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Infertility benefits through Carrot Fertility provided by the Directors Guild of America-Producer Health Plan


The Directors Guild of America-Producer Health Plan (“Health Plan”) partnered with Carrot Fertility (“Carrot”) to offer infertility benefits for covered participants and dependent spouses effective July 1, 2022.

The Health Plan recognized the challenges faced by many of our participants pursuing parenthood, and now covers qualified participants and their dependent spouses for medically necessary infertility treatment based upon a medical diagnosis of infertility. An eligible participant and the dependent’s spouse, if any, may each receive up to a total lifetime maximum benefit of $30,000 for infertility treatment. The $30,000 lifetime maximum benefit is an aggregate total of all covered services received from all in-network Carrot providers.

Who qualifies?

To qualify for the new infertility benefit, you must:

  • Be a participant or dependent spouse currently covered under Earned Active, Earned Inactive, Regular Carry-over, or related COBRA Continuation coverage with the Health Plan. This excludes participants and spouses on Extended Self-Pay coverage, Retiree coverage, or any other Self-Pay coverage; and
  • Have a diagnosis of infertility for either yourself or your spouse. (A diagnosis of infertility is determined by your treating physician).

What’s covered under the Health Plan’s infertility benefits?

The Health Plan’s infertility benefit through Carrot provides coverage for medically necessary treatments for a medical diagnosis of infertility and access to infertility, family forming education, and pregnancy support, including:

  • Access to a personalized Carrot Plan to guide you through every step of your family-forming journey;
  • A Carrot Card®, a pre-funded card that lets you pay for eligible care and services without waiting for reimbursement;
  • A dedicated Care Team to help guide your journey;
  • Carrot’s network of 3,600+ clinics around the world so you can find the right provider for you;
  • Significant savings on infertility medications through Carrot Rx® powered by Alto. See section Getting Your Infertility-Related Prescription Medications below for more details;
  • At-home support through Carrot’s telehealth platform, including unlimited, free virtual visits with Carrot’s team of family-forming experts;
  • Medically necessary testing, diagnostics and treatments, including In vitro fertilization (IVF), Intrauterine insemination (IUI), genetic testing related to infertility, and short-term infertility preservation (for example, short-term egg freezing or semen freezing if scheduled to undergo procedures that may result in loss of fertility, such as radiation or chemotherapy);
  • Mental health and emotional support from experts who specialize in family-forming journeys;
  • A library of expert-produced educational resources, including articles, how-to videos, and dynamic guides;
  • Free consultations at adoption agencies (although adoption services are not a covered benefit; and
  • Pregnancy support that includes virtual chats with doctors and specialists, on-demand videos to support mindfulness, access to lactation consults, and much more.

For more information, please see Article IV, Section 9(n) of the Health Plan Summary Plan Description Section titled “What’s Covered Under Medical Benefits,” “Infertility,” The Health Plan SPD, and all updates, are available for free online at www.dgaplans.org, or you may contact the Health Plan to request a hard copy be sent to you at no costs. The Health Plan SPD shall control to the extent of any inconsistencies.

Carrot is available in 120+ countries, and services available may vary by geography, and local rules and regulations.

What’s NOT covered under the infertility benefits?

Following are examples of infertility treatments and services not covered under the new infertility benefit. Any of the following services must be paid for out of pocket:

  • Infertility treatment provided by a non-Carrot provider;
  • Infertility treatment provided to anyone other than the participant or his/her dependent spouse;
  • Long-term (1 year or longer) fertility preservation, including elective egg or sperm freezing;
  • Expenses related to surrogacy or adoption;
  • Pregnancy-related expenses (which, however, could be covered under the Health Plan’s medical benefit. See “Maternity Care” under Article IV, Section 9(m) of the Health Plan Summary Plan Description for details.  You may also contact Carrot for more information about covered and non-covered pregnancy support services);
  • Herbal treatments;
  • Nutrition counseling;
  • General genetic tests; and
  • Physical therapy.

Note

Only a medical provider can provide a participant or their spouse with an infertility diagnosis, not Carrot or the Health Plan. Medical providers can determine infertility based on any commonly accepted medical guidelines, including but not limited to those issued by the Centers for Disease control or the American Society of Reproductive Medicine. Regardless of which of those guidelines 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 for family forming.

In understanding your infertility benefits, it is important to point out that the Health Plan is a not-for-profit, ERISA covered health plan that is subject to variety of federal laws, including IRS rules that affect the taxability of health benefits. These rules determine whether a benefit will be tax-free to you, or whether all or part of it might constitute taxable income to you. In order for the Health Plan to provide medical benefits to you on a non-taxable basis, the benefit must be a reimbursement for “qualifying medical expenses” (QMEs) as defined in Internal Revenue Code Section 213(d).

