Home / Health Insurance / Articles / Health Insurance Coverage / Does health insurance cover infertility treatment?

Does health insurance cover infertility treatment?

Team AckoDec 31, 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

Emotional and Social Implications of Infertility
Is Infertility Treatment Covered Under Health Insurance?
Causes Of Infertility
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
Employer-Provided Health Insurance and Infertility Coverage
What Does Health Insurance Cover for Infertility?
Is IVF Covered by Insurance?
Why Is IVF Not Covered Under Insurance?
Wrapping Up

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. Primary infertility refers to a medical condition where the couple cannot conceive children despite regular unprotected sex for a year, while secondary infertility is a medical condition where the couple was able to get pregnant once but is unable to conceive children again.

When a couple cannot have a child, it affects more than just their physical health; it changes the dynamics of their relationships and social lives. When dealing with the mental and physical effects of infertility, it is crucial to have comprehensive health insurance, as these difficulties sometimes overlap with the cost of therapies.

Emotional Distress and the Need for Mental Health Support

Feelings of inadequacy, worry, anxiety, and melancholy are all emotional costs of infertility. People and couples can deal with the emotional toll through therapy and counselling. But many people put off getting professional help because of how much it can cost. Helping to alleviate this burden are modern health insurance policies that cover mental health therapies, such as counselling for stress connected to infertility.

Social stigmatisation of infertility is a common cause of emotional and relational distress. To cope with social pressures and overcome stigma, people can benefit from having access to counselling through insurance. Insurance companies that provide instructional materials about infertility also help get the word out.

The Importance of Health Insurance in Times of Financial Stress

The high cost of infertility treatments like IVF and IUI makes them unaffordable for some people. The already emotionally charged journey is frequently made much more difficult by the overwhelming expense of operations, which causes tremendous financial hardship. Insurance for fertility treatments can alleviate this burden, allowing more individuals to access advanced procedures. Families may have fewer out-of-pocket expenses if they have a comprehensive plan that covers diagnostic testing, medicines, operations (such as IVF), and even embryo freezing.

The Importance of Maintaining a Regular Schedule of Medical Treatment

Infertility treatments can last for months or even years and involve regular doctor appointments and continuous monitoring. A decent insurance plan guarantees continuity of care, which pays for hospital visits for related issues, long-term therapies, and follow-ups.

Encouraging Preventive Measures

Infertility can occasionally be caused by preventable health issues or lifestyle choices. Regular health check-ups and screenings are encouraged by plans with preventive care features. These can help identify and manage any reproductive concerns before they worsen.

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 coverage with maternity coverage. The coverage for infertility in modern health insurance plans can vary. Some plans might only pay for certain 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 longer waiting period, caps on expenses, or sub-limits. It is wise to compare different plans to ensure you receive the right coverage and financial assistance.

Causes Of Infertility

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

Here are some common infertility treatments that may be covered under health insurance plans, along with options that might be available as add-on coverage:

In Vitro Fertilisation (IVF): The processThis 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 into 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)

To fully understand the specific coverage details, limitations, exclusions, and other important information, please refer to the policy's terms and conditions.

Key Points to Consider While Buying Health Insurance for Infertility Treatment

It's important to note that not all health insurance plans cover infertility treatment. To ensure you understand your coverage, review your plan's terms and conditions. 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.

Employer-Provided Health Insurance and Infertility Coverage

Though such offers are unusual, employer-provided health insurance plans in India are progressively including coverage for infertility treatment in their benefits packages. Based on recent statistics, less than 1% of Indian employers provide thorough infertility coverage under group health insurance. Companies like Google and Flipkart have been observed to have IVF and related procedures included in company policies.

This pattern demonstrates a growing awareness of the challenges faced by India's estimated 12-18 million infertile couples. Some companies striving to encourage employee well-being now agree that treatments like IVF or ICSI, which may cost between ₹1 lakh and ₹4 lakh each cycle, are vital.

Ask your HR department these questions to find out whether your company's health insurance covers infertility treatment:

1. What infertility treatments are covered? Check whether the policy includes diagnostic procedures, fertility medications, or advanced treatments like IVF.

2. Are there any waiting periods? Some plans may require a waiting period before you can access infertility benefits.

3. Are there cost limits? Confirm whether there are caps on the reimbursement amount or restrictions on the number of treatment cycles covered.

4. Who is eligible? Understand whether the coverage extends to dependents or is limited to the employee and spouse.

5. Are there exclusions? Review what treatments or conditions might not be covered under the policy.

This inclusion marks a significant step toward normalising conversations about reproductive health, which is still a taboo topic in India. Companies implementing such practices reduce employee financial load and promote a more friendly working environment. However, employees must carefully review their policies to grasp the scope and restrictions of the coverage.

What Does Health Insurance Cover for Infertility?

Health insurance in India is evolving to include infertility coverage under select policies. This coverage often encompasses diagnostic procedures, such as hormonal testing and ultrasounds, as well as treatments like IUI (Intrauterine Insemination) and IVF (In Vitro Fertilisation) in some cases. Coverage typically varies, with limitations on the number of cycles or capped costs. Policies may also include medication expenses, fertility counselling, or related services. It's important to review the terms, including waiting periods and exclusions, when selecting a plan for infertility coverage.

Is IVF Covered by Insurance?

Yes, some health insurance plans in India now offer partial coverage for IVF treatments, either as part of comprehensive maternity benefits or through add-ons. Coverage generally includes initial consultations, diagnostic tests, and limited treatment costs while excluding advanced procedures or multiple cycles. Employers may also provide health insurance benefits covering IVF. However, specifics such as waiting periods, cost caps, and exclusions vary by policy. Prospective policyholders should clarify details directly with insurers or consult an HR representative for employer-provided plans.

Why Is IVF Not Covered Under Insurance?

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

Wrapping Up

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.

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 provided outside India. Please check the policy's terms and conditions to see if it 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.