Does Sentara Health Plans cover IVF?
What Sentara Health Plans (Virginia, formerly Optima Health) publishes about covering IVF and other fertility treatment, in its own words, with the document each statement is in.
- Documents read · checked 21 h ago
Only if your employer added it. Sentara's 2026 large group evidence of coverage says fertility treatments, including assisted reproduction and the tests and drugs that support it, are not covered unless a rider lists them, and names IVF and artificial insemination among infertility services it does not cover otherwise; it covers diagnosing and treating the conditions behind infertility, with pre-authorization. Its 2026 individual and family plans exclude assisted reproduction and fertility drugs with no rider. Its federal employee plan covers IVF.
What Sentara's documents say
Read on Oct 26, 2026. The words in quotation marks are the source's own.
Only if your employer added a rider; not on individual plans
“Fertility treatments including assisted reproductive technologies (ART) and any diagnostic tests or drugs to support ART are not Covered Services unless listed as a Covered Services under a rider.”
“Unless listed as a Covered Service in this EOC, or under a rider, Infertility Services listed below are not Covered Services:”
“Member-specific benefits take precedence over medical policy and benefits may vary across plans.”
What the employer plans exclude without a rider
IVF programs, artificial insemination or any other artificial means of conception, and storing reproductive material; infertility drugs are excluded unless a plan rider lists them.
“In-vitro Fertilization programs;”
“Artificial insemination or any other types of artificial or surgical means of conception;”
“Reproductive material storage;”
“Infertility drugs are excluded from Coverage unless listed as a Covered Service under a Plan rider.”
Diagnosis is covered
Covered services are limited to diagnosing and treating the conditions that cause infertility, and they need pre-authorization.
“Covered Services are limited to the following services to diagnose and treat underlying conditions resulting in Infertility:”
“INFERTILITY SERVICES Pre-Authorization is Required”
Who counts as infertile
Unable to conceive after 12 months of unprotected intercourse or donor insemination under 35, or six months over 35.
“INFERTILITY means that the Member is unable to conceive or produce conception after 12 months of unprotected intercourse or therapeutic donor insemination in women younger than 35 years or within 6 months in women older than 35 years”
Self-funded employer plans
Sentara administers, but does not underwrite, large group self-funded plans, whose employer sets the benefits; its medical policies say member-specific benefits take precedence.
“Large group self-funded health plans and BusinessEDGE® plans are administered but not underwritten by Sentara Health Administration, Inc.”
“Member-specific benefits take precedence over medical policy and benefits may vary across plans.”
Sentara plans we read
Three plan lines with three different answers.
Large group employer plans (POS and HMO, 2026)
Only with a riderAssisted reproduction, IVF and insemination are not covered unless the employer's plan adds them by rider.
“Fertility treatments including assisted reproductive technologies (ART) and any diagnostic tests or drugs to support ART are not Covered Services unless listed as a Covered Services under a rider.”
Individual and family plans (2026)
IVF not coveredAssisted reproduction and the tests and drugs that support it are not covered, and infertility drugs are excluded.
“Fertility treatments including assisted reproductive technologies (ART) and any diagnostic tests or drugs to support ART are not Covered Services.”
“Infertility drugs are excluded from Coverage.”
Federal employees (FEHB HMO, Northern Virginia, 2025)
IVF, 3 a yearAssisted reproduction including IVF, limited to three a year, and artificial insemination, three a year, with precertification and 20% coinsurance; fertility preservation before a treatment that causes infertility, with up to 12 months of storage.
“Assisted Reproductive Technology (ART)-Limited to 3 per year”
“Artificial insemination-Limited to 3 per year”
“Note: Precertification is required. See Section 3.”
“Includes short-term storage coverage while the member is undergoing therapy (up to 12 months)”
Whether your Sentara Health Plans plan covers IVF
The Sentara Health Plans policy says how it pays for IVF when a plan includes it. Three things decide whether yours does.
- 1.Your employer's choice
Most people with Sentara Health Plans coverage get it through work, and the employer picks the benefits. About 50% of employers with 500 or more workers now cover IVF.
- 2.Your plan type
A fully-insured plan follows the law of the state it is issued in. A self-funded plan, which 67% of covered US workers have, does not: it covers whatever the employer chose.
- 3.Your state's law
Some states require fully-insured plans to cover IVF, some require insurers only to offer it, and most require nothing. Your state's line is below.
What specific employers publish about their fertility benefits, including which insurer or benefit company runs them: companies that cover IVF.
Does Sentara Health Plans cover IVF in Virginia?
Virginia's insurance law applied to a Sentara Health Plans plan issued there. A state law reaches plans issued in that state, usually your employer's state, not where the clinic is.
Sentara Health Plans in Virginia
Not because of state law: Virginia has no law requiring private plans to cover IVF, so IVF under a Sentara Health Plans plan there depends entirely on what the employer chose (or, for a plan you buy yourself, on the plan's own terms). Virginia law and clinics
State laws as summarized by RESOLVE Insurance Coverage by State, read Oct 1, 2026.
How to see what your Sentara Health Plans plan covers
A policy or program page is a summary. Your own plan's documents are what it pays by.
- 1On a plan through work, ask HR whether your plan has an infertility rider: without one, IVF is not covered.
- 2Read your Schedule of Benefits and evidence of coverage, and call Sentara Member Services with questions.
- 3Get pre-authorization for infertility services before treatment.
Sentara Health Plans and IVF: common questions
Does Sentara Health Plans cover IVF?
Only if your employer's plan adds it by rider, its 2026 large group evidence of coverage says. Its 2026 individual and family plans exclude assisted reproduction, IVF included, and fertility drugs.
Does Optima Health cover IVF?
Optima Health is now Sentara Health Plans. Its 2026 employer plans cover IVF only with an infertility rider, and its individual plans exclude it.
Does Virginia require insurance to cover IVF?
No Virginia law requires private plans to cover IVF, so a Sentara plan covers it only if your employer adds it.
- Sentara Health Plans Point of Service (POS) Large Group Evidence of Coverage (form LGPOSEOC.2026) (Sentara Health Plans, Effective Date: 01/01/2026)
- Not Medically Necessary, Experimental, Investigational and Unproven Guidelines, Medical 348 (Commercial) (Sentara Health Plans, Effective Date 1/1/2026)
- Sentara Health Plans Medical Policies (provider site) (Sentara Health Plans, current page, copyright 2026)
- Sentara Standard Individual and Family Plan (Off Exchange) HMO Evidence of Coverage (form IHMOEOC.26), Section 6 Infertility Services (Sentara Health Plans, Plan year 2026 (benefit summaries: effective beginning on or after 01/01/2026))
- Sentara Health Plans 2025 FEHB brochure RI 73-910 (HMO High Option, Northern Virginia), Section 5(a) Infertility services (Sentara Health Plans, Plan year 2025)