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Is In Vitro Fertilization (IVF) Covered Under Insurance?

In Vitro Fertilization or IVF isn’t a medically necessary treatment, and therefore, its cost isn’t covered under the health insurance policy or mediclaim. Generally, couples or individuals undergoing IVF have to bear the complete expense of treatment on their own. But, since IVF is an expensive treatment, some insurers have begun providing a certain amount of coverage for it. Read on to know everything about IVF insurance coverage, and ways in which you can manage your IVF expense.

In Vitro Fertilization or IVF isn’t a medically necessary treatment, and therefore, its cost isn’t covered under the health insurance policy or mediclaim. ... Read More

IVF Treatment Insurance Claim

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IVF Treatment with Insurance at Pristyn Care

Why Is IVF Not Covered Under Insurance?

Health insurance or Mediclaim policies can be quite beneficial for patients suffering from serious health conditions but can’t bear expensive treatment costs. They offer coverage for various aspects of treatment including hospitalization expenses, pre and post-treatment costs, cost of daycare procedures, ICU charges, and so on. But, insurance coverage is usually only offered in the case of medically necessary treatments. What isn’t generally covered under the benefits of insurance is infertility care.

However, some insurers have now started offering insurance coverage for certain infertility treatments, including IVF. This coverage may include the cost of the entire IVF treatment, a cycle of IVF, the cost of hormonal assessments or medical testing, expenses of OT, etc. The coverage provided by these insurers is subject to differ, and therefore the patients must seek clarity while purchasing the policy.

The reason why companies have started providing coverage for infertility treatments is due to its increasing demand among people. The procedure helps couples and individuals experience parenthood when they can’t conceive naturally.

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Aditya Birla Health Insurance Co. Ltd.

National Insurance Co. Ltd.

Bajaj Allianz General Insurance Co. Ltd.

Bharti AXA General Insurance Co. Ltd.

Future General India Insurance Co. Ltd.

HDFC ERGO General Insurance Co. Ltd.

How to get IVF Treatment under Insurance?

Some insurers have now started offering insurance coverage for certain infertility treatments, including IVF. This coverage may include the cost of the entire IVF treatment, a cycle of IVF, the cost of hormonal assessments or medical testing, expenses of OT, etc. The coverage provided by these insurers is subject to differ, and therefore the patients must seek clarity while purchasing the policy.

1 Intimation

Fill up the pre-auth form at the network hospital for cashless approval. Fill up the pre-auth form at the network hospital for cashless approval

2 Approval/Rejection

Fill up the pre-auth form at the network hospital for cashless approval. Fill up the pre-auth form at the network hospital for cashless approval

3 Hospitalisation

Hospitalisation can be done on the basis of pre-auth approvalHospitalisation can be done on the basis of pre-auth approval

4 Claim Settlement

At the time of discharge, we settle the claim directly with hospitalAt the time of discharge, we settle the claim directly with hospital

1 Hospitalization At Non Network Hospital

You need to pay the bills initially and preserve the original invoices

2 Register A Claim

Post hospital discharge send us all your invoices and treatment documents

3 Verification

We verify your claim related invoices and treatment documents

4 Claim Settlement

We send the approved claim amount to your bank account

Top Fertility Specialists for IVF Treatment

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Dr. Amit Agrawal

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Dr. Nidhi Jhawar

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Types of Insurance Coverage For IVF

Since several insurers have now begun offering coverage for IVF treatments, it is essential to understand the types of coverage these insurance providers may provide for IVF. In general, the insurers offer coverage for the following expenses under their IVF insurance policies:

Full infertility insurance coverage: This may include the cost of the entire treatment or a cycle of IVF.

Insurance for infertility diagnosis only: This may include coverage for the diagnostic tests performed before the IVF procedure. The tests may include hormonal profile testing, semen analysis, genetic testing, imaging tests for both males and females, tests for DNA abnormalities, ovarian reserve testing, hysterosalpingography, laparoscopy, etc.

Insurance for infertility diagnosis and limited fertility treatment: This may involve coverage for the cost of diagnostic tests for IVF and partial coverage of the total cost of treatment.

Medication coverage which may include fertility drug prescriptions: This may include coverage of the cost of the fertility drugs used in the IVF procedure.

Note: To get an accurate understanding of what’s exactly covered in your insurance plan, you should contact your policy provider who’ll give you a detailed insight into their insurance plans.

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Factors To Consider While Choosing Insurance Policies For Infertility

As you would with any other insurance policy, make sure to research what your insurance plan for IVF will cover. This will help you understand whether the policy is worth purchasing and differentiate between different policies. Look at the following aspects of the insurance policy before choosing it:

Eligibility criteria: See if you fit the eligibility criteria set by the insurance provider. This may include age, gender, occupation, medical history, etc.

Sum insured: This includes the coverage offered by the health insurance plan. This can differ depending on your choice of insurance provider, and the plan you choose.

Waiting period: The waiting period refers to the period for which you have to wait before getting the insurance benefits.

Validity: The validity of the policy may include the number of times you can avail of IVF expenses, the number of IVF cycles included in the plan, and so on.

Exclusions: This involves the list of things that are not included in the policy. This can differ from policy to policy.

Premium: You must obtain clarity on how much premium amount you have to pay for your policy every month.

