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How to File Claims
Rules regarding claims depend on whether you use a WINFertility in-network provider or an out-of-network provider, as shown below:
Provider
Claims Process
WINFertility In-Network Provider
If you use a WINFertility in-network provider, you will have the associated costs automatically processed by WINFertility as the services are received, up to the lifetime maximum. This means you won't have out-of-pocket costs for services provided by the WINFertility provider and will not have to submit claims for reimbursement. Ancillary services prescribed by the WINFertility provider to outside labs, facilities, or providers may not be payable directly by WINFertility, but would be eligible for reimbursement.
Out-of-Network Provider
If you use an out-of-network provider, you will pay for those services out-of-pocket and then submit a request for reimbursement of eligible services to WINFertility, up to the lifetime maximum. Claims must be submitted within six months of when the eligible expenses are incurred.
Please see "Where to Submit Claims" for your claim administrator's phone and address information.
Your request for reimbursement must include the following:
  • A complete WINFertility Out-of-Network Reimbursement Form which can be found on parents@jpmc;
  • An itemized statement or claim form indicating the description of services, dates incurred, amounts, and name of the patient/person receiving the fertility services;
  • Proof of payment.
Separate claim forms must be submitted for each family member for whom a claim is made.