A couple’s decision to have a child can lead to a wonderful and long-awaited change in their lives. But sadly, infertility can occasionally prevent someone from realizing their long-held desire to start a family.
Nothing brings greater delight than having children. However, infertility has deprived some couples of this joy. Among young Indian couples, it has become one of the most pressing health concerns.
In India, there were already close to 30 million infertility-affected couples, by 2020. It is critical in this situation to get medical attention, conduct your homework, and comprehend the scope of your health insurance coverage. Many affected couples examine health insurance options in order to find out if fertility testing is covered by insurance, in the hope of finding one that will pay for the price of infertility treatments.
IVF, usually in-vitro fertilization, is the most widely used assisted reproductive method in India and internationally. If statistics are to be believed, IVF treatment has resulted in the birth of more than 8 million children since it was first used. In India alone, 2-2.5 lakh IVF procedures are performed annually, according to the Financial Express. And India has the capacity to increase this figure to 5–6 lakh annually.
Couples who are unable to conceive naturally due to conditions such as fallopian tube obstruction, an ovulation disorder, poor sperm quality, or insufficient sperm can benefit from IVF treatment. IVF can be performed with the couple’s own eggs and sperm or with donated eggs or sperm. In IVF, the sperm and eggs are mixed and fertilized in a petri dish. The fertilized egg is placed into the female’s uterus where it grows into an embryo and continues to develop for the next nine months of the pregnancy.
However, this begs the question – are fertility tests covered by insurance because infertility therapies, including IVF, are not always inexpensive. Due to the costs, not everyone can afford the procedure without hesitation, frequently depriving couples of their happiness. Nobody can assure that the surgery will be successful. If you’re lucky, you could be able to get pregnant for the first time. If not, you might need to repeat the first step and a few cycles afterward.
IVF is expensive, and the more cycles required, the more expensive it is. As a result, a lot of infertility-affected couples ask if they have fertility testing insurance coverage and look for health insurance coverage for the costs of infertility treatments.
In this Article
- 1 Average Cost of IVF Treatment In India
- 2 Is Fertility Testing Covered By Insurance
- 2.1 Are Fertility Tests Covered By Insurance In India?
- 2.2 Infertility Treatment Procedures Covered Under Health Insurance
- 2.3 Things to Check Before Buying Health Insurance for Infertility Treatment
- 2.4 Insurance Policies In India That Cover IVF And Other Infertility Treatments
- 2.5 Do Insurances Cover Fertility Drugs, Adoption, And Surrogacy?
- 2.6 Financing Fertility Treatment With A Personal Loan
- 2.7 FAQs
- 2.8 Conclusion
Average Cost of IVF Treatment In India
|Average cost of IVF treatment (in INR)
|1,25,000 – 1,65,000
|1,30,000 – 1,80,000
|1,40,000 – 1,80,000
|1,40,000 – 1,80,000
|1,40,000 – 1,70,000
|1,40,000 – 1,80,000
|1,25,000 – 1,85,000
Is Fertility Testing Covered By Insurance
The Indian Society for Assisted Reproduction (ISAR) estimates that up to one in six married couples in India—10 to 15% of them—have trouble getting pregnant. These individuals may need medical assistance, but the cost of such care is prohibitive. A good financial defense against medical expenses is health insurance. But are fertility tests covered by insurance? Let’s investigate.
Health insurance providers typically offer a basic range of healthcare services, including outpatient treatment, emergency care, prescription medicines, pediatric services, and maternity and newborn care. Infertility care does not frequently fall under the benefits. So, first things first: learn what is covered by your insurance.
The standard classification of cover in this regard is as follows:
- Full coverage for infertility insurance
- There is no fertility insurance.
- Insurance only covering infertility diagnoses
- Insurance coverage for limited fertility treatments and infertility diagnoses
- Medical insurance (which may or may not include fertility drug prescriptions)
Are Fertility Tests Covered By Insurance In India?
Treatment for infertility is expensive both domestically and overseas. An IVF procedure, for example, can cost between Rs 1 lakh and Rs 2 lakh with no assurance of success. However, the majority of health insurance companies do not provide insurance to cover fertility tests or pay for infertility treatments.
There are some people who do, though.
The BMB Nirbhaya Scheme, offered by Bharatiya Mahila Bank, will be the sole general health insurance offering coverage for IVF treatment costs as of March 2022. However, only women with various financial situations are covered. The first two children’s maternity benefits and cashless services are available to women under this program.
