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. Infertility services are subject to a $20,000 combined lifetime maximum benefit for each covered individual (yourself and/or your spouse/domestic partner). This limit applies to all benefits combined in a lifetime, and applies regardless of whether the services were received in-/out-of-network or outside the United States or under a U.S. domestic Medical Plan such as Option 1, Option 2 and the Medicare Indemnity and under prior U.S. medical plans of JPMorgan Chase (such as the Point of Service High/Low and the Consumer Driven Health Plan) and the medical plans of a heritage organization that was acquired by JPMorgan Chase. This limit does not apply to the diagnosis of infertility and/or its cause. All procedures and access will be governed by Cigna Global Health Benefits' protocols for determining appropriateness of care. Please Note: In order to receive benefits for infertility services, you must contact Cigna Global Health Benefits and receive precertification before obtaining services.
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. In order to use infertility benefits covered under the Plan, you must notify your health care company and meet the following eligibility criteria:
- Covered individuals or their partners must not have undergone a previous elective sterilization procedure, (e.g., hysterectomy, tubal ligation, vasectomy), with or without surgical reversal, regardless of post reversal results;
- Covered individuals must have had a day 3 FSH test in the prior 12 months if under age 35 or in the prior six months if age 35 or older;
- Day 3 FSH level of a female covered individual must not have been greater than 15 mIU/mL in any (past or current) menstrual cycle, regardless of the type of infertility services planned (including donor egg, donor embryo or frozen embryo cycle); and
- Only those infertility services that have a reasonable likelihood of success are covered.
- Coverage is limited to:
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.
Diagnostic services to determine or cure the underlying medical conditions are covered in the same manner as any other medically necessary services.