Does Your Health Insurance Cover IVF?

IVF, or In Vitro Fertilisation, is introduced for couples who cannot conceive naturally due to infertility. This procedure offers a chance for such couples to experience the joy of parenthood.

It is a clinically tested procedure in which a female egg and male sperm are combined in the laboratory. If the egg and sperm fertilise successfully, the embryo is planted into the woman's uterus to achieve a pregnancy.

To get a successful result in IVF procedures, healthcare practitioners do a proper diagnostic, which includes a uterus examination, semen testing, etc. The process of IVF is lengthy and expensive and can put a financial burden on you if you do not have health insurance with IVF cover.

Also Read: Health Insurance Covers Infertility Treatment

As mentioned, the IVF procedure is long and requires frequent doctor visits and medications. So often, individuals or couples look for health insurance plans that cover IVF. Most standard or traditional medical insurance policies do not cover infertility treatment like IVF.

However, due to the increasing number of infertility cases, top insurance providers have started offering coverage for IVF treatment as a standalone policy or as an add-on to health insurance plans. Note that the level of health insurance coverage for IVF may vary from insurance provider to provider.

Also Read: Pregnancy Health Insurance

Step 1: Proper Diagnostic

One crucial step in the IVF procedure is proper diagnostics, which includes examination, testing, etc. This is usually done to rule out any medical complications related to the procedure.

Step 2: Ovarian Stimulation

The next step of the in vitro fertilisation procedure is ovarian stimulation. In simple words, medications are offered to stimulate the ovaries to produce multiple eggs, which enhances the chance of pregnancy.

Step 3: Egg Retrieval

After that, eggs are retrieved from the ovaries. The eggs are generally retrieved using a minor surgical procedure. After the retrieval, patients may experience mild discomfort or cramping.

Step 4: Sperm Retrieval

The next step is the submission of a sperm sample by a male individual on the same day of egg retrieval. After collection, the sperm undergoes a washing and spinning process to separate and identify the healthiest ones for fertilisation.

Step 5: In-vitro Fertilisation

Once the eggs and sperm are collected, the next step is fertilisation. The fertilisation process can occur naturally, where the sperm is placed with the eggs, or through ICSI (Intracytoplasmic Sperm Injection), where a sperm is injected directly into each egg.

Step 6: Embryo Culturing and Transfer

After fertilisation, the embryos are monitored for development, and the best ones are selected for implantation. The healthy embryo is carefully planted in the female reproductive organs.

Step 7: Routine Pregnancy Tests

Once the embryos are successfully planted, the mother must take a pregnancy test to confirm the procedure's success.

Before diving into what health insurance covers for IVF treatment, it is crucial to understand why IVF coverage is necessary in a health policy. Below are some reasons to invest in health insurance that covers IVF:

High Treatment Cost

The cost of the IVF procedure in India is hefty, which can be between ₹1,00,000 to ₹3,00,000. The procedure involves various clinical tests, medication and more. These extra expenses can easily drain your savings if you do not have health insurance with IVF coverage.

Quality Medical Care

Another reason for having health insurance with IVF cover is to get access to quality medical care. The IVF procedure is delicate and expensive. With insurance, policyholders can avoid financial stress and get the best care throughout the process in a reputed IVF facility with high success rates.

Comprehensive Medical Coverage

The health insurance plans that cover IVF come with broader coverage for IVF that involves diagnostic, testing, consultation and other assisted reproductive technology. This will help in understanding what course of action will best suit the individual.

Multiple IVF Cycles

IVF treatment generally requires more than one cycle for success. Health insurance with IVF cover can help reduce the financial burden of multiple cycles. It also increases the chances of a successful pregnancy without the added stress of mounting costs.

Access to Advanced Technology

IVF treatment employs advanced methods like embryo freezing, genetic testing and egg retrieval. Insurance coverage for IVF helps people access these technologies. This boosts success rates and reduces financial stress.

There are so many specialised health insurance plans that cover IVF. With so many options available, choosing the best plan can be daunting. Therefore, here are some factors that can help you choose the best health insurance with IVF cover.

