Does Health Insurance Cover Fertility Treatments?

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According to the Indian Society of Assisted Reproduction, India is home to at least 27.5 million infertile individuals, men and women alike. These individuals or couples may require the help of assisted reproductive techniques (ARTs) to have a child of their own.

Infertility treatments like IVF, IUI, etc., are generally expensive and many couples might find it difficult to pay for them. This is where the insurance policies provided by insurance agencies will be of great help to them. 

Couples seeking infertility treatments can avail the health insurance policies provided by the agencies and cover most costs of the treatment. This article discusses in detail what treatments are covered by the policies and the types of insurance policies for infertility treatments.

Does Insurance Cover Infertility Treatments?

Infertility is a major issue all over the world, and the cost for treatments is also undeniably high. The average cost of fertility treatments in India ranges somewhere between INR 1 Lakh to INR 4 Lakhs. This is also considering the fact that fertility treatments do not always successfully get a couple pregnant.

Regardless of all these issues, not all insurance plans cover fertility treatment costs. But in the last years, considering how so many millions of people suffer infertility and cannot pay for the treatments, some insurance agencies have come forward to offer insurance coverage for certain fertility treatments. 

These fertility plans are either included in the patient’s base policy or offered as add-on coverage. Some agencies also include fertility treatments under maternity coverage.

It is important to note that not all fertility plans offer comprehensive coverage. It is best to go through the plans before deciding on buying one.

Infertility Treatments Covered by Health Insurance

These fertility coverage plans come under the patients’ health insurance plans, and not all the procedures involved in fertility treatments come under them. An infertility treatment plan may cover the following treatments.

  • In Vitro Fertilization (IVF): It involves collecting mature eggs and sperm from the female and male, respectively, and fertilizing them in a laboratory under artificial conditions.
  • Intrauterine Insemination (IUI): It involves collecting healthy sperm from the male and inserting it directly into the uterus for fertilization. 
  • Gamete Intrafallopian Transfer (GIFT): It involves mixing the eggs and sperm in a laboratory dish and planting them in the fallopian tubes.
  • Intracytoplasmic Sperm Injection (ICSI): It involves picking a single, healthy sperm and injecting it directly into the egg’s cytoplasm for fertilization. 

Types of IVF Insurance Coverage

Based on the extent of the coverage offered by each plan, patients can buy four different health insurance plans for IVF treatments. Patients can go through these four coverage options and decide which one suits them best.

Insurance for infertility diagnosis only

This insurance policy only covers the cost of diagnosing infertility. They do not cover the cost of IVF treatments but involve any surgery or other procedures needed to diagnose infertility.

Insurance for infertility diagnosis and limited fertility treatments

This policy covers the cost of infertility diagnosis and other minor treatments that come under IVF, like oral or injected medications.

Insurance for medications (can possibly include fertility drug prescriptions)

This policy covers the cost of the medications prescribed by the fertility doctor. It may also include coverage of the drugs prescribed for infertility.

Full infertility insurance coverage

As the name suggests, this policy covers the entirety of the IVF treatment. Some agencies may also offer IVF health insurance benefits in their policies. It is important to read through the policy before choosing it to understand how many cycles of IVF treatments the policy covers.

Things to Check Before Choosing Health Insurance for Infertility Treatments

Before choosing which health insurance policy to buy for infertility treatments, one should read the terms and conditions listed by the agency to understand what the policy entails and what the requirements are to apply for it.

Here are some things one must check before buying insurance coverage for infertility treatments.

  • Who is eligible to apply for the policy?
  • How long should one wait to avail the policy? It can range between 2 to 6 years. 
  • How much cost is covered under the policy? This is for both infertility diagnosis and treatments. 
  • What treatment procedures are covered under the policy?
  • What are the sub-limits and extent of the policy?
  • Are there any add-ons for any infertility treatment expenses?

Infertility results when either or both partners have problems with their reproductive systems. There are many causes of infertility in both males and females. Below are some known causes of female and male fertility problems.

Conclusion

Infertility is a growing issue that is affecting individuals all over the world. With the number of people seeking infertility treatments increasing, the need for health insurance and other policies to cover the cost of treatments is also increasing.

There are several health insurance plans in India that cover fertility treatments for couples who are unable to birth a child naturally. They can research and buy the policy that suits their needs and realize their dream of having a family.

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Dr. Rukkayal Fathima

Dr Rukkayal Fathima, India's Leading Gynaecologist and the best fertility doctor in Chennai. She has 11+ years of experience and treated 1000+ patients. She finished her M. S., Obstetrics and Gynaecology from the Institute of Obstetrics & Gynaecology (Madras Medical College), Chennai. She is a visiting consultant at St. Isabelle Hospital, Motherhood Hospital, Rainbow Hospital & Mehta Hospital. Dr Rukkayal Fathima specialises in Obstetrics care, Early Pregnancy Scan, IVF, ICSI, TESA/Micro TESE, Menopause advice, Gynaecological surgeries and endoscopy. She is a Co-Founder of Hive Fertility, the Best Fertility Center in Chennai.

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