IUI program

I have found lots of cost saving programs for IVF but never for IUI but I ran across one for IUI this week that sounds very promising.

What are your thoughts? I don't wanna get roped into anything that'll cost us.

http://www.winfertility.com/

Dear Patient:
Thank you for your interest in the WINFertilitysm Quality Discount Treatment Program. We know that for most people, having difficulty building a family is an unwelcomed surprise. Fortunately, the field of Reproductive Endocrinology has made miraculous breakthroughs over the last three decades, enabling more people than ever before to become parents. We’re proud to be long-standing contributors to the family-building efforts for thousands of people annually who have achieved a successful outcome and look forward to helping you on your path to parenthood.
WINFertility is neither a provider nor insurer of health care services. Our goal is to offer a network of qualified medical specialists and specialty pharmacies and a management program that makes the pursuit of parenthood more available and more affordable to more people who have no insurance coverage or who have exhausted their benefits. That is the very reason there is no clinical or age qualification to participate in our program. The WINFertility program offers a unique, pricing system that delivers a single, discounted rate for both quality medical treatment and medications for each treatment cycle that we call “bundles”. Our peer-reviewed, evidenced-based treatment protocols, developed over more than a dozen years, use medical procedures that have been shown to have the fastest and most direct route to having a baby. We also know that infertility treatment is complex, stressful and often confusing for patients. An important part of the WINFertility Program is the 24/7 availability of our FertilityCoach Nursessm who will help you understand your treatment options and provide oversight and support, so that you can make the very best decisions about your care.
Your WINFertility reproductive specialist is an exclusive provider of our program in your local marketplace, having attained outstanding treatment success rates, completed our thorough credentialing process and peer-review by our Medical Advisory Board. Our on-going quality review and satisfaction survey system provides patients with additional peace of mind.
Enclosed in this information packet is our program overview, financing information, enrollment form, contract details, frequently asked questions, and a contact information form. Should you have any questions, our knowledgeable Customer Service Team and FertilityCoach Nurses are available at (TOLL FREE) 1-855-705-4IVF (4483), Monday – Friday, 9 am – 7:30 pm EST, or you can email us anytime at info@win-healthcare.com
Our family looks forward to helping you achieve yours. Sincerely,
Lisa Marcus, RN, ASN
Senior Director, Clinical Services

1311 Mamaroneck Avenue, Suite 140 ● White Plains, NY 10605 ● TOLL FREE (855) 705-4IVF (4483)
GETTING STARTED
Four simple steps will get you started with the WINFertility Treatment Program.
 Call WINFertility toll free at 1-855-705-4IVF (4483).
 You will speak with a member of our experienced Customer Service Team. We will find out about
you, your unique situation and your needs. You will have a FREE phone consultation with one of our FertilityCoachsm Nurses, who will answer your questions and concerns about diagnosis, treatment options and your specific plan.
 We will provide an approximate cost of the Treatment Bundle (final quote will be generated when your fertility specialist determines your exact treatment and medication).
 Read the Program Terms and Conditions complete and sign the
WINFertility Enrollment Form.
Enrollment requires a $100 Registration Fee that is credited toward your first purchase of a Treatment Bundle if you become a Program Participant.
 If you are paying the Registration Fee by check or money order, send the Fee with your signed Enrollment Form to WINFertility.
 If you are paying by credit card, call 1-855-705-4IVF (4483). Send the signed Enrollment Form to WINFertility via FAX, email or regular mail.
 WIN will obtain your network fertility physician’s treatment plan.
 We will prepare an exact price quote for your initial Treatment Bundle, which will pay for medical treatments and pharmaceuticals during your first cycle.
 We will mail/email your WINFertility Program Quote and Invoice to you (typically within 3 business days). A similar process will apply for any subsequent treatment cycles you require.
 Review and sign the program quote.
 If you are paying for the Treatment Bundle Fee by check or money order, send the Fee with your
signed Program Quote to WINFertility.
 If you are paying by credit card, call 1-855-705-4IVF (4483). Send signed Program Quote to
WINFertility via FAX, Email or regular mail.
Once your payment is processed, your FertilityCoach Nurse will activate your enrollment. You would then proceed with treatments from your WINFertility physician. When your physician prescribes drugs for you, your FertilityCoach Nurse will contact the Pharmacy to facilitate the processing and shipping of your specific medications order.” QUESTIONS? Contact a member of the Customer Service Team, Monday – Friday, 9:00AM – 7:30 PM, toll free at 1-855-705-4IVF (4483).