The definition of QMEs is complicated, but basically includes expenses for the costs of diagnosis, cure, mitigation, treatment or prevention of disease, or for the purpose of affecting any part or function of the body. The expense must be primarily to treat or prevent a physical or mental disability or illness.

Under the IRS rules, QMEs do not include expenses incurred by donors or gestational surrogates. Similarly, QMEs do not include adoption expenses. It would only include expenses incurred by you and your dependents.

This means that if you or your spouse receive a medical diagnosis of infertility from your provider, you qualify for the $30,000 lifetime benefit ($60,000 if both of you are diagnosed with infertility).

The following benefits are still available through Carrot, without cost, regardless of whether you have an infertility diagnosis:

  • The Carrot Read & Learn library includes expert-authored articles and other dynamic educational content, enabling participants to learn in a way that best works for them. Personalization means giving participants the option to self-serve content, explore more structured learning paths, etc. Access to medically-reviewed resources at the right time empowers participants to make informed decisions;
    • Articles/videos: Available to all participants, regardless if they have a Carrot Plan or an infertility diagnosis;
    • Guides: Available to participants with a Carrot Plan, regardless if they have an infertility diagnosis. For males, relevant guides include low testosterone and pregnancy/postpartum. The Carrot guide goes in-depth into a journey-specific topic, spotlighting the most important, clinically-vetted content related to that topic. Guides are formatted to be easy to follow and immersive, breaking up content by sub-topic and allowing participants to self-navigate and learn at their own pace;
  • Care Navigation;
  • Discounts on Legacy at-home sperm analysis and freezing kits;
  • Support locating high-quality providers, including fertility clinics, adoption or gestational surrogacy agencies and attorneys, and donor banks; and
  • Unlimited virtual chats with Carrot experts in fertility, LGBTQ+ family-forming, adoption, gestational surrogacy, and pregnancy.

Getting Started with Carrot

It takes just a few simple steps to create your account and get your free Carrot Plan that unlocks your access to additional, exclusive resources.

  1. Go to app.get-carrot.com/signup to create your Carrot account.
  2. Explore your online benefit guide and expert-produced resources.
  3. When you are ready, get your free, personalized Carrot plan to unlock your full benefit.

Get the Carrot Mobile App

After you’ve created your Carrot account at app.get-carrot.com/signup, download the Carrot mobile app to gain access to Carrot’s full suite of resources on the go. Participants everywhere can view their available Carrot Card balance, benefit guide and provider finder or even visit with a Carrot expert from the convenience of their phone or tablet.

Download the app below.

 

Using the Infertility Benefit


Please note the following important considerations applicable to the infertility benefit:

  • All infertility treatments must be considered medically necessary under the terms of the Health Plan and related to a medical diagnosis of infertility to be covered under the Health Plan’s $30,000 lifetime benefit.
  • Infertility treatment must be received from in-network Carrot providers to be eligible for coverage. Infertility treatment received from any provider that is not an in-network Carrot provider is not covered by the Health Plan.
  • All infertility treatment-related prescription drugs must be purchased through Carrot Rx® (fulfilled by Alto Pharmacy) to be covered under the Health Plan’s benefit.

Getting Your Infertility-Related Prescription Medications

Beginning April 1, 2024, all eligible fertility-related prescriptions must be filled through Carrot Rx for your eligible medications to be covered with Carrot funds. CarrotRx has partnered with Alto Pharmacy. Your medications will need to be filled directly with Alto Pharmacy and communication on the status of your prescriptions will be coming from Alto as well. When medications are received, it will state it is from Carrot Rx (powered by Alto) on the box.

If you currently receive your fertility-related medications through a pharmacy other than Carrot Rx, you will have until May 15, 2024 to transition your prescriptions to Carrot Rx. After May 15, 2024, expenses you submit from non-Carrot Rx pharmacies will be denied.

Carrot Rx offers savings of up to 40%, as well as price matching on most fertility-related medications and next-day or same-day delivery when needed. With Carrot Rx, you also get 24/7 access to certified clinicians who can answer any questions you might have about your medications.

For more information about getting your fertility-related medications with Carrot Rx, including frequently asked questions, exceptions to the Carrot Rx-only prescription policy and a step-by-step guide to ordering your prescriptions through Carrot Rx, click here to download a helpful pdf.

Have additional questions about your Carrot benefit?
Visit www.get-carrot.com/employee-support to connect with the Carrot Care Team.