Will Health Insurance Cover IVF/Infertility Treatments?

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Infertility affects approximately 49 million couples and 186 million individuals worldwide, according to data from the World Health Organisation (WHO). As per the data, the prevalence of infertility ranges from 3.9% to 16.8%, implying that nearly 27.5 million Indian couples are affected by this condition. The costs associated with treatments related to infertility are huge. One IVF cycle costs ₹1,00,000 in India, according to a Financial Express article published on 22nd July 2022, and on an average, a couple spends somewhere between ₹2,00,000 to ₹5,00,000 for the entire process.

How does one afford such high costs? Will having health insurance make it easier to pay for these costs? Is the cost of infertility treatments covered by health insurance? We’ll find out - in this article.

Let’s dive right in!

What Is Infertility?

Infertility is the inability to conceive after a year or more of unprotected intercourse.

While the exact cause of infertility is difficult to determine, it may be caused by low levels of certain hormones in both men and women. In most cases, the inability to become pregnant is the only symptom of infertility - and no other symptoms exist.

There are 2 types of infertility in women -

  • Primary Infertility

    It occurs when a woman, who has never been pregnant, is unable to conceive after a year of not using birth control.

  • Secondary Infertility

    It occurs when a woman is unable to conceive after having at least one successful pregnancy.

Infertility affects men too. In men, infertility can be caused due to poor sperm quality, low sperm count, or blockage in the tubes of the reproductive system.

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Types Of Infertility Treatments

Generally, there are 3 types of infertility treatments -

  • Medicines
  • Surgical procedures
  • Assisted Conception [It includes Intrauterine Insemination (IUI) and In Vitro Fertilisation (IVF)]

Does Health Insurance Cover The Cost Of Infertility Treatments?

Traditionally, insurance policies did not cover the cost of infertility treatments. A few insurance companies, however, have now introduced infertility treatment cover under their health insurance plans. The cover is available as an in-built benefit in some plans, while in others, it is available as an add-on benefit.

The coverage of infertility treatment expenses under health insurance may vary across insurance companies. And, not all insurers will cover each and every infertility treatment.

Types Of Infertility Treatment Covered Under Health Insurance

Many insurers state in their policy documents that they will cover medical expenses if you are hospitalised for infertility/subfertility treatment which may include but not be limited to IVF, IUI, ZIFT, and ICSI. Let's get a basic understanding of all these treatments.

In Vitro Fertilisation (IVF)

IVF is a type of assisted reproductive technology in which eggs are harvested at the end of stimulation and the sperm and eggs are placed together in a lab dish. The eggs are then fertilised by the sperm. One of the fertilised eggs (embryo) is then inserted into the uterus by a provider.

Intrauterine Insemination (IUI)

IUI is a type of artificial insemination. It involves inserting sperm into the uterus during ovulation.

Gamete Intrafallopian Transfer (GIFT)

GIFT is a three-step procedure that involves removing the eggs, combining them with sperm, and immediately placing them in the fallopian tubes, where the egg is fertilised.

Intracytoplasmic Sperm Injection (ICSI)

ICSI is a procedure that is similar to IVF. An embryologist (a highly trained laboratory technician) directly injects a single sperm into each of the harvested eggs, after which a provider transfers the embryo into the uterus.

Conditions For Coverage Of Infertility Treatment Costs Under Health Insurance

Here’s a list of conditions related to the coverage of infertility treatments that you must be aware of -

  • Written Prescription From Medical Practitioner

    The expenses related to infertility will be covered only if it is prescribed in writing by a medical practitioner. The treating doctor must mention in writing that you or your spouse will be able to conceive only if you undergo the treatment for infertility.

  • Costs May Not Be Covered Up To The Sum Insured

    While insurers provide coverage for infertility treatment, a few provide coverage up to the sum insured that you choose. Some insurers may only cover the treatment costs up to a certain percentage of the sum insured, or they may specify a limit up to which they will pay for the expenses.

    The coverage limit may differ across insurance companies. Digit Insurance, for example, only covers the cost of infertility treatments up to 10% of the chosen sum insured.

  • Limitations In Availing Of The Benefit

    Certain insurers may limit the use of the infertility benefit to once per policy year. This means that you can only get coverage for infertility treatment expenses only once in a policy year.

  1. Digit Insurance has explicitly stated in their policies that they will only cover these costs once during the policy's term.
  2. New India has mentioned in their policy that if this benefit is used once during a policy tenure, it will not be available for subsequent renewal, regardless of the amount claimed in the expiring policy.
  • Waiting Period

    You cannot claim for the infertility treatment costs from day one of opting for the infertility cover. The insurance company may impose a waiting period - once it is completed, you’ll be able to claim for the infertility treatment costs.

    The details related to the waiting period will be mentioned in the policy wordings and the length of the waiting period may vary from insurer to insurer.

  • Treatment Expenses For Both Males And Females May Be Covered

    Normally, insurance companies cover treatments for infertility in women. However, a few insurance companies, like HDFC Ergo, have stated in their policy that they may provide the infertility cover to both men and women.

What Are The Things You Should Check Before Purchasing Health Insurance With An Infertility Cover?

  • Check if your insurance policy covers the cost of infertility or not. If it does, then check whether the infertility coverage is available with the base benefits or as an optional benefit.

    In case it is available as an optional benefit, you must know that you’ll need to make an additional payment to get it added to your policy.

  • Check whether the cost of prescribed medicines are covered or not.
  • Check the limit up to which the policy will cover the infertility treatment expenses. The limit for infertility cover may vary from insurer to insurer.
  • Check the waiting period. The infertility treatment costs may not be covered from day one - the insurer may impose a waiting period.

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Which Insurers Provide The Infertility Treatment Cover?

Parameters Go Digit HDFC Ergo New India Assurance
Base or Add-on Covered as a part of Maternity Benefit. Covered as a part of Maternity Benefit. Covered as a part of the base benefits.
Coverage Limit Up to 10% of the sum insured Up to 50% of the normal delivery sum insured Up to ₹1,00,000 or ₹2,00,000 - depends on the plan you select
Number of times the benefit can be used Once in a policy year No limit mentioned in the policy wordings If you use the benefit once, it won’t be available for subsequent renewals

So, the No Claim Bonus increases cumulatively with each claim-free year until you reach five consecutive claim-free years, at which point your NCB gets capped at 50%.

Wrapping Up!

That is all about the coverage of infertility treatments under health insurance policies. While the costs of infertility treatments are covered by some insurance companies in India, they will be covered only if certain conditions are fulfilled. To avoid any hassles in the future, ensure you’re aware of all the conditions before you buy a policy with the infertility cover.