1311 Mamaroneck Avenue, Suite 140 ● White Plains, NY 10605 ● TOLL FREE (855) 705-4IVF (4483)
Quality Discount Treatment Program
FREQUENTLY ASKED QUESTIONS
What are the advantages of ‘bundles’?
As infertility treatment is so complex, determining actual costs have been a confusing experience for patients. Because the WINFertility Program consolidates the costs into treatment packages or ‘bundles’, patients have a simpler way to approach and decide on infertility treatments. Discounts of up to 50% off unbundled treatments and medications and pricing predictability offer patients additional peace of mind while pursuing their dreams of building a family.
Why are your prices less expensive than other programs?
WIN is the only Infertility Management Services company that contracts directly with drug manufacturers, specialty pharmacies and Board Certified Fertility Specialists on a large scale that covers thousands of patients annually. We are now able to pass along the volume discount savings and specific dosing management savings directly to patients in the form of single, discounted packages we call bundles. Even if patients require more than one cycle, our WINFertility Treatment Program bundles are less expensive.
I’m 44 years old----do I qualify for your program?
The WINFertility Program is designed to provide greater access to all who require high-quality infertility treatment. There are no clinical or age qualifications to participate. If one of our network physicians determines that you need treatment and you have no insurance coverage, you can enroll in our Program.
Can I just buy the medications through you? Or, can I just get the
treatment through you?
Unfortunately, we cannot separate the treatments from the medications. It is because we bundle both treatment and medications together that we are able to negotiate directly with drug manufacturers, pharmacy distributors and physician practices to keep our costs down and pass along the savings to patients in the form of extremely low pricing.
I am already in treatment with another practice. Can I use your program at my current fertility practice?
WIN signs an exclusive contract with a single practice in a geographic area to offer our WINFertility Program. In order to take advantage of the offer, you would have to be treated by one of our network physicians. Depending where you are in your treatment, it may not be difficult to switch at this point in time. One of our FertilityCoach Nurses can discuss your current situation and provide you with clinical answers that can help you make that decision.
1311 Mamaroneck Avenue, Suite 140 ● White Plains, NY 10605 ● TOLL FREE (855) 705-4IVF (4483)
Do you have a fertility clinic near me?
We are working aggressively to expand our network nationally. If we do not currently have a practice that is commutable or convenient for you, we may be able to make your location a priority for our Provider Network Expansion Team.
Speak to a member of our Customer Service Team for more information.
How is the WINFertility Program different from the multi-cycle treatment plans
with refunds?
The multi-cycle treatment plans that exist today require that you meet certain medical and age criteria to participate and that you pay cash for the program. WINFertility is open to all who require infertility treatment and who have no infertility insurance coverage.
Multi-cycle plans require a significant payment up front for medical treatment only (medication costs run an additional $2,500 - $10,000). The multi-cycle plan costs more than 2 1⁄2 times the charges for a single, bundled attempt with WINFertility (which includes all medications for the cycle).
With the multi-cycle plans, patients may get up to 6 medical treatment attempts for that price (medications extra). If you don’t have a pregnancy or a baby, you receive a partial refund. If you have a successful outcome, you have paid that significantly higher price (approx. 2 1⁄2 times the WINFertility bundled price, medications included).
Multi-cycle plans may be a sensible choice for those who would like a type of ‘insurance plan’, in case they need another IVF attempt. However, with IVF success rates in the 50-70% range, multi- cycle plans might not be the best financial decision for every patient.
The WINFertility Program offers ‘pay as you go’ packages that include treatment and medications and are up to 50% less than the unbundled rates. Should you require another attempt, our discounted packages are still more affordable than paying for multiple cycles that you may never need.
I have some insurance coverage, but it is all so confusing. Can I just submit my bill from you to my insurance company and see what they’ll pay?
The WINFertility Program was developed specifically for people who have no insurance coverage for infertility treatment and for those who have already exhausted their benefits. You will need to investigate your coverage and contact your insurance carrier to learn exactly what treatment and medications your company has elected to cover. Once you have determined what is covered and what isn’t, enrolling in our program is easy and very cost effective.
The WINFertility Program is for cash-paying patients only. It is part of how we are able to negotiate such deep discounts with our physicians, pharmacies and drug manufacturers and pass the savings on to our patients. Participating enrollees must pay in advance for our discount bundles. This component is another way we’re able to negotiate prices that are most favorable to you. So, your best approach is to find out what your insurance is willing to cover, have those treatments paid by your insurance carrier and if you still require treatment and medications, WINFertility is your best option.