Know IVF Eligibility Criteria

Most IVF-covered health insurance comes with age eligibility criteria. This means coverage will be available for women who fall within the specified age criteria, which is usually between 21 and 40. Furthermore, many insurance providers also have conditions for pre-existing conditions related to fertility.

Understand IVF Treatment Cost

Another important factor to consider when buying IVF health insurance is treatment cost. IVF can be expensive. So, it is vital to understand the costs and financial details. This helps avoid any last-minute surprises.

Know IVF Coverage and Specifics

Another key point when buying health insurance for IVF is the plan’s coverage details. Not all health insurance plans cover IVF treatment. So, it is important to check if your plan includes IVF coverage. If the health policy does offer coverage, make sure it includes the different medications and procedures involved in the treatment.

Learn About Waiting Period

Most health insurance with IVF cover also comes with a waiting period. This means that policyholders can not take advantage of the plan during this time. They can only benefit from the policy once the waiting period is over.

The waiting period for health insurance with IVF coverage varies from insurance provider to provider. It typically ranges between 2 to 4 years. Therefore, it is crucial to learn about the waiting period before choosing medical insurance with IVF coverage.

Understand Claim Procedure

Another crucial thing to know before purchasing a plan is about the claim procedure. The claim procedure can be daunting, so it is crucial to familiarise yourself with it. It is best to know if you need to carry out pre-authorisation when making a claim request. It is best to go with an insurance provider that offers a high claim settlement ratio.

Many health insurance plans that cover IVF also offer coverage for other infertility treatment procedures. Some of the common infertility treatments that are covered under the health insurance online are listed below:

Intrauterine Insemination (IUI)

One of the common infertility treatments that are covered under a specialised medical insurance plan is Intrauterine Insemination. Under this procedure, the sperm is inserted into the uterus during the ovulation phase. The procedure is well-curated and performed by the healthcare professional in the laboratory environment.

Gamete Intrafallopian Transfer (GIFT)

Another infertility treatment that is covered under specialised health insurance plans is Gamete Intrafallopian Transfer. Under this process, the eggs and sperm are mixed up in the laboratory. When it is prepared, it is then planted in a fallopian tube.

Intracytoplasmic Sperm Injection (ICSI)

It is another common infertility treatment where sperm is injected into a female egg in a laboratory. Once it is prepared, the embryo is planted in the uterus.

Also Read: Does Health Insurance Cover Congenital Diseases in India?

Knowing “Is IVF covered by health insurance?” is crucial for avoiding a claim rejection in the hour of need. However, apart from this, there are various reasons which can lead to claim rejection if not paid attention to. Some of these mistakes are highlighted below:

• Many health insurance policies explicitly exclude fertility treatments, including IVF. Always check the fine print of your policy to see if IVF is covered.

• Even if IVF is covered, some insurance providers may have limitations on the number of cycles or the total amount they will pay. If you exceed these limits, a claim could be denied.

• If the required medical documents or treatment records are not provided or are incomplete, the insurance provider might reject the claim.

• Some health insurance policies have waiting periods for IVF treatments. If you claim during the waiting period, it may be rejected.

• If you have a pre-existing condition that can affect the IVF treatment procedure, the insurance provider can reject the claim.

Also Read: 5 Things to Know About Maternity Insurance in India

Infertility is a common issue among many couples who want to have children. IVF procedures give hope to such parents. However, the IVF procedure is expensive and can easily drain your financial savings. Hence, it is crucial to invest in health insurance online with IVF coverage.

A medical insurance plan also offers a safety net to individuals and couples against various unforeseen medical emergencies. With adequate health policy coverage, you can get treatment in a quality medical care facility.

TATA AIG offers health insurance plans that are customised to your unique healthcare needs. For example, our family medical insurance is a cost-effective solution designed for families. Under the plan, medical coverage is offered to all insured members, such as spouses, children, etc.

We also offer maternity coverage as an add-on with our medical insurance plans, where you can get gynaecologist consultations, premenstrual syndrome (PMS), infertility counselling and more. We have a team of 650+ claim experts on board to assist you during the claims process. Secure your and your family's health now with our health insurance plan.