Does Health Insurance Cover IVF Treatment?

 “Does Health Insurance Cover IVF Treatment”

Does Health Insurance Cover IVF Treatment

In India, health insurance firms are meant to cover hospitalisation as a result of illnesses and disorders. Most mediclaim plans do not cover maternity, new born babies, or IVF (in-vitro fertilisation) treatments since they are regarded a pregnancy-related condition rather than a sickness. However, there is fresh hope when it comes to infertility insurance. Insurers are warmed to the notion of creating health insurance that includes infertility coverage.

Insurers are increasingly looking to foot the bill for IVF treatments under their health insurance policies as a first step toward covering fertility treatments. To prevent fraud, insurance firms aim to give these treatments to policyholders after a considerable waiting period and by capping sub limits. In most cases, IVF and infertility-related costs are not covered by health insurance. A single IVF cycle costs around Rs 1.25 lakh. As it will be part of a health plan, insurers want to set a limit on it. When a couple is having trouble conceiving naturally, IVF therapy can assist. The cost of IVF treatment might reach Rs 2.5 lakh each cycle. Fertility issues affect around 10-15% of couples

In IVF, the insurance plan will stipulate the number of embryo-transfer attempts, and if the first is unsuccessful, further cycles may be reimbursed. Outpatient care, emergency treatments, pediatrics services, and maternity and new-born care will all be covered under these plans. There is a reluctance to cover IVF because it is a planned procedure. It is, nevertheless, likely to be included in high-sum-insured premium policies. There is a need for fertility treatment to be covered as part of a basic health plan. As part of the lifeline version II, companies are aiming to cover IVF and bariatric procedures. The cost of bariatric surgery might range between Rs 4 lakh and Rs 7.5 lakh.

Fertility medications, treatment cycles, surrogacy, and adoption

Drugs for infertility might be a little perplexing. While one type of medicine may be covered by your insurance, another may not. So, while prescription medications are still a risk, you should discuss it with your genetic endocrinologist ahead of time.

Intrauterine insemination (IUI), in vitro fertilisation (IVF), or frozen embryo transfer are all options for some families (FET). Knowing what insurance advantages you are eligible for will help you select what therapy to get.

A personal loan for infertility treatment

While most health insurance policies previously excluded infertility treatments, the growth in the incidence of infertility issues is allowing insurance firms to provide infertility treatment covers. Other financing options, like as HDFC Bank's hassle-free and simple Personal Loans, can assist you meet the expenditures of childbirth.

Health Insurance and IVF Treatment

A medical insurance policy may give one of four types of IVF coverage. These are the following:

  • Insurance for infertility in its entirety

  • Only infertility diagnosis is covered by insurance.

  • Infertility diagnosis and limited fertility treatment are covered by insurance.

  • Medication coverage, which may include prescriptions for fertility drugs

It's critical that you understand what your health insurance policy covers.

Infertility Diagnosis

When asking about infertility diagnosis in health insurance policies, the insured may require the following information:

  1. Semen analysis (male)

  2. Hormone testing (male)

  3. Testing for genetic mutations (male)

  4. Biopsy of the testicles (male)

  5. Imaging (male)

  6. Testing for DNA abnormalities (male; this one is very specialised and rare)

  7. Testing for ovulation (female)

  8. Hysterosalpingography (female)

  9. Testing of the ovarian reserve (female)

  10. Ovulatory and pituitary hormones are tested (female)

  11. For uterine or ovarian illness, imaging tests such as pelvic ultrasound are used (female)

  12. Hysteroscopy (female; rarely used)

  13. Laparoscopy (female; used to diagnose endometriosis, scarring, fallopian tube obstructions, and ovarian issues)

If your insurance policy covers infertility diagnosis, you'll want to know which expenditures are covered and how much you may claim. Remember that infertility treatment may be extremely costly, costing lakhs of rupees.

Infertility Treatment

If your infertility insurance policy covers treatment, women should double-check which procedures are covered.

  1. In vitro fertilisation (IVF)

  2. Intracellular sperm injection (ICSI)

  3. Assisted hatching

  4. IUI (intrauterine insemination

  5. Genetic testing before implantation (PGD)

  6. Ovarian hyperstimulation syndrome (OHSS)

  7. Transfer of frozen embryos (FET)

  8. Intrafallopian Gamete Transfer (GIFT)

Medicines and Drugs for Fertility Treatment

It's also crucial to know which medications (if any) are covered under your medical insurance plan's infertility insurance. Inquire about treatment cycles, surrogacy, and adoption-related insurance.

Health Insurance Plans Covering IVF Treatment

  1. Magma HDI OneHealth Insurance Policy

Magma HDI General Insurance Company's primary health insurance product is the OneHealth Insurance Policy. In-patient hospitalisation, day care treatment, pre and post hospitalisation, organ donor expenses, no claim bonus, AYUSH cover, bariatric surgery, psychiatric cover, even Lasik surgery cover, and most importantly, insurance coverage for IVF treatment are all covered under this Magma HDI medical insurance policy. The health insurance plan will cover IVF treatment-related medical expenditures if they are received in a clinic that is legally registered under applicable law and on the written recommendation of a specialised medical practitioner. This treatment must be performed before the insured individual reaches the age of 40. Even with a total plan sum insured of Rs. 2,000, the Magma HDI OneHealth Insurance Policy provides a very substantial IVF Treatment cover of up to Rs. 50,000. 

  1. Digit Health Care Plus Policy

The Go Digit General Insurance Limited's Digi Health Care Plus Policy is a new health insurance policy that offers a lot of benefits at a reasonable price. In addition to being comprehensive, the policy is written in a straightforward manner for ordinary readers, with fewer and less complex terms and conditions. A quick glance at their prospectus reveals that their policy may be tailored to meet the demands of various individuals and groups. Infertility Treatment is available as an add-on insurance with the Digit Health Insurance plan. If you are hospitalised on the recommendation of a medical practitioner for infertility or subfertility treatments, the insurance company will cover your medical expenditures. This fertility treatment insurance covers a variety of treatments, including IVF, IUI, ZIFT, ICSI, and others. In this health insurance policy, the sum covered for IVF coverage is either a percentage of the total sum insured or a specific number. The cost of infertility treatment under this plan cannot exceed 10% of the hospitalisation benefit.

  1. New India Mediclaim Policy

The New India Premier Mediclaim Policy, which offers a sum insured of one crore, was launched in February 2017 as a health insurance for HNIs.

This is a first for any PSU insurance firm in India, and it covers a wide range of procedures that would normally be excluded from standard mediclaim plans (coverage ranging from 2 lakh to 10 lakh rupees). In fact, before the Premier Mediclaim plan was introduced, the maximum sum insured given by any New India health insurance plan was just Rs. 8 lakhs. The plan has fewer limits and includes dental insurance, psychiatric therapy, infertility treatment, obesity treatment, maternity care, and even dietician consultations. The plan has a minimum value insured of 15 lakhs and a maximum sum insured of 1 crore. The New India Assurance Premier Mediclaim Policy pays for medical expenditures related to infertility treatment. Outpatient therapy is included in these expenses. Infertility is explicitly mentioned in the policy, while subfertility is not mentioned.

Infertility affects over 27.5 million couples in India, with the number increasing by more than 10% in 2020. In India, health insurance firms have finally warmed up to the idea of including IVF coverage in their policies. Infertility in India is a societal issue as well as a financial one. Infertility treatment is a natural extension of maternity and new-born infant health insurance coverage.







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