1311 Mamaroneck Avenue, Suite 140 ● White Plains, NY 10605 ● TOLL FREE (855) 705-4IVF (4483)
PAYMENT AND PRICING
SIMPLER, DISCOUNTED PRICING
The WINFertility Program uses an innovative pricing approach to simplify the process for patients to make decisions about treatments, medications and costs. We did this by using evidence-based treatment protocols to create “Treatment Bundles” that, for a single discounted price, include the medical treatments and appropriate medication dosages recommended by your fertility specialist for a single treatment cycle.
Bundled pricing enables us to directly contract with drug manufacturers, pharmacies and fertility specialists and pass along these volume discounts to our patients at costs that are up to 50% less than unbundled fee- for-service and retail pharmacy rates.
COST COMPARISON
National Cycle Costs vs. WINFertility Bundle
2011 U.S. average cost per ‘typical’ IVF cycle1 Typical WINFertility Bundle Rate2
WINFertility Patient Savings ($) WINFertility Patient Savings (%)
$ 18,574 $ 11,800
$ 6,774 36.5%
1Source: ASRM study, internal market research via phone and website posting.
2 Prices include all treatments and medications for a single cycle. Your actual cost for the Treatment Bundle(s) you require will be quoted after enrollment in the Program and receipt of treatment plan from the fertility specialist.
CONVENIENT PAYMENT OPTIONS Check
 Enrollees paying by check qualify for the Cash Discount, equal to approximately 2.5% off the Treatment Bundle price.
 Cashiers’ checks and money orders enable treatment to commence immediately.
 Personal checks or check pay-by-phone require 5 business days to clear before treatment may
commence.
Credit Card Payment
 WIN accepts MasterCard, VISA, Discover or American Express.
 Credit Card Payments enable treatment to commence immediately. Financing
 Through a partnership with CitiBank, WIN Enrollees can conveniently finance their treatment
with options including secured loans with a preferred discount and unsecured loans with a
preferred discount.
 To learn more, call the WINFertility CitiBank Account Director at 1-866-422-1432.
1311 Mamaroneck Avenue, Suite 140 ● White Plains, NY 10605 ● TOLL FREE (855) 705-4IVF (4483)
Banking with rewards.
Take your banking relationship to a whole new confidence level.
As a WIN Fertility client, you’ll have access to great banking and lending solutions offered by Citibank through a special program:
■ A Citibank® Account Package with no monthly service or non Citibank ATM fees when you sign up for direct deposit.1
■ Access to a full range of loans and lines of credit
• 1% discount on the APR for Personal Loans2
• 0.1% discount on the variable APR for a Home Equity Line of Credit3
■ Online, telephone and ATM4 access to funds and account information For more information on how to start a relationship with Citibank,
call (866) 422-1432 today.
Terms, conditions, and fees for accounts, products, programs and services are subject to change.
1
2
3
4
As a WIN Fertility client, the monthly service fee and non-Citibank ATM fee are waived for a regular checking account opened in the Citibank Account Package with a monthly direct deposit to the account. Otherwise a monthly service fee of $20.00, and a $2.00 non-Citibank ATM fee, will be charged when minimum balance requirements are not met. All accounts subject to approval. Charges for other account-related services apply. Fees charged by other institutions for your transactions on non-Citibank ATMs are beyond Citibank’s control and are in addition to the fees listed here.
Rates quoted as of 09/09/2011. As a WIN Fertility client, your Annual Percentage Rate (APR) may be as low as 9.49% APR or as high as 24.49% APR. To qualify for the lowest rate, customers must use Citibank Auto Deduct (an automated monthly debit from a Citibank deposit account) for repayment and have a good credit history. If you are in default, your APR may increase by 2.00%. If you borrow $5,000 for 5 years at 9.49% APR, to repay your loan you will have to make 60 monthly payments of approximately $104.98. No down payment is required. To qualify for a Personal Loan, you must have a one month tenure on a Citibank deposit account or a linked CitiMortgage / Citi Credit Card. Loans subject to credit approval.
