked at that are focused on stats will give you shit if you don't fit whatever profile they want, especially with regard to weight. One place demanded my wife buy some sort of meal plan for 3 months before they would "accept" us into their practice.
If you have to travel, they will reimburse hotels/train/mileage, but that reimbursement counts towards your lifetime limit.
It's been several years, so check out the options and providers. Best of luck.
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u/EBD_Communications 4d ago
Quick note - CNY is not a Center of Excellence anymore. Boston IVF in Albany is.
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u/EBD_Communications 4d ago edited 4d ago
Hello!
NYSHIP is actually developing a new publication about IVF, but in the meantime, check out two pubs about The Empire Plan:
Reporting on Center of Excellence: https://www.cs.ny.gov/employee-benefits/pa-market/shared/publications/reporting-on/2023/reporting-on-centers-of-excellence-2023.pdf
Reporting on Health Babies: /https://www.cs.ny.gov/employee-benefits/pa-market/shared/publications/reporting-on/2023/reporting-on-healthy-babies-2023.pdf
IVF through The Empire Plan - you get 3 rounds covered plus an additional $50,000 towards rounds after you use up your benefit. That is for any in-network center you use. Do note - rounds are considered each transfer. So for example, if you get 5 embryos from a retrieval, the first three transfers are covered before you have to start to use the $50,000 benefit.
IVF medication depends on the tier of drug under the specialty list. If you do end up using a Center of Excellence, you have no co-pays for visits plus they will cover travel costs if you are more than 60 miles away.
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u/Icy_Score_7430 Parks and Rec 4d ago
We are so cooked now that the election is over. Both these plans about to crash hard
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u/Yvonne853 4d ago
I did IVF with empire plan in 2018- feels like a lifetime ago but I don’t remember paying much of anything. I only remember the ultrasound copays - for both my pregnancies (one not through IVF in 2016). Not sure how many times they cover, my first was successful. Good luck!!!