Benefit Decisions
These policies may not apply to all Progyny members. Please reach out to your Patient Care Advocate to see if these benefit decisions apply to you.
Out-of-Network Donor Purchase
All donor tissue purchases must be authorized at an in-network tissue bank.
Members must use an in-network tissue bank for donor tissue purchases as determined by their benefit.
Exceptions for specific genetic characteristics or religion will be considered on a case-by-case basis for out-of-network coverage.
Consecutive Donor Purchase
The purchase of donor tissue is limited to one per egg and sperm source at a time.
The number of cohorts of donor eggs or vials of donor sperm are limited to 1 cohort of donor eggs per sperm source and 4 vials of donor sperm per egg source as determined by their benefit.
A fertilization attempt is required prior to purchasing additional cohorts/vials and embryo banking policy applies.
Exceptions will be considered on a case-by-case basis.
Voluntary Sterilization
Coverage may be denied for those individuals who have undergone voluntary sterilization.
Diagnostic testing and treatment for those who have had a medical procedure for permanent sterilization may not be covered as determined by their benefit.