Rates quoted as of 09/09/2011. As a WIN Fertility client, your Variable Annual Percentage Rate (APR) can be as low as Prime plus 1.64% (currently 4.89% variable APR) and as high as Prime plus 5.89% (currently 9.14% variable APR). For FL and NV properties, Variable APR can be as low as Prime plus 2.14% (currently 5.39% variable APR) and as high as Prime plus 5.89% (currently 9.14% variable APR). For IL properties, Variable APR can be as low as Prime plus 1.39% (currently 4.64% variable APR) and as high as Prime plus 5.89% (currently 9.14% variable APR). To qualify for the lowest rate, customers must use Citibank Auto Deduct (an automatic monthly debit from a Citibank deposit account) for repayment, must meet relationship balance requirements, have a good credit history, meet certain loan-to-value and lien position conditions, and take an initial draw of at least $25,000 at closing. Additional rate discounts may apply. The variable APR is indexed to the Prime Rate as published in the “Money Rates” section of The Wall Street Journal. Maximum APR is 18%. Annual Fee: $50 (not applicable if collateral property is located in TX.) Customers who elect to pay closing costs will receive an additional 0.25% rate reduction. Closing costs can range from approximately $341 to $17,267, except in NY where they can range from approximately $396 to $24,277. Closing costs may vary based upon the line amount, property location and title insurance required. An Early Closure Release Fee may be charged to recover all costs incurred in originating your loan and may apply if you close your account within 36 months (not applicable if collateral property is located in TX.) Property insurance and the fee to release an existing mortgage may be required. Certain limitations apply. Loans subject to credit approval. Rates are subject to change without notice. Applicable for loan sizes up to $1 million. No third lien positions. Home Equity Lines of Credit are available to U.S. residents only. Not available for collateral properties located in Alaska. Not available for investment properties. During the draw period, (i.e., the first 5 years of repayment) your monthly minimum payments can be as low as “interest only,” giving you the flexibility to pay more when you desire. If you choose to pay only the amount of interest due, then at the end of the interest only period you will still owe the original amount you borrowed and your monthly payments will increase because you must pay back the principal as well as interest. Your payment could increase even more if your variable rate increases.
Restrictions may apply.
©2011 Citibank. Citibank, N.A. Member FDIC and Equal Housing Lender. Citi, Citibank, and Citibank with Arc Design are registered service marks of Citigroup Inc. CAW-WIN (9/11)

ENROLLMENT FORM and CONTRACT
WINFertility, Inc.sm (“WIN”) is pleased to offer to you the services of our WINFertilitysm Quality Discount Treatment Program (“Program”). Under the Program, WIN will offer you bundles of medical services and drugs (“Bundles”) that will be provided to you by independent physicians (“WINFertility Physicians”) and pharmacies that participate in our Program. In most cases, each single Bundle will provide all of the medical and pharmacy services you require for a single treatment cycle.
To purchase each Bundle your doctor recommends, you will pay to WIN a single flat price. Depending on tests your doctor will use to determine how well you will respond to infertility medications, the costs of your Bundles will vary. However, Bundles do not cover your entire cost of infertility care. There will be tests, including tests necessary for your physician to determine the recommended Bundle, as well as additional services your doctor recommends, that are not included in Bundles. Bundles do not include any hospital costs, costs of hospital-based providers, or the fees charged by any physicians other than your WINFertility Physician. A given Bundle will only apply to one treatment cycle, and the price you pay will only provide you with drugs and services specifically included in the Bundle. If you need additional doses of a drug covered by the Bundle for that cycle, you will have to buy an additional, lesser cost Patient Monitoring Bundle that will provide the additional drugs and related medical-monitoring services. If you need infertility services or drugs for another treatment cycle, you will need to purchase another Bundle. If you need services or drugs that are not available through a Bundle, you will have to arrange payment directly with your physician practice.
With the WINFertility Program the price you will pay for each Bundle will reflect a significant discount off of the cash retail price uninsured patients would normally pay for the services and drugs included in that Bundle. WIN will pay your doctor and pharmacy for all services and drugs included in the Bundle that they provide to you. Except for the initial purchase price of the Bundle, no co-pays or other out-of-pocket costs will apply to services or drugs in WINFertility’s Bundles.
Please carefully read the Disclosures made below, as well as the attached Terms and Conditions and Descriptions of Bundles. To enroll in the Program, please complete, submit and sign this Enrollment Form.
DISCLOSURES
 A Bundle applies to only one treatment cycle.
 Purchase of a Bundle is payment only for those drugs and infertility services specifically included in
the Bundle. If you need additional drugs or services, you will have to purchase an additional, lesser cost Patient Monitoring Bundle, or for services or drugs not available through Bundles, pay the provider on an out-of-pocket, fee-for-service basis.
 WIN is not an insurer, and the Program does not constitute insurance. WIN only arranges for you to receive the services and drugs that are included in the Bundles you purchase.
 WIN is not a provider of medical services or a dispenser of pharmaceuticals. WINFertility Physicians are not WIN’s employees, but are private practicing physicians who join our provider network as independent contractors. WIN is a facilitator that arranges for certain services and pharmaceuticals for its Enrollees, often at a discounted rate. WIN does not carry professional malpractice insurance, and does not direct or control the WINFertility Physicians’ professional medical judgment.
