Traditional Exclusions in Health Insurance Plans

In India, traditional medical insurance policies usually exclude infertility treatments, as they are considered elective or non-essential. Many couples often ask, Does health insurance cover in vitro fertilisation? In most cases, the answer is no.

Most standard health insurance plans exclude costs associated with infertility diagnosis, medications, or procedures like IVF, IUI, or ICSI. As a result, couples mostly pay for these infertility treatments from their own savings.

Although IVF treatment itself may not be covered under all plans. TATA AIG She Care+ Rider offers supportive services like infertility counselling and gynaecologist consultations, helping individuals take informed, confident steps forward.

Evolving Coverage in New Health Insurance Plans

The scenario is gradually changing with new-age and comprehensive health insurance with infertility coverage. Some insurers now include infertility treatment as an add-on benefit or within maternity coverage.

These IVF cover health insurance plans may offer limited coverage for consultations, diagnostic tests, and certain procedures. However, coverage limits, waiting periods, and exclusions differ between insurers, so policyholders should always review the fine print.

Growing Availability of Health Insurance with Infertility Coverage

Some modern insurance providers now recognise the growing need for reproductive health support. They are offering health insurance with infertility coverage or are providing IVF insurance as an add-on to maternity insurance.

These plans provide partial or full benefits for fertility-related consultations, diagnostic tests, and advanced treatments such as IUI, IVF, and ICSI. IVF medical insurance plans are commonly placed under covers with a higher sum insured amount.

IVF cover in health insurance may also extend to procedures involving donor programmes or hormonal therapies, depending on the policy. However, the extent of coverage, waiting periods, and eligibility conditions differ across insurers.

Policyholders should therefore review inclusions carefully before purchase, as not all IVF health insurance covers are the same. This shift is a positive step that helps more couples afford and avail themselves of infertility treatment without feeling financially overwhelmed while trying to start a family.

IVF medical insurance is a type of health plan that helps cover the high costs of fertility treatments like In IVF. A common question people ask is, “Does medical insurance cover IVF?” In the past, most regular health policies did not include infertility treatments at all.

However, in recent years, some insurers have started offering specific plans or add-ons that include IVF under maternity or fertility coverage. These policies may cover consultation fees, diagnostic tests, medications, and procedures related to IVF.

For those wondering, is IVF covered in health insurance? You must understand that the answer depends on the insurer and policy type. Some modern health plans now include partial or full IVF coverage, which helps couples access treatment and reduces out-of-pocket expenses and access fertility treatments.

According to the World Health Organisation, infertility is considered the inability to conceive after trying naturally for one year without using contraception.

As per the National Family Health Survey-5 (NFHS-5), infertility affects nearly 17.5 - 18.1% of couples in India and abroad, with rising cases seen in urban and semi-urban areas. Stressful lifestyles, late marriages, obesity, smoking, hormonal imbalances, and environmental toxins are among the leading causes in both men and women.

For many couples, the path to parenthood is not easy. It often brings emotional stress and financial strain. With repeated tests, frequent hospital visits, and costly treatments like IVF, both mental health and savings can take a hit. That is why early diagnosis and awareness matter - they can make a real difference.

• Ovulation Disorders: Irregular or absent ovulation due to hormonal imbalance or PCOS.
• Fallopian Tube Damage: Blocked or scarred tubes prevent egg-sperm meeting.
• Low Sperm Count or Quality: Reduced sperm count or poor movement can make fertilisation difficult.
• Endometriosis: Tissue growth outside the uterus disrupts conception.
• Age-Related Decline: Fertility decreases significantly after age 35.
• Lifestyle Factors: Smoking, alcohol, obesity, stress, and poor diet impact fertility in both sexes.

• Intrauterine Insemination (IUI): A simple, non-invasive procedure where doctors place the processed sperm directly into the uterus to aid fertilisation.
• In Vitro Fertilisation (IVF): Eggs are fertilised with sperm in a lab. The embryo is then transferred into the uterus.
• Intracytoplasmic Sperm Injection (ICSI): Doctors inject one healthy sperm directly into an egg, usually when male infertility is the main concern.
• Donor Programmes: Donor eggs, sperm, or embryos are used when either partner’s reproductive cells are unsuitable.
• Surrogacy: A gestational surrogate carries the embryo for couples unable to carry a pregnancy.

