Assisted Reproduction Treatment in Health Insurance

Health Insurance Coverage for Assisted Reproduction Treatment

Assisted reproductive technology (ART) is used to treat infertility problems. Assisted Reproductive Technology (ART), a complex and biotechnologically advanced technique which can aid a couple in conceiving when all the other conventional medical and corrective surgical procedures have failed. In vitro fertilisation, IVF is the most common and effective type of ART. The techniques of assisted reproductive technologies can be used for both males and females.

Infertility is an increasing concern in India, with many couples struggling to conceive naturally because of different medical and lifestyle factors. Assisted Reproductive Treatment (ART), like Virto Fertilization (IVF), has become a beacon of hope for those seeking to fulfil their dreams of parenthood. Nevertheless, the financial burden of IVF treatments can be overpowering. This raises the vital question: Is IVF covered under insurance? The answer is yes; many health insurance companies have started offering IVF insurance coverage to support individuals and couples seeking infertility treatment.

Types of Assisted Reproductive Technology

1. In Vitro Fertilization and Embryo Transfer (IVF-ET) – The procedure entails collecting eggs from the ovaries and merging them with sperm in a laboratory setting to create an embryo. After that, the embryo is implanted in the uterus.

2. Gamete Intrafallopian Transfer (GIFT) – The eggs and sperm are mixed in a laboratory dish before being planted in the fallopian tubes.

3. Intrauterine Insemination (IUI) – The procedure involves injecting sperm into the uterus during ovulation in a lab.

4. Zygote Intra Fallopian Transfer (ZIFT) – A method of fertilising a woman’s egg outside of her body and implanting it in one of her fallopian tubes.

5. Intracytoplasmic Sperm Injection (ICSI) – A single sperm is injected into a single egg in a lab dish and the embryo is placed in the uterus.

Financial Cost of ART

ART treatments can be quite costly. The cost of an IVF cycle ranges between ₹1,00,000 to ₹3,00,000 depending on the clinic's charges and the precise protocol of treatment. All these add to the costs of medications such as diagnostic tests, and further cycles.

As a consequence, many individuals and families begin researching health insurance to mitigate some of these expenses.

What is IVF (In Vitro Fertilization)?

IVF, or In Vitro Fertilization, is a medical procedure where the egg is fertilised outside the body in a laboratory petri dish. It is one of the most popular forms of assisted reproductive treatment (ART) for individuals or couples with fertility problems. IVF may involve a series of procedures, including stimulation of the ovaries to release multiple eggs, removal of the eggs, sperm collection, fertilisation, and transfer of the embryo. It may take multiple cycles to be successful in conceiving, which can be costly regarding medical expenses.

The Growing Demand for IVF Insurance in India

Infertility treatment is costly, and IVF is no different. In India, one IVF cycle can cost between ₹1,00,000 to ₹3,00,000 or more, depending on a myriad of factors like the clinic, medical tests, drugs, and procedures involved. With the cost involved, IVF insurance has become a growing necessity for individuals seeking ART, especially since more and more couples are now seeking IVF as a viable solution for their fertility problems.

With this trend, the demand for IVF health insurance policies is growing. Couples are looking for policies that can cover the expense of IVF, as well as associated treatments like sperm or egg donation, surrogacy, and other infertility treatments.

Is IVF covered by insurance?

For years, IVF was never included in general health insurance policies in India. However, as more individuals become aware of fertility and the necessity of infertility insurance, insurers understand the importance of covering IVF procedures. Is IVF covered by insurance? The response is more favourable, as most health insurance companies now cover IVF and other methods for infertility under special policies.

IVF Insurance Coverage in India

Health insurance companies in India have now included IVF insurance coverage in their policies. These policies help cover the medical expenses of IVF, including hospitalisation, doctor consultations, medication, and fertilisation procedures. However, one must be careful about the coverage details as not all policies might provide full IVF insurance coverage.

Here's an overview of what to expect from IVF insurance policies:

Covering IVF Procedures: Insurance policies can cover the expenses of IVF cycles, such as egg retrieval, sperm extraction, and embryo implantation. However, some policies might have a limit on the number of IVF cycles covered, which can vary with the provider.

Add-ons and Riders: Most providers provide IVF health insurance as add-on covers or riders that can be attached to a standard health insurance policy. These riders provide additional coverage for infertility procedures and are particularly beneficial for individuals who need infertility insurance but do not have it as part of their standard policy.

Waiting Period: The insurer may wait 1 to 4 years before paying for infertility treatment like IVF. The waiting period depends on the insurer's policy. Thus, it is necessary to plan and ensure the policy covers IVF when needed.

Age Limitations: Most insurers have age restrictions for IVF coverage. Most often, the cover is available for women between 21 and 40. Beyond this age, some policies do not cover or limit the number of IVF cycles.

Treatment Limitations: Some health insurance policies cover standard IVF procedures but do not cover other procedures like egg or sperm donation, ICSI (Intracytoplasmic Sperm Injection), or surrogacy. Thus, it is important to read policy terms and conditions and understand what is covered under the policy.

Exclusions: Most ordinary health insurance policies exclude IVF as part of the standard cover, especially if the policy does not have specific infertility cover. It's thus essential to select specialist policies or riders that cover ART.

Is Infertility treatment covered under Health Insurance?

Typical Health Insurance plans don’t cover the cost of infertility treatments.

In India, about 27.5 million couples suffer from infertility issues, which includes 1.5% more men than women. Hence, the health experts have pitched for an urgent need to include fertility treatments in Health Insurance plans.

Newly emerging Health Insurance plans include infertility treatment coverage or provide it as an add-on cover.

The scope of the coverage of such Health Insurance plans may differ among insurers. Some insurers may cover only specific infertility treatments. Therefore, it is recommended to check the Inclusions and Exclusions, and the level of coverage for infertility before purchasing one.

The Health Insurance plans covering infertility treatment may offer coverage after the certain waiting period, caps on the treatment expenses or specific sub-limits.

List of IVF treatment procedures covered by Health Insurance

The list below shows the different types of coverage for IVF treatments categorised under Health Insurance.

Full infertility insurance cover
Infertility diagnosis alone covered
Infertility diagnosis and limited fertility treatment cover
Medication coverage (fertility drug prescriptions)
Ensure to check the terms and conditions of the policy to understand the coverage details.

Procedure for Claim

If it is an ART claim, make sure to do the following in case of a claim:

Alert the Insurance Company: Inform the health insurance company regarding the ART procedure. Obtain pre-authorizations if required.

Collect Documents: Treatments and plans, invoices, and reports issued by medical authorities will support your claim.

Submit the Claim: File the claim according to the insurer's rules. Complete documentation avoids delays in the processing of claims.

Star Health Insurance offers Star Women Care Insurance Policy covering the treatment of Assisted Reproduction Treatment. As per the policy, the Company will reimburse medical expenses incurred on Assisted Reproduction Treatment for the sub-fertility subject to a Waiting Period of 36 months from the date of the first inception of the policy. The Company will pay for one Assisted Reproduction Treatment cycle for each policy year. And for the purpose of claiming this benefit, in-patient treatment is not mandatory.