 WIN pays contracted WINFertility Physicians and WINFertility Pharmacies from the price you pay for the Bundle. WIN retains a portion of the price you pay for the Bundle as compensation from you for WIN’s administration of the Program.
 Your physician may determine that the services or drugs offered in the Bundles are not right for you. In that case, you will need to arrange for your infertility care directly with your physician.
Form DC-EFC - rev. 09/26/2011

Section 1. Enrollee Information
Name (including MI): _________________________________________________________________ Address: ____________________________________________________________________________ City: ______________________________________ State: ___________________ Zip: __________ Date of Birth: _______________________________ Primary Phone: ___________________________ Alternate Phone: _____________________________
Email Address: _______________________________________________________________________ Preferred means of contact above: ________________________________________________________ Alternative Contact: ___________________________________________________________________
Section 2. Certification of No Infertility Insurance Coverage (check one)
Enrollee has no health care insurance at this time.
Enrollee’s health care insurance does not cover either medical care or drugs for infertility. Enrollee has exhausted her health care insurance for both infertility medical services and drugs.
Section 3. Payment of Non-refundable Enrollment Fee: $100.00, which will be credited to the purchase of your first Bundle.
Payment Information:
Check (enclosed) Money Order (enclosed)
Credit Card: Please call TOLL FREE 1-855-705-4IVF (4483).
Before signing this enrollment form, please carefully read the attached Terms and Conditions. By signing this form, Enrollee agrees that the attached Terms and Conditions are expressly made a part of this enrollment form, and that together they will form the terms of a binding contract between Enrollee and WIN. Contract for enrollment in the Program will be confirmed when a fully signed copy of this form is returned to you by WIN.
Enrollee’s Signature__________________________________________Date: ______________
TO BE COMPLETED BY WINFertility:
Enrollment Accepted, effective: ____________________ (“Effective Date”)
WINFertility Physician Group: ______________________________________________ SIGNATURE: WINFERTILITY, INC.
____________________________________________________
This contract may be executed in any number of counterparts, each of which when so executed shall be deemed an original and all of which together will constitute one and the same instrument, binding upon all parties hereto, notwithstanding that all of such parties may not have executed the same counterpart. Delivery by facsimile or electronic mail of an executed counterpart of a signature page to this contract shall be effective as delivery of an original executed counterpart of this contract.
Form DC-EFC - rev. 09/26/2011

Terms and Conditions of Program Contract
Enrollee and WIN agree as follows:
1. Enrollment. Enrollee hereby enrolls in WINFertilitysm Quality Discount Treatment Program (“Program”). The terms, conditions and costs that apply to the Program are described below.
2. Description of Program.
A. Each Enrollee in the Program will have the opportunity to purchase WIN’s infertility service bundles (“Bundles”). Each Bundle will provide Enrollee with medical infertility treatments from a Reproductive Endocrinologist who is an independent contract with WIN to participate in the WINFertility network (the “WINFertility Physician”) and drugs prescribed in conjunction with infertility treatments from a specialty pharmacy in the WINFertility network (the “WINFertility Pharmacy”). By packaging the medical and pharmacy care into Bundles, Enrollee will pay less than the standard retail market price for the same bundle of services. To participate in the Program, Enrollee must accept and pay for each Bundle in advance. However, Enrollee will never be obligated to make any additional purchases from WIN. Enrollee may elect to stop purchasing Bundles at any time, although payments for Bundles already purchased will not be refunded. Unless an additional Bundle is purchased after Enrollee’s previous Bundles are exhausted, Enrollee will leave the Program and become solely responsible for arranging and paying for any infertility treatments Enrollee may elect to have. However, Enrollee may elect to re-enter the Program at any time, with no additional Enrollment Fee.
B. Enrollee’s WINFertility Physician will recommend the Bundle(s) that Enrollee requires. In most cases, each single Bundle will provide all of the medical and pharmacy services that are required for a single treatment cycle. However, because this is not an insurance program, WIN must place a maximum limit on the services and drugs included in each Bundle. Therefore, on occasion Enrollee’s WINFertility Physician may determine that an additional or supplementary Bundle is required for completion of a given cycle. In addition, Bundles do not include all of the services that Enrollee will need (see “What is Excluded from Bundles,” below). Enrollee understands that (i) the Program does not provide medical insurance and only provides the specific set of services that the Enrollee pays for, (ii) Enrollee will be responsible for paying in advance for each Bundle that Enrollee requires, and (iii) Enrollee will also be responsible for paying separately for any services that are not included in the Bundle that Enrollee purchases.
3. What is Included in a Bundle. The medical services and drugs included in each Bundle are described on Attachment A. WIN reserves the right to change the number, composition or price of Bundles at any time, which changes shall be effective without prior notice. However, except for delays caused by cancelled cycles, no change will affect any Bundle that Enrollee has already purchased.