Inclusions of Infertility Treatment in Health Insurance Plans

Health insurance plans that include IVF treatment generally cover the following:

• Ovarian Stimulation: Coverage for hormonal medications used to stimulate the ovaries to produce multiple eggs.
• Egg Retrieval and Fertilisation: Includes the cost of retrieving eggs from the ovary and fertilising them with sperm in a laboratory.
• Embryo Transfer: Covers the medical procedure of transferring the fertilised embryo into the uterus.
• Embryo Harvesting: Expenses related to the collection, preservation, and handling of embryos.
• Pre-implantation Diagnostic Tests: Coverage for genetic or chromosomal testing of embryos before implantation.
• OPD Doctor Consultations: Reimbursement or cashless benefit for outpatient visits to fertility specialists.
• Inpatient Hospitalisation Expenses: This includes room charges, nursing fees, and other hospital costs during your fertility treatment stay.
• Day-care Procedures: Covers treatments or procedures done on the same day that do not need an overnight stay.
• Medicines: Takes care of the cost of prescribed fertility medicines and hormone injections.
• Teleconsultations: Allow you to consult fertility specialists online without visiting the clinic every time.

Please note: The inclusions may vary depending on the insurer and the specific health insurance with infertility coverage. Some policies may offer only partial coverage or set limits on the number of IVF cycles.

Exclusions of Infertility Treatment in Health Insurance Plans

• Donor Material Costs: Expenses for donor eggs or sperm are usually not covered.
• Surrogacy Payments: Any payment made to a surrogate or gestational carrier is excluded.
• Unauthorised Procedures: IVF conducted without a certified doctor’s recommendation is not claimable.
• Pre and Post Treatment Costs: Expenses incurred before or after the IVF cycle are excluded.
• Experimental Treatments: Unproven or investigational infertility procedures are not covered.
• Reversal Surgeries: Reversal of voluntary sterilisation procedures like vasectomy or tubectomy is excluded.
• Cryopreservation Charges: Costs for freezing and storing eggs, sperm, or embryos are not included.
• Subsequent IVF Attempts: IVF for a second or later child is usually not covered.
• Unrecognised Clinics: Treatments at unregistered fertility centres are excluded.
• Fertility Enhancement Surgeries: Procedures like bariatric surgery or ovarian drilling are not covered.

• Age Requirement: Most insurance companies offer IVF coverage to women aged between 21 and 42 years.
• Confirmed Infertility Diagnosis: A qualified gynaecologist or fertility expert must confirm that you are facing infertility before treatment begins.
• Marital Status: Most insurers offer IVF cover only to legally married couples, although some newer plans are now open to single women too.
• Medical Recommendation: IVF should be recommended by a doctor, backed by proper medical tests and clinical proof.
• Previous Treatment History: Some insurers review past fertility treatments or unsuccessful attempts before approving claims.
• Waiting Period: The insured must complete the mandatory waiting period, usually ranging from 2 to 6 years, before claiming IVF benefits.
• Treatment Clinic Recognition: The IVF procedure should be conducted at an IRDAI-approved and recognised fertility clinic.
• Policy Tenure and Renewal: Continuous policy renewal without lapse is often required to maintain eligibility for IVF coverage.

A medical insurance plan covering infertility treatment will usually have certain terms and conditions that the policyholder will have to adhere to. Therefore, before you buy health insurance online for fertility treatment, check the policy for the following aspects:

• Eligibility Criteria: Each insurer defines specific eligibility conditions for fertility treatment coverage. Factors such as age, marital status, medical history, and previous treatments can influence approval. Always verify these before applying.
• Coverage for Diagnosis: Some plans include the cost of diagnostic tests like hormone assessments, ultrasound scans, and fertility evaluations, while others may exclude them. Confirm this inclusion to avoid unexpected expenses.
• Covered Procedures: Check whether the policy includes treatments such as IUI, IVF, ICSI, and related procedures. Some plans may also cover pre-implantation genetic testing or embryo transfer.
• Policy Limitations and Coverage Extent: Understand the financial limits, number of cycles covered, and whether partial or full reimbursements are offered. Each insurer sets its own coverage cap.
• Waiting Period for Claims: Most policies have a waiting period before you can make a claim, which may range from 2 to 6 years. Planning ahead helps you benefit from the coverage when needed.
• Medication Coverage: Clarify if prescribed fertility drugs and hormonal injections are covered, as these can significantly add to treatment costs.
• Add-ons for Infertility Treatment: Some insurers offer optional add-ons for specific infertility treatments or advanced procedures. Evaluating these add-ons can help customise your plan for better support during the fertility journey.

Understanding whether infertility treatments like IVF are covered under health insurance is crucial for couples planning their parenthood journey. As awareness around reproductive health grows, more insurers are introducing plans that address infertility-related needs.

However, the scope of coverage, waiting period, and eligibility still vary widely across providers. Choosing the right women health insurance policy ensures better financial preparedness and peace of mind during infertility treatment.

At TATA AIG, we offer an extensive range of health insurance plans that combine flexibility, affordability, and strong financial protection. Our specialised plans ensure that women receive the care they need at every stage of life, from wellness and maternity to fertility-related concerns.

With the convenience of buying health insurance online, we make it easier to secure your future with just a few clicks. Choose TATA AIG to secure your health and empower your future.

Get your health insurance online today.