The majority of general health insurance companies simply pay for the costs of the OT, the anesthetic treatment, and the costs of the hormonal assessment and medical testing. The couple will each be responsible for paying for their own share of the remaining treatment costs and related medical expenses. As a result, there aren’t many businesses in India that offer coverage for IVF procedures. But as the number of couples using IVF rises year after year, health insurance providers are considering fertility testing insurance coverage for IVF in their insurance plans.
While some of them include coverage for infertility treatments in the standard policy, others only offer add-on coverage. A few insurers also intend to combine the coverage for infertility treatments with maternity insurance or to make it an option for policies with higher sums insured.
Different infertility insurance policies may offer varying levels of coverage, though. Not all insurance policies may provide comprehensive coverage and pay for all infertility treatments. Before choosing a health insurance plan, it is best to compare them and see what costs are covered by each. A health insurance plan that covers infertility treatment may also have a lengthy waiting time, a sub-limit, or a capping clause.
To select a plan that covers infertility treatment in the best way possible, it is crucial to compare health insurance coverage. You can ask your health insurance provider-is if fertility testing is covered by insurance policies that their company is offering.
Diagnosis of infertility
Insurance cover fertility test for diagnosis of infertility may include the following:
- Hormonal profile testing
- Tests for DNA abnormalities
- Genetic testing
- Semen analysis
- Imaging tests for both male and female
- Ovarian reserve testing
Infertility Treatment Procedures Covered Under Health Insurance
An infertility insurance policy might cover for the following infertility treatment procedures:
- In Vitro Fertilisation (IVF
- Intrauterine Insemination (IUI)
- Gamete Intrafallopian Transfer (GIFT)
- Intracytoplasmic Sperm Injection (ICSI)
- Assisted hatching
- Preimplantation genetic diagnosis (PGD)
- Ovarian hyperstimulation syndrome (OHSS)
- Frozen embryo transfer (FET)
Things to Check Before Buying Health Insurance for Infertility Treatment
Due to the complexity of infertility treatments, complete health insurance coverage is necessary. There can be a few terms and conditions attached. As a result, it’s crucial to review the items below before purchasing health insurance for infertility treatment. Look at this:
- To find out if you qualify for infertility treatment coverage, review the eligibility requirements (which depend on your age, gender, way of life, employment, and/or medical history).
- Check to see if the coverage covers the expense of an infertility diagnosis.
- Check the policy’s list of treatments for infertility.
- Check the policy’s sub-limits and co-payment details for the numerous infertility treatment procedures that are covered (your sum insured might be restricted, and you might need to participate in part of the claimable amount)
- Depending on the insurer, the waiting period for coverage of infertility treatment maybe 2 to 6 years (none of the insurance policies to date allows IVF treatment from day one)
- Check to see if the cost of the medications used to treat infertility are covered.
- Verify the maximum number of claims you can submit under your policy (number of times one can avail IVF expenses on their health insurance plan)
- Check to see whether there is an add-on cover for costs associated with infertility treatment.
Treatment for infertility is not just a medical requirement but also a social one. We advise conducting extensive research first if you are considering IVF and looking for plans that can cover the cost of your treatment. Learn as much as you can about the various treatment modalities so that when it comes time to choose an insurance company, you can make the best decision for your needs. To choose an affordable infertility insurance plan, be sure to evaluate health insurance options.
Insurance Policies In India That Cover IVF And Other Infertility Treatments
Some health insurance policies that cover IVF and similar fertility treatments are:
- Nirbhaya by Bharatiya Mahila Bank
Women with low financial standing who have opened an account with the bank are eligible for IVF treatment coverage under Nirbhaya. The policy relieves women of any financial strain by providing coverage for maternity care, hospitalization costs, and infertility therapy. The insured amount ranges from INR 1 lakh to INR 5 lakh, and the price for INR 1 lakh of insurance coverage for women starting at age 22 and older is INR 1,745. The Nirbhaya policy also covers maternity coverage starting in the third year as well as gynecological health checkups starting in the fourth year. The policy also includes coverage for miscarriage costs.