4. What is Excluded from Bundles. Enrollee understands that services not expressly listed in the description of a Bundle are excluded, and are not covered by Enrollee’s payment for that Bundle. Excluded services (that Enrollee will be required to receive and pay for separately) also include, but are not limited to: (a) Prescreening tests; (b) anesthesia; (c) hospital charges (rare, but may be incurred in the rare event an admission is needed for a complication of medications or medical procedures such as infection, bleeding or severe ovarian hyper- stimulation syndrome); (d) medical and facility costs of surgical procedures, such as operative laparoscopy, D&C, cyst aspiration, that are not in-vitro fertilization procedures; (e) if donor sperm
Form DC-EFC - rev. 09/26/2011

is being used, the cost of the samples; (f) if donor eggs are being used, all charges for recruiting, screening, including any fees paid directly to the donor (if applicable); and (g) cryopreservation and storage of embryos. If Enrollee requires any such excluded services, Enrollee will be required to separately pay the charges of the provider of such excluded services directly to the provider. Excluded services are not part of the Program, and will not be arranged or paid for by WIN.
5. How the Program Will Work.
A. Selection of WINFertility Physician. Upon acceptance of Enrollee’s enrollment in the Program, WIN will facilitate Enrollee’s selection of a compatible WINFertility Physician. If Enrollee was referred to the Program by a WINFertility Physician, Enrollee will remain under that WINFertility Physician’s care.
B. Arranging for Testing (cost not included in Program). Enrollee’s WINFertility Physician will provide an initial workup and develop Enrollee’s personalized treatment plan. The workup will, at the outset, include a number of basic tests that will be needed for both partners. Some additional testing may be required in specific situations and/or between treatment cycles. The cost of testing is not included in the Program or any Bundle, and it is the responsibility of the Enrollee to pay the provider directly at the time of testing.
C. Medical and Pharmaceutical Infertility Treatments. Enrollee’s WINFertility Physician will determine the Bundle for the initial infertility treatment cycle and each subsequent treatment cycle that is recommended for Enrollee based on Enrollee’s test results and diagnosis. Before each cycle begins, WINFertility will send a Bundle Purchase Statement that specifies the Bundle determined by the WINFertility Physician, and includes an Invoice for the price of the Bundle. Enrollee must sign and return the Bundle Purchase Statement, together with payment (or credit card authorization) to WIN before the WINFertility Physician will commence the treatment cycle. All payments for Bundles under the Program must be made only to WIN, and not to the WINFertility Physician or WINFertility Pharmacy. WIN will not give any credit or otherwise have responsibility for payments for treatments or drugs included in a Bundle, if the payment is made to the physician, pharmacy or anyone other than directly to WIN. WIN will pay Enrollee’s WINFertility Physician and the WINFertility Pharmacy directly for all services and drugs included in the Bundle that are provided to Enrollee during the cycle. Enrollee will not be charged any co-pays or other out-of-pocket costs for services that are included in the Bundle purchased by Enrollee.
D. Cancelled/Delayed Cycles. Treatment cycles are cancelled on occasion, which may be for medical or other reasons. If Enrollee has purchased a Bundle and that cycle is cancelled, that unused Bundle may (if suitable) be used later if the cancelled cycle is rescheduled. Should Enrollee delay using a purchased Bundle due to a cancelled cycled or for any other reason, Enrollee will be responsible for any increase in Bundle prices that occurs during the period of such delay. WIN does not guarantee that it will be able to arrange for the services or drugs included in such Bundle if the Bundle is not fully used within ninety (90) days after it was purchased, in which case WIN shall have the right to cancel the unused portion of the Bundle. Subject to WINFertility’s Cancellation Policy in effect from time to time, WIN will credit the Enrollee for the unused portion of the medical services and drugs included in a purchased Bundle if (i) a cancelled cycle is not rescheduled, (ii) the Bundle was already partially used during the cancelled cycle, (iii) the Bundle is not appropriate for the rescheduled cycle, or (iv) WIN cancels a Bundle that was not fully used within 90 days of purchase. However, no credit will be given for drugs that were dispensed or services of the WINFertility Physician that occurred prior to the cancellation.
