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.

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.

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.