Toolkits

Fertility Preservation Benefit Mandates: A Toolkit to Improve Effectiveness for Legislators

This Legislator Toolkit outlines specific strategies and recommendations for improving the implementation of FP benefit mandates among key partners, including legislators in states with and without mandates.

Key Recommendations for Legislators

1. Require coverage of comprehensive FP services
2. Prohibit the use of prior authorization for FP services
3. Coverage and cost-sharing for FP benefits should be required to be at parity with other specialty services
4. Design or expand fertility preservation benefit mandates to include publicly insured people
5. Legislation should allocate resources for regulators to enforce FP benefit mandate compliance by health insurers

This toolkit also includes specific materials that can be used to improve access to FP benefits:

• Background on Fertility Preservation
• Overview of State Fertility Preservation Benefit Mandates
• Methodology for Development of Toolkit Recommendations
• Recommendations for Legislators
• Heterogeneity of Health Insurance Coverage Requirements
• The Difference Between Fertility Preservation and Infertility Services

Fertility Preservation Benefit Mandates: A Toolkit to Improve Effectiveness for Insurance Regulators

This Insurance Regulator Toolkit outlines specific strategies and recommendations for improving the implementation of FP benefit mandates among key partners, including state health insurance regulators.

Key Recommendations for State Health Insurance Regulators

1. Craft and disseminate specific guidance to improve health plan implementation
2. Require insurers to provide specific benefit coverage details online
3. Treat appeals from consumers in an urgent manner
4. Monitor and audit health plan contracts for compliant benefit coverage
5. Provide educational and/or training opportunities across multiple levels

This toolkit also includes specific materials that can be used to improve access to FP benefits:

• Background on Fertility Preservation
• Overview of State Fertility Preservation Benefit Mandates
• Methodology for Development of Toolkit Recommendations
• Recommendations for Improving State Fertility Preservation Benefit Mandate Implementation Among Insurance Regulators
• Common CPT Codes for Insurance

Fertility Preservation Benefit Mandates: A Toolkit to Improve Effectiveness for Health Insurance Plans

This Insurer Toolkit outlines specific strategies and recommendations for improving the implementation of FP benefit mandates among key partners, including health insurance plans.

Key Recommendations for Health Insurance Plans

1. Cover comprehensive FP services
2. Ensure FP service coverage is at parity with other specialty services
3. Remove prior authorization
4. Configure FP benefits separate from infertility benefits
5. Facilitate benefit verification through easily accessible benefits information
6. Educate member and provider services teams on FP benefits
7. Ensure network adequacy
8. Provide on-line up-to-date list of FP providers
9. Automatically make insurance plan call transcripts available to members

This toolkit also includes specific materials that can be used to improve access to FP benefits:

• Background on Fertility Preservation
• Overview of State Fertility Preservation Benefit Mandates
• Methodology for Development of Toolkit Recommendations
• Recommendations for Health Insurance Plans
• Handout on the difference between FP versus infertility services
• Common CPT codes for FP services

Fertility Preservation Benefit Mandates: A Toolkit to Improve Effectiveness for Oncology and Fertility Clinics

This Clinic Toolkit outlines specific strategies and recommendations for improving the implementation of FP benefit mandates among oncology and fertility clinics.

Key Recommendations for Oncology and Fertility Clinics

1. Stay up to date on FP clinical guidelines
2. Learn about your state’s law/s on FP insurance coverage
3. Contract with health insurance plans
4. Support financial counseling and navigation
5. Fertility and oncology clinics should facilitate FP care among clinics
6. Monitor implementation of financial processes that facilitate FP access

This toolkit also includes specific materials that can be used to improve access to FP benefits:

• Background on Fertility Preservation
• Recommendations for Oncology and Fertility Clinics
• Overview of State Fertility Preservation Benefit Mandates
• Philanthropic Resources

Fertility Preservation Benefit Mandates: A Toolkit to Improve Effectiveness for Advocacy Organizations

This Advocate Toolkit outlines specific strategies and recommendations for improving the implementation of FP benefit mandates among key partners, including advocacy organizations.

Key Recommendations for Advocacy Organizations

1. Call for and/or create an external FP financial navigation resource that smaller clinics/clinic systems could use for their patients.
2. Call for and/or offer a continuing medical education (CME) module on FP options
3. Capture and disseminate patient stories to drive coverage for FP services
4. Identify channels and/or create mechanisms for disseminating the patient toolkit and measuring its effectiveness
5. Create a template letter and instructions for patients to notify their employer about the need for medically indicated FP coverage and challenges in accessing FP insurance benefits.

This toolkit also includes specific materials that can be used to improve access to FP benefits:

• Background on Fertility Preservation
• Overview of State Fertility Preservation Benefit Mandates
• Methodology for Development of Toolkit Recommendations
• Recommendations for Advocacy Organizations

Fertility Preservation Benefit Mandates: A Toolkit to Improve Effectiveness for Patients

This Patient Toolkit outlines specific strategies and recommendations for improving the implementation of FP benefit mandates among patients.

Key Recommendations for Patients

1. Learn health insurance basics
2. Verify FP benefit coverage with health insurance plan
3. Confirm FP state-level benefit mandate requirements
4. Learn about the appeals process for denials of FP benefit coverage

This toolkit includes specific materials that can be used to improve access to FP benefits:

• Background on Fertility Preservation
• Overview of State Fertility Preservation Benefit Mandates
• Methodology for Development of Toolkit Recommendations
• Recommendations

Fertility Preservation Benefit Mandates: A Toolkit to Improve Effectiveness for Researchers

This Researcher Toolkit outlines research recommendations for significant gaps in knowledge that need to be addressed to improve the effectiveness of FP benefit mandates.

This document also includes specific materials that can be used to improve access to FP benefits:

• Background on Fertility Preservation
• Overview of State Fertility Preservation Benefit Mandates
• Methodology for Development of Toolkit and Research Priorities
• Research Priorities Categorized by Level Involved in Mandate Implementation