6. Limitations. WIN facilitates Enrollee to obtain necessary medical care from their WINFertility Physician and infertility drugs from the WINFertility Pharmacy. Neither WIN nor WINFertility provide professional medical services or pharmacy services, and no physician-patient relationship is created between Enrollee and WINFertility by this Agreement. Enrollee
Form DC-EFC - rev. 09/26/2011

shall address all Program medical questions, and seek all Program medical services exclusively from the WINFertility Physician, who shall be solely responsible for Enrollee’s infertility medical care under the Program. Enrollee acknowledges that (a) WINFertility and WIN do not employ the WINFertility Physicians, who are independently contracted physicians maintaining their own private practices and malpractice insurance and, therefore, (B) WINFertility and WIN do not carry malpractice insurance.
7. No Guarantees. Enrollee understands and agrees that neither WIN nor any WINFertility Physician makes any representation or guarantee that treatments under the Program will be successful in enabling Enrollee to become pregnant or achieve any other goals that may apply to treatments. All medical services, including those facilitated by WIN Fertility and WIN, entail risks. Enrollee agrees to discuss all aspects of care with the WINFertility Physician as part of the informed consent process. Enrollee agrees that neither WIN nor WINFertility is responsible for obtaining informed consent for treatments, and that all treatment decisions shall be made solely by Enrollee in conjunction with consultations with Enrollee’s WINFertility Physician.
8. Representations. Enrollee represents and warrants the she (and her spouse/partner, if applicable) has received a fair and reasonable explanation of the Program, understands how the Program will operate and the cost for which Enrollee will be responsible, and has had an opportunity to discuss the Program with a WIN or WINFertility representative and to have all Enrollee’s questions fully answered. Enrollee understands that the Program is only available to persons who have no coverage for infertility services under a health plan, or who have exhausted any such coverage. Enrollee represents that no such coverage exists as of the date of this Agreement. Enrollee specifically understands and agrees that having indemnity coverage that pays infertility benefits to the Enrollee is a violation of the Terms and Conditions of the Program, and that the WINFertility Physician will have no obligation to provide any information that would enable Enrollee to submit claims for any such non-disclosed insurance. If in the future Enrollee becomes covered for infertility treatments by a health plan, Enrollee shall notify WINFertility, and Enrollee’s enrollment in the Program will terminate. However, no refund for any Bundle purchased by Enrollee will be made. Enrollee has read and understands all the Disclosures made on the first page of the Enrollment Form, and acknowledges and agrees that all such Disclosures are part of the Terms and Conditions of the Program contract.
9. Miscellaneous. This Agreement -- consisting of the Enrollee’s Enrollment Form, these Terms and Conditions, and Attachment A -- contains the entire agreement between the parties related to the subject matter hereof, and supersedes any prior written or verbal understanding related thereto. This Agreement is solely between WIN and Enrollee, and does not make any other person a beneficiary hereof with contractual rights against WIN. Enrollee shall indemnify and hold harmless WIN from any claim (including legal fees and costs) brought by any third party arising from Program services or any other services under this Agreement. This Agreement can be changed only with a written amendment signed by both Enrollee and WIN. This Agreement shall be governed by the laws of ___________ (enter state where Physician is located), without giving effect to its choice-of-laws or conflict-of-laws principles. No presumption based on which party drafted this Agreement shall be applied in determining either party’s rights hereunder. Disputes arising out of this Agreement shall be brought exclusively in a court of proper jurisdiction located in _____________________ (enter county and state where Physician is located). Under no circumstances shall WIN be liable to Enrollee for punitive, exemplary, indirect or special damages.
Form DC-EFC - rev. 09/26/2011

Attachment A WINFertility Bundle Inclusions
IVF Cycle Bundles
Medical Services in Bundles
 Transvaginal gyn ultrasounds
 Estradiol
 FSH
 Progesterone
 hCG/ pregnancy tests
 Oocyte retrieval
 Oocyte retrieval ultrasonic guidance
 Oocyte identification from follicular fluid
 Sperm wash
 Insemination of oocytes
 Culture of oocyte(s) / embryo(s)
 Assisted embryo hatching, microtechniques (any method)
 Preparation of embryo for transfer
 Embryo transfer
 ICSI
Medications in Bundles
You may receive some or all of the medications based on your Physician’s treatment plan.
 Leuprolide
 Follistim AQ
 Pregnyl
 Progesterone
 Ganirelix/Antagon
 Menopur
 Ovidrel
 Endometrin
As needed:
 Clomiphene Citrate
 Tetracycline
 Doxycycline
 Generic Zpack
 Generic Estrace
 Medrol
 Aspirin
 Needles
 Syringes
 Alcohol Swabs
 Sharps Container
Note: Physician chooses suppression type (e.g. Leuprolide or Ganirelix), trigger agent (e.g. Pregnyl or Ovidrel) and luteal support (Endometrin or Progesterone). Based on your reaction to the medications, your physician may indicate you require additional medication doses. As a result, you may incur additional charges if the amount exceeds the maximum dosages included in the prescribed bundled package.
