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In an attempt to understand the lack of insurance coverage for infertility and the possible benefits of infertility coverage, we ask that you take the opportunity to complete the following survey:

1. Does your current insurance carrier cover any portion of your infertility?
Yes No

2. Does your insurance carrier cover any major medications used for infertility treatment to include Repronex, Follistem, Progesterone, or HCG shot?
Yes No

3. Does your insurance carrier cover only a limited number of IVF cycles?
Yes No

4. If your insurance carrier covers infertility, what is your monthly premium cost range?
$75-$100
$ 101-$150
$ 151-$200
$ 200-300

5. What is the name of your insurance carrier?
(20 charc. max.)

6. How would you benefit from infertility insurance?




 

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