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Does health insurance cover infertility treatment?

Team AckoJan 17, 2024

It is an absolute joy when a baby arrives in the family. However, some couples may find it difficult to conceive a child. Infertility is to be blamed for the inability to conceive a child. According to the Indian Society for Assisted Reproduction (ISAR), up to one in six or 10 to 15% of married couples in India find it difficult to conceive a child and may require medical advice and the treatment cost is expensive. Health insurance is an excellent financial shield against medical costs. But is there health insurance that covers infertility treatment? Let’s find out.

Contents

What is infertility?
Is infertility treatment covered under health insurance?
Causes of infertility and treatments covered under health insurance
- Types of infertility treatment procedures covered under health insurance
List of IVF treatment procedures covered under health insurance
Key points to consider while buying health insurance for infertility treatment
Why Is IVF Not Covered Under Insurance?
- In a nutshell
Frequently asked questions

What is infertility?

Infertility is the inability to conceive a child after one year or more of regular unprotected sex. Both men and women can suffer from this medical condition. There are two types of infertility — primary and secondary. While the former refers to a medical condition where the couple cannot conceive children despite regular unprotected sex for a year, the latter refers to a medical condition where the couple was able to get pregnant once but is unable to conceive children again.

Is infertility treatment covered under health insurance?

Traditionally most health insurance plans do not cover the cost of infertility treatment. However, new-age insurers have been designing plans that include infertility treatment coverage or offer it as an add-on cover. Some plans link infertility treatment cover with maternity cover. The scope of the coverage for infertility in these new-age health insurance plans may differ between insurance plans. Some may cover only specific infertility treatments. Therefore, it is better to check the inclusions and exclusions and the level of coverage for infertility before buying one.

Some health insurance plans covering infertility treatment may have a more extended waiting period, caps on the expenses, or sub-limits. It is prudent to compare different health plans covering infertility treatment to ensure you receive the right coverage and financial assistance.

Causes of infertility and treatments covered under health insurance

There are various reasons for infertility. Here are some of the common causes of infertility.

Diabetes
Smoking
Obesity
Sedentary lifestyle
Excessive alcohol consumption
Unhealthy eating habits
Stress
Male or female reproductive conditions
Infections
Irregular sleep patterns
Advancing age of women
Surgical abortion
Genetic reasons
Pollution
Frequent use of emergency contraptions

Types of infertility treatment procedures covered under health insurance

Some popular infertility treatments are covered under health insurance, and some may be offered as an add-on cover.

In Vitro Fertilisation (IVF): The process involves gathering eggs from the ovaries and combining them with the sperm in a laboratory environment to make an embryo. The embryo is then transplanted to the uterus.
Intrauterine Insemination (IUI): The procedure involves inserting sperm into the uterus during ovulation in a laboratory environment.
Gamete Intrafallopian Transfer (GIFT): The process involves mixing the eggs with the sperm in a laboratory dish and planting it in the fallopian tubes.
Intracytoplasmic Sperm Injection (ICSI): The procedure involves injecting a single sperm into a single egg in a laboratory dish, and the embryo is placed in the uterus.

List of IVF treatment procedures covered under health insurance

Here are the different types of coverage for IVF treatments categorised under health insurance.

Full infertility insurance cover
Infertility diagnosis only cover
Infertility diagnosis and limited fertility treatment cover
Medication coverage (fertility drug prescriptions)

Please do check the terms and conditions of the policy to understand the coverage details.

Key points to consider while buying health insurance for infertility treatment

Not all health insurance plans cover the cost of infertility treatment. A recommendation is to check the terms and conditions of the plan. Here are some important factors to consider before buying health insurance for infertility coverage.

Check if the cost of fertility diagnosis is covered under the plan.
Check the eligibility criteria to understand who is eligible under the plan.
Check the treatment procedures covered under the plan.
Check the sub-limits and extent of the coverage.
Check the waiting period for infertility treatment since it can differ between insurers.
Check if prescribed medication is also covered under the plan.
Check if add-on covers cover other types of infertility treatment procedures.

Why Is IVF Not Covered Under Insurance?

IVF is not considered as a necessary treatment and is usually not covered by most insurance policies. The cost of IVF treatments are very high and are usually borne by the couples that decide to go ahead for the treatment. However, there has been a shift in recent times and companies are now covering certain procedures in IVF treatments.

In a nutshell

A newborn baby is a bundle of joy in a family. However, infertility can be a hindrance to starting a family. In India, more than 27 million couples suffer from infertility. To overcome the financial burden of treating infertility, some insurance companies are offering health insurance plans that cover the cost of infertility treatment either as an add-on cover or as part of the base plan. Compare different infertility treatment health insurance plans before purchasing the policy to get the right coverage and financial protection.

Frequently asked questions

Here are some common questions and their answers about health insurance coverage for infertility.

Does infertility affect both men and women?

Yes, the medical condition can affect both males and females.

Can I avail this coverage outside India?

Most insurance plans do not cover infertility treatment availed outside India. Please check the terms and conditions of the policy to check if the policy is valid outside India.

Does health insurance with infertility treatment coverage cover the second child?

Yes, most plans cover the cost of treatment for both primary and secondary infertility conditions.

Does Aarogya Sanjeevani Health Insurance Policy cover infertility treatments?

No, it does not cover the cost of treating infertility. Any type of sterilisation or contraception, assisted reproduction services, artificial insemination and advanced reproductive treatments such as IUI, IVF, GIFT, ICSI, reversal of sterilisation and gestational surrogacy, etc. are not covered.

Which is the best insurance for infertility treatment?

It is important to know the type of infertility treatment that you and your spouse should undergo. Once this is decided, opt for a health insurance plan that covers multiple types of infertility treatment and the treatment cost that you have to undergo. Health insurance plans that cover infertility treatment may not cover all types of infertility treatment. Hence, check the inclusions and exclusions of the plan before buying the insurance policy.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.