Form DC-EFC - rev. 09/26/2011

Attachment A WINFertility Bundle Inclusions
IUI Cycle Bundles
Medical Services in Bundles
 Transvaginal gyn ultrasounds
 Estradiol
 FSH
 Progesterone
 hCG/pregnancy tests
 Intra-uterine insemination
Medications in Bundles
You may receive some or all of the medications based on your Physician’s treatment plan.
 Follistim AQ
 Menopur
 Pregnyl
 Ovidrel
As needed:
 Clomiphene Citrate
 Tetracycline
 Doxycycline
 Generic Zpack
 Generic Estrace
 Medrol
 Aspirin
 Needles
 Syringes
 Alcohol Swabs
 Sharps Container
Note: Physician chooses trigger agent (e.g. Pregnyl or Ovidrel).
medications, your physician may indicate you require additional medication doses. As a result, you may incur additional charges if the amount exceeds the maximum dosages included in the prescribed bundled package.
Based on your reaction to the
Form DC-EFC - rev. 09/26/2011

Attachment A WINFertility Bundle Inclusions
Frozen Embryo Transfer Cycle Bundles
Medical Services in Bundles
 Transvaginal gyn ultrasounds
 Estradiol
 Progesterone
 Thawing of cryopreserved embryo(s)
 Preparation of embryo for transfer
 Embryo transfer
Medications in Bundles
You may receive some or all of the medications based on your Physician’s treatment plan.
 Endometrin
 Progesterone
As needed:
 Generic Estrace
 Needles
 Syringes
 Alcohol Swabs
 Sharps Container
NOTE: Based on your reaction to the medications, your physician may indicate you require additional medication doses. As a result, you may incur additional charges if the amount exceeds the maximum dosages included in the prescribed bundled package.
Form DC-EFC - rev. 09/26/2011

CYCLE CANCELLATION POLICY
Certain variables within the fertility treatment cycle (including over-response or under-response to the medications) may require the cycle to be cancelled. Management (including cancellation) of your cycle is determined solely between you and your physician, based on the criteria your physician uses during the cycle monitoring process to determine a treatment cycle that is safe and as effective as possible for you.
WIN’s Cancellation Policy applies to the following six situations, each of which depends on the Treatment Bundle you have purchased and the timing of the cancellation.
 Cancelled at baseline (IUI Bundle). This type of cancellation is done prior to the patient taking any stimulation medications and typically occurs because of an elevated hormone level or ovarian cyst discovered during the initial cycle monitoring (e.g., lab test or ultrasound).
 Cancelled after medication (IUI Bundle). This type of cancellation is done after your medication has been started and is typically necessitated because of an over- or under-response to the medications.
 Cancelled at baseline (IVF Bundle). This type of cancellation is done prior to the patient taking any stimulation medications and typically occurs because of an elevated hormone level or ovarian cyst discovered during the initial cycle monitoring (e.g., lab test or ultrasound).
 Cancelled before retrieval but after medication (IVF Bundle). This type of cancellation is done after your medication has been started and typically occurs because of either an over- or under-response to the medications.
 Cancelled after the retrieval (IVF Bundle). This type of cancellation is done, for example, when there has been no transfer after retrieval due to poor or no fertilization of the oocytes or hyper-stimulation of the ovaries.
 Cancelled frozen embryo transfer (FET Bundle). This type of cancellation is done, for example, when there has been no transfer due to poor endometrial response to the medication or failure of the embryos to survive the thawing process.
For any of the above six types of cancellations, you may elect to receive either a refund or a credit toward the next cycle. If the cost-effective credit is selected, the unused portion of the Treatment Bundle you purchased, less a minimal processing fee, will be applied to the cost of the Treatment Bundle for your next cycle. If you elect to receive a refund, the unused portion of the Treatment Bundle you purchased, less an administrative fee, will be refunded to you, but you would need to pay the full price of the required Treatment Bundle for any future cycle arranged by WINFertility.
Whether you choose a credit or a refund, the unused portion of the Treatment Bundle you purchased will be determined by WINFertility, based on outcome-of-service information provided by your WINFertility Physician. WINFertility will pay Network Physicians and/or Pharmacies directly for their respective services, and will then notify you of your credit or pay refunds, as applicable, in most cases within 7 days after receipt of the physician’s information. Refunds will be paid in the same method of payment you used to pay WIN, e.g. check, credit card, etc. Refunds or credits for any cancellation or withdrawal from the Program that is not covered by one of the six situations described above are at WINFertility’s sole discretion.