Infertility Treatment Procedures
There are special covered procedures that induce pregnancy but do not treat the underlying medical condition. They include (but are not limited to) artificial insemination and in vitro fertilization.
If you are enrolled in the JPMC Medical Plan, you and your covered family members can receive help from WINFertility nurses with selecting a high-quality provider, understanding treatment options, and receiving clinical and emotional support. Enroll with WINFertility and complete a nurse consultation to have access to a $30,000 medical lifetime maximum benefit ($10,000 medical benefit if you do not engage with WINFertility). Medical benefits (e.g., provider network, claims administration) will continue to be managed by your health care company — Aetna or Cigna. Prescription drug benefits are managed by CVS Caremark.
This lifetime limit does not apply to the services used to determine the initial diagnosis of infertility and/or its cause. All procedures and access will be governed by the health care company's clinical policies for determining appropriateness of care. Please also see the "Infertility Drugs" information under "What's Covered and Not Covered" for information on a $10,000* lifetime maximum on prescription drugs related to infertility treatment. Please contact your health care company for specific details.
Please Note:
- To receive benefits for infertility services, you must contact your health care company and receive precertification before obtaining services.
- To have access to the $30,000 medical lifetime maximum you must enroll with WINFertility and complete a nurse consultation
* The lifetime maximum for prescription drugs under the infertility benefit includes the charges paid by the Plan. Your prescription drug out-of-pocket expenses (dollars you pay towards the deductible, coinsurance/copayment and costs for non-covered drugs) are not included in the either the Medical or prescription drug plan lifetime maximum.