The Board of Trustees of the SAG-AFTRA Health Plan is pleased to announce the unanimous approval of infertility treatment benefits. Beginning January 1, 2025, Participants and their covered spouses will be eligible for medically necessary infertility treatment coverage through Carrot, a comprehensive network of infertility treatment benefit providers. Covered infertility treatment and prescription drugs obtained from Carrot providers will be covered with no cost share up to the family lifetime maximum of $30,000. 

We ask that you please do not call Carrot or the Health Plan yet with questions about this benefit as we have just begun the implementation process with Carrot. It will take some time to build the tools needed to provide you with exceptional service and we are targeting completion in the fall. 

Limited information is available below. We will update our website and will communicate directly with Participants once more information is available. 

Media inquiries should be directed to [email protected]  

 

The following is summary information only and is intended to give a broad overview of the benefits available through Carrot on and after January 1, 2025. The Summary of Material Modifications (SMM) which is the full description of the Plan language describing the new benefits will follow in late summer. 

How can I access the new benefits after January 1, 2025?

Participants and their covered spouses can register through Carrot or download the app. After answering some questions, the Carrot team will introduce you to your dedicated Care Team who will help you navigate your family building journey. Participants (and/or their covered spouses) who have a clinical diagnosis of infertility can receive medically necessary treatment (IVF, IUI, prescription drug therapy, etc.) from curated Carrot providers at no cost to them up to the $30,000 family lifetime maximum. Even if you or your spouse do not have a diagnosis of infertility, you will still have access to Carrot’s extensive educational library, care navigation, discounts on certain services and unlimited virtual chats with Carrot experts.

How do I receive a diagnosis of infertility?

Only a medical provider can diagnose infertility. Neither the Plan nor Carrot can provide this diagnosis. As with all medical care, talk with your provider if you believe you have this condition. 

Medical providers can determine infertility based on any generally accepted medical guidelines. While the Centers for Disease Control (CDC) guidelines state that in general, infertility is defined as not being able to get pregnant after at least one year of unprotected sex, providers can make the diagnosis based on any number of guidelines, including, but not limited to, those issued by the American Society of Reproductive Medicine (ASRM). Unlike the CDC guidelines, the ASRM recently updated its guidelines to define infertility as a disease, condition, or status including the following: 

  • The inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors. 
  • The need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos in order to achieve a successful pregnancy either as an individual or with a partner. 
  • Regardless of which guideline is used, if you or your spouse has a medical diagnosis of infertility from your provider, you are eligible for the $30,000 lifetime benefit. 

Examples of benefits available through Carrot to Participants and their covered spouses beginning January 1, 2025*

  • Intrauterine Insemination (IUI) 
  • In Vitro Fertilization (IVF) 
  • Semen analysis 
  • Genetic testing related to fertility 
  • Short term storage costs for eggs, sperm, and/or embryos as part of a treatment 
  • Short term fertility preservation for males and females (ex. freezing eggs or semen if member is scheduled to undergo a procedure that may result in loss of fertility, such as radiation or chemotherapy) 
  • Fertility medication 

*Please note, benefits are only covered when the Participant and/or spouse has a clinical diagnosis of infertility from a medical provider. Only benefits that are considered Medically Necessary are covered.