Anyone planning to get an insurance policy for their IVF treatment must carefully assess all these important aspects in order to make an informed decision. Doing so will help you get the maximum benefit out of your policy.

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FAQs around IVF Treatment and Insurance Coverage

What is the cost of IVF treatment in India?

In general, IVF treatment in India can cost you anywhere between Rs. 70,000 to Rs. 1,25,000. This is the cost per cycle of IVF. But, you should note that the cost of IVF is not the same throughout the country, and may vary based on various factors.

Is the cost of IVF treatment the same across the country?

No. The cost of IVF differs across the country. The difference can occur due to a range of factors, including: - The location of the patient - Choice of hospital or fertility clinic - Fees of the fertility specialist - Cost of diagnostic tests for IVF - Cost of medication - Cost of follow-up sessions - Cost of donor sperm - Cost of anesthesia - Fees of anesthesiologist - Other additional costs. Any hospital or fertility clinic considers all these factors before giving patients the final quote.

Why is the cost of IVF and other infertility treatments not covered under insurance?

Insurance is generally offered for medically necessary treatments. IVF, among other fertility treatments, does not fall under the category of medically necessary treatments, and therefore, most insurance companies do not cover the cost of IVF. But, some organizations have come up with specially curated insurance plans that offer coverage for IVF treatments, along with other benefits.

Top Health Insurance Providers For IVF In India

Due to a surge in the number of couples and individuals seeking IVF, several organizations have begun offering carefully curated insurance policies that cover the cost of IVF treatment. Some insurance policies available presently for IVF include:

Magma HDI OneHealth Insurance Policy

Magma HDI OneHealth insurance policy provides comprehensive coverage for IVF procedures, which includes:

Hospitalization cost
Daycare treatment cost
Donor expenses
Pre-hospitalization expense

They provide coverage for IVF- related medical costs, based on the total expense provided in writing by a fertility specialist. The OneHealth Insurance policy provides coverage of up to Rs. 50,000 in overall plan sum insured of INR 2,00,000. The waiting period is 3 years from the date of policy inception.

Nirbhaya by Bharatiya Mahila Bank

Nirbhaya Bhartiya Mahila Bank is another organization that has come up with insurance policies that cover the cost of IVF and other fertility treatments. Their policy provides coverage for:

Infertility treatment,
Hospitalization expenses,
Maternity coverage

The policy holder receives an insured sum of Rs. 1 lakh to Rs. 5 lakh. This organization aims to reduce the financial burden of women who wish to experience motherhood. They also offer maternity coverage from the third year and gynecological health checkups from the fourth year. Their policy also covers the expense of miscarriage.

Note: This insurance is only available for account holders in Bhartiya Mahila Bank.

Digit Health Care Plus Policy

The Digi Health Care Plus Policy is a relatively new health insurance policy introduced by Go Digit General Insurance Limited. The policy has several features and offers maximum benefits at competitive prices. They offer coverage for various infertility treatments, including IVF, IUI, ZIFT, ICSI, and so on. Their carefully designed plan offers infertility treatment cover as an add-in cover that one can opt for. As per the terms and conditions of the policy, the insurance company will cover the medical expenses if you are hospitalized on the advice of a fertility specialist for any infertility treatment.

Other Ways To Manage IVF Cost

If you are dissatisfied with the coverage offered by insurance and feel it’s not the best solution for you, there are some other ways in which you can manage the cost of your IVF treatment, such as:

Child Loan:

HSBC in association with Genome which happens to be a fertility clinic provides a credit personal loan for couples who wish to experience parenthood. The interest rate of this loan is 14%, and they have an easy repayment option of over 1 to 5 years.

Finance Schemes From Bajaj Finance:

Bajaj Finance also offers finance schemes for IVF and other fertility treatments. You can reach out to their team to understand their plans, and to get other necessary details.

Personal Loan:

Another great way of managing your IVF expenses is getting a personal loan. A personal loan can be a good source of financing for couples and individuals who wish to have a baby. Several banks offer personal loans at relatively reasonable interest rates. Make sure you conduct thorough research before applying for a personal loan.

Pristyn Care For Cost-Effective IVF Treatment

Several couples and individuals who can not conceive naturally, and wish to avail of infertility treatments to experience parenthood often take a step back due to the hefty treatment costs. Therefore, at Pristyn Care, we put together comprehensive IVF treatment packages at cost-effective rates to let the maximum number of people avail of fertility treatments and experience the joy of parenthood. We even provide No Cost EMI offers to let patients pay in easy monthly installments. In addition, to further reduce the total expense of treatment, we provide FREE consultation and follow-up sessions with the best fertility specialists in the country.

Pristyn Care also provides a range of other facilities to make the treatment journey of patients more convenient. Our additional facilities include home sample collection, a care coordinator to assist patients throughout their treatment journey, in addition to several other benefits. We ensure the complete comfort of patients at every step of their treatment journey with us. You can reach out to our team to schedule your appointment with expert fertility specialists. Call us today.

Takeaway

Infertility is a growing issue that affects several couples and individuals every year. With the increasing number of cases, there has been an upsurge in the demand for quality infertility treatments, of which IVF treatment is considered the most reliable and sought-after. Even though most insurance companies do not cover the cost of IVF procedures, patients can explore the insurance options given above to ease their financial burden. But, make sure you research the specifics and terms and conditions of the policies before taking the final call.