- Magma HDI OneHealth Insurance Policy
The OneHealth Insurance Policy is Magma HDI General Insurance Company’s premier health insurance programme. The policy provides complete coverage, including pre-hospitalization and post-hospitalization for IVF treatment, donor costs, daycare services, and hospitalization costs. OneHealth provides coverage for IVF-related medical costs incurred at a facility that has been properly registered in accordance with applicable law* and in accordance with the written recommendations of an infertility specialist. Only those who are 40 years old or younger qualify for the coverage. Even with a total plan sum insured of INR 2,00,000, the OneHealth Insurance Policy provides IVF Treatment coverage of up to INR 50,000. Before one can use this benefit, there is a 3-year waiting period starting from the day the policy was first issued.
- Digit Health Care Plus Policy
Go Digit General Insurance Limited recently unveiled the Digi Health Care Plus Policy, a comprehensive health insurance plan that offers affordable premiums. IVF, IUI, ZIFT, ICSI, and other fertility treatments are covered by Digit Health Care insurance. Additionally, the plan covers infertility treatment coverage as an optional add-on insurance. If you are hospitalized for any infertility treatment as recommended by a medical specialist under the terms of this policy, the insurance provider will cover your medical costs. The sum insured for Digit Health’s IVF coverage is constrained to either a set dollar amount or a certain percentage of the total sum insured.
Do Insurances Cover Fertility Drugs, Adoption, And Surrogacy?
Drugs used to treat infertility can be a little unclear. While your insurance might pay for some medications, it might not. Therefore, while prescription medications continue to be a problem, you should discuss it with your genetic endocrinologist well in advance.
In vitro fertilization (IVF), frozen embryo transfer, or intrauterine insemination (IUI) can all be successful first attempts for some families (FET). The type of treatment you should receive will depend on your understanding of the insurance benefits you are eligible for. An insurance policy might limit the maximum number of attempts at embryo transfer, for instance, during IVF. If the first cycle wasn’t effective, another one might be covered.
But if IUI and IVF don’t work for you, you can choose to use a gestational surrogate to carry your child to term. Your insurance may or may not cover the removal and fertilization of your eggs, depending on the terms of your surrogacy contract. And if you decide to move forward with adoption, find out if your insurance company will reimburse you for the costs.
Financing Fertility Treatment With A Personal Loan
Although most health insurance policies are used to exclude infertility treatments, the surge in infertility issues is giving insurance providers a chance to start offering policies that cover infertility therapies.
One need not give up hope of becoming a parent even if their insurance does not cover reproductive treatments. Other financing options, like simple personal loans provided by many banks nowadays, can assist you in covering the costs of childbirth.
- Can I use my insurance coverage outside of India?
Treatment for infertility received outside of India is typically not covered by insurance policies. Please review the policy’s terms and conditions to determine whether it is applicable outside of India.
- Which insurance policy is the best for treating infertility?
Knowing the kind of infertility therapy you and your spouse should receive is crucial. Once this has been decided, choose a health insurance plan that will pay for the cost of any necessary treatments for infertility as well as a variety of treatment options. Some types of infertility treatments may not be covered by health insurance plans that cover infertility treatment. Therefore, before purchasing an insurance policy, make sure to review the plan’s terms and exclusions.
- What does health insurance that covers prescription drugs include?
The medication used during IVF operations can range from basic pills to injectables to ovulation meds and more. The cost of the drugs used in the IVF therapy is covered by this insurance. However, it is crucial to read the policy documentation or speak with your insurance company to see precisely which of your drugs might be covered due to the advantages of this cover.
- How do I check my insurance plan for fertility coverage
You can call the customer service number listed on your insurance card, speak with your company’s HR or benefits staff, or call your fertility specialist to have them check your coverage and help you with the details in order to learn more about your specific insurance plan. You can also go online to your insurance company’s website to check your benefits. You might also have a look at your partner’s insurance. Some patients “double-up” and utilize both plans, switching to their partner’s plan.
If you need help choosing the best course of action, speak with the financial counselor at your fertility specialist. They will be pleased to review both your and your partner’s insurance policies so that you can maximize coverage and lower your out-of-pocket expenses.
Fertility treatments might be intimidating, but with sufficient research and the appropriate resources, planning a baby and expanding your family is possible without breaking the bank.
Treatment for infertility is not just a medical requirement but also a social one. We advise conducting extensive research first if you are considering IVF and looking for plans that can cover the cost of your treatment. Learn as much as you can about the various treatment modalities so that when it comes time to choose an insurance company, you can make the best decision for your needs.