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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, which. 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 copayment and costs for non-covered drugs) are not included in the either the Medical or prescription drug plan lifetime maximum.
Planning Treatments That May Cause Infertility
Covered individuals with a diagnosis of cancer who are planning cancer treatment, or medical treatment for any condition that is demonstrated to result in infertility, are considered to meet the definition of infertility. Planned cancer treatments include bilateral orchiectomy, bilateral oophorectomy, hysterectomy, and chemotherapy or radiation therapy that is established in the medical literature to result in infertility. To use infertility benefits covered under the Plan, you must contact your health care company and work with them and your doctor to determine your appropriate course of treatment.
Coverage is limited to:
  • Collection of sperm;
  • Cryopreservation of sperm, eggs and reproductive tissue;
  • Ovulation induction and retrieval of eggs;
  • In vitro fertilization; and
  • Embryo cryopreservation.
Cryopreservation costs are covered for the period of infertility treatments, which is generally one year. Long-term cryopreservation costs (anything longer than 12 months) are not covered under the Plan
Infertility Diagnostic Services
Diagnostic services to determine or cure the underlying medical conditions are covered in the same manner as any other medically necessary services.