Does Your Health Insurance Policy Cover Infertility Treatment?

Health insurance policies provide compensation for various types of medical issues and assist policyholders in reducing the cost of treatments. In response to the changing needs of the population and their demands, health insurance companies have also begun to cover various medical conditions in their plans, providing the policyholders with extensive insurance coverage. It includes critical illness plans, family floater plans, accident insurance, maternity benefit plans, etc. Nowadays, health insurance companies also have Maternity Health Insurance which cover the expenses towards delivery, hospitalization, medications, vaccinations, etc., of the baby. On the other hand, there is also a bigger question – does insurance cover infertility treatment?

Santhosh & Priya have been married for the past eight years, but they are yet to become parents. They are undergoing treatments for infertility and are hopeful for things to turn around. As per their doctor’s advice, IVF seems to be a viable and guaranteed option for pregnancy. The couple’s only concern now is, does health insurance covers IVF since they both have health insurance policies provided by their employers. From their research, not many health insurers offer coverage for infertility treatments, is what they have found. Reluctant to discuss is IVF covered by insurance in an open forum, fearing judgment, Santhosh & Priya decided to finance the cost of treatments among themselves by using the money from savings to pay for medical consultation, treatment, and medications.

The birth of a child is an important milestone for any family that can change the lives of a couple in a million ways, but infertility can hinder that dream. About 27.5 million couples across India are suffering from some kind of fertility issue, and that number is only projected to increase by more than 10% every year. This being the reality, it is very important to look out for medical attention and also understand the scope of coverage by your Health Insurance plan.

Does Health Insurance Cover Infertility Treatment? 

Unfortunately, there aren’t many health insurance companies that offer infertility treatment bundled in their plans. Although there were reports of insurers planning to cover the cost of infertility and allied treatments under their medical insurance policies, not much has been said about the implementations. Moreover, even the companies that cover infertility treatment procedures, have a long waiting time, and an even longer list of conditions are put in place, limiting the amount of coverage to reduce the chance of fraud. 

Because of the recent rise in inflation, the cost of medical treatments has also increased. As a result, the most common infertility treatment, IVF (In Vitro Fertilization) cost starts from Rs.1.25 lakhs and goes up to 2.5 Lakhs per cycle. If you are paying higher premiums, the infertility treatment coverage comes pre-included in certain health insurance policies, along with pediatric, maternity, and newborn costs.

What Causes Infertility?

While talking about infertility treatments, it is essential also to know what is infertility and the causes of infertility.

Look over the most prevalent causes of infertility:

• Obesity and sedentary lifestyles
• Diabetes
• Consumption of alcohol in massive quantities
• Stress
• Irregular sleep patterns
• Poor eating habits
• Smoking habits
• Conditions that affect women’s reproductive health, such as PCOS or uterine fibroids, etc.
• Men’s reproductive issues such as lower sperm count, quality, ejaculation issues, etc.
• Increase in women’s age
• Tuberculosis and infections
• Consistent use of contraceptives in emergency
• Abortions
• Pollution & Genetic/ Hereditary reasons.

Treatments Covered Under Infertility Treatment Insurance

While there are a handful of insurers that do provide coverage for infertility treatments, here is a detailed look at the treatments that are covered by them. If you are buying individual covers or addons, make sure to read the policy documents for the complete list of treatment procedures covered by the plan. The cost of these infertility treatments shall only be covered, and any other treatment methodology wouldn’t get covered by the insurer.

• IUI (Intrauterine Insemination): This is a method of treatment that involves inserting sperms directly into the uterus at the time of ovulation.
• IVF (In Vitro Fertilization): Eggs are collected from your ovaries and merged with the sperm of your spouse in the lab setup. The resultant embryos are transferred and placed in the uterus.
• Gift (Gamete Intrafallopian Transfer): The female eggs are removed and transfused with the sperm of the male, in a lab environment, before being placed into the fallopian tube of the female.
• ICSI (Intracytoplasmic Sperm Injection): A single sperm is injected into a single egg in the lab, and the resultant embryo is transplanted into the uterus of the female.

Checklist Before Buy Health Insurance for Infertility Treatment 

A health insurance policy with infertility treatment coverage could come with some specific terms and conditions. Therefore, it is essential to look for the following points before purchasing your desired health insurance for the treatment of infertility:

• Confirm if you satisfy the eligibility requirements set by the insurer for coverage of infertility treatment
• Verify if the insurance policy covers the cost of infertility treatment.
• Examine whether the procedures for infertility treatment are included in the policy.
• The waiting period for the infertility treatment coverage must be looked at since it ranges between 2 and 6 years, depending on the insurance company.
• Review the coverage and sub-limits on various procedures for infertility that are covered by the policy.
• Check for the coverage of the cost of medications used during infertility treatment.
• Pay attention to the claim settlement ratio of the insurance company before purchasing the policy from a specific health insurer.

The Conclusion

There are many things to consider when you are attempting to file a claim with your insurance company if it is for infertility treatment. First, because most health insurance companies do not offer coverage on treatments for infertility and related treatments, be sure to evaluate health insurance plans beforehand to shortlist a perfect infertility insurance plan, which is also costing within the budget. Hence read through the fine print of your policy to ensure that it is in line with your needs, if of prime importance.