Your partner in family building benefits

Treatment is organized into separate bundles of covered medical, pharmacy, and diagnostic services based on key milestones in your individualized treatment plan. For example, your initial consultation and diagnostics are considered to be one treatment bundle; subsequent procedures like oocyte retrievals and embryo transfers are each considered to be separate bundles. Bundles are subject to copayment and deductible based on the cost-sharing rules of your CalPERS Basic health plan. Your Progyny Care Advocate can walk you through what is included within the bundled services and how bundles may apply to your care. 

• Your out-of-pocket costs will be based on the cost-sharing rules of your CalPERS Basic health plan. 

• You may be responsible for a copayment and deductible based on the cost-sharing rules of your CalPERS Basic health plan. 

• Costs may vary based on your specific Basic health plan and the covered service received. Out-of-network providers and services are not covered.

• Progyny can help you understand how your benefit applies before care begins and guide you on next steps. We recommend you contact us before starting any treatment. 

Elective egg freezing for personal or future planning purposes is not covered under the benefit. Coverage may be available when egg freezing is medically necessary or part of covered family-building treatment and all applicable plan requirements are met. Medical necessity is evaluated using established clinical criteria, including guidance from the American Society for Reproductive Medicine (ASRM) and the American Society of Clinical Oncology (ASCO), as applicable.

Infertility services provided to or on behalf of a gestational carrier or surrogate are covered only to the extent that the services would otherwise qualify as Covered Services under the member’s benefit plan and satisfy all applicable medical necessities, prior authorization, utilization management, provider network, and benefit requirements applicable to the member.  Compensation, agency fees, matching fees, other non-medical expenses or legal advice associated with a surrogate or gestational carrier arrangement or adoption are not covered. 

Your medication is covered under Progyny Rx, which is designed to work seamlessly with your treatment plan. There is only one authorization process, so your treatment and your medication will be authorized at the same time. Progyny partners with leading mail order specialty fertility pharmacies to bring you clinical support and overnight delivery of your medications.

Progyny understands the importance of having diverse perspectives available for our members, and that some members may prefer to work with advocates with a shared gender identity. If you wish to request a male, transgender, and/or non-binary PCA, please make this known during your onboarding call or any time when speaking with your PCA. 

Progyny PCAs speak several languages, and we utilize a medical translation service for real-time (live) telephonic interpretation in over 200 languages. When you call in to speak with a PCA you will have the opportunity to select which language you would like use for the conversation.

A reproductive endocrinologist (REI) is an infertility doctor who primarily focuses on female reproductive health and infertility to achieve a patient’s family building goals. A reproductive urologist (RU) is specialized in male reproductive health and supports male-factor infertility treatments to help an individual or a couple improve their infertility outcomes. Most patients begin their journey with an REI for an initial consultation and to undergo diagnostic testing, so they are better able to understand their family building options. After this step, they may be referred to a reproductive urologist if additional testing is required. A patient may also connect directly with a reproductive urologist (RU) without a referral, pending their specific journey. Your REI and RU must be in-network with Progyny to use your benefit.

We want to ensure that you do not experience any disruption in care during the transition period. If you are currently undergoing or seeking to begin infertility treatment before July 1, 2027, your coverage will be provided by your CalPERS Basic health plan; those services are to be billed to your current health plan and according to their existing infertility coverage guidelines.  

If you are planning to undergo an initial consultation or infertility treatment on or after July 1, 2027, those services are to be billed to Progyny when taking place at a Progyny in-network provider. Let your infertility clinic know that your coverage is changing to Progyny on July 1, 2027. Progyny will coordinate with your clinic to ensure covered services are authorized. Reach out to Progyny once phone lines open on or after June 1, 2027 to notify your PCA before starting services.  

If your current clinic is in the Progyny network, you may continue treatment with that clinic and provider. If not, Progyny will help you transition to an in-network clinic. Your dedicated PCA can assist you with finding an in-network provider once PCAs are available starting June 1, 2027. 

You can search for an in-network provider and find a list of in-network labs at progyny.com/find-a-provider. This search tool includes detailed information for each Progyny in-network clinic, including provider profiles with demographics, infertility sub-specialties, and other unique practice characteristics. When using the provider directory, choose ‘Progyny Fertility & Family Building’ as the Progyny plan to access the list of in-network clinics.

Your coverage includes a lifetime limit of 5 years from the time the genetic material is first cryopreserved when the tissue is stored at an in-network clinic. Additionally, when you’re ready to use your stored tissue, your coverage may cover your treatment plans. The tissue must be stored at a clinic in the Progyny network. Contact Progyny toll-free starting June 1, 2027, Monday through Friday from 6 am – 6 pm PT to learn about the coverage options and next steps. As June 1 approaches, you can return to this page for the CalPERS dedicated phone number to connect with a PCA. The cost of additional years of storage after 5-year limit will be an out-of-pocket expense to you. Separate cryopreservation and storage time limits apply for iatrogenic infertility. 

If your tissue is stored at an out-of-network infertility clinic, your Progyny PCA can guide you through the process. Transportation of tissue is covered by Progyny and subject to copays and cost share, as outlined in your health plan Evidence of Coverage. 

Your coverage includes a lifetime limit of 5 years from the time the genetic material is first cryopreserved when the tissue is stored at an in-network tissue storage provider. Additionally, when you’re ready to use your stored tissue, your coverage may cover your transportation of your tissue and subsequent treatment plans. The tissue must be stored at a tissue storage provider in the Progyny network. Contact Progyny toll-free starting June 1, 2027 to speak to a PCA, Monday through Friday from 6 am – 6 pm PT to learn about the coverage options and next steps. The cost of additional years of storage after the 5 year limit will be an out-of-pocket cost to you. Separate cryopreservation time limits apply for iatrogenic infertility. 

If your tissue is stored at an out-of-network fertility clinic or long-term tissue storage provider, your Progyny PCA will help guide you through the process. Transportation of tissue is covered by Progyny and subject to copays and cost share, as outlined in your health plan Evidence of Coverage.

If your provider recommends a test, medication, or service that is not listed as a covered service under Progyny, please contact a PCA to confirm your coverage and discuss next steps. If the test, medication, or service is not covered by Progyny or your health plan, you may be financially responsible.

For example, cholesterol, Pap smear, HPV, and other tests that are not specific to infertility are not covered by Progyny but still may be covered by your health plan.