Is IVF Covered by Insurance? Understanding Your Options

In-vitro fertilisation (IVF) is a type of assisted reproduction technology (ART). In IVF, an egg is fertilised with a sperm outside a body, in a petri dish, and later this fertilised egg is implanted in the woman’s uterus. 

First, medicines are administered to women seeking IVF to produce multiple eggs from their ovaries. Then the doctor extracts the eggs and stores them in a cold storage bank. Similarly, the father has the sperm that are collected and stored. Using some of the procured eggs, the doctor fertilises the eggs in a laboratory. The doctor puts one or more embryos (fertilised eggs) into the uterus. Pregnancy occurs when the fertilised eggs implant in the uterus lining. 

There are several steps in the IVF process, and it takes many months for the entire process to complete. IVF increases the chances of conceiving if you are facing fertility issues.

In India, infertility is a common problem, affecting about 15 to 20% of couples of reproductive age. IVF treatment is a popular option for couples struggling with infertility, but the high cost of treatment can be a major barrier. This is where insurance coverage for IVF becomes important.

Here are some reasons why insurance coverage for IVF treatment is necessary in India:

1. High Cost of Treatment: IVF treatment can be expensive, with costs ranging from ₹ 1,00,000 to ₹ 2,50,000 per cycle. Many couples require multiple treatment cycles to achieve a successful pregnancy, which can quickly add to a significant financial burden.
2. Lack of Affordable Options: Many couples in India cannot afford IVF treatment without insurance coverage. While some insurance providers do offer coverage for infertility treatment, it is not yet widely available, and coverage limits can be restrictive.
3. Emotional Stress: Infertility can be a stressful and emotionally taxing experience for couples. The financial burden of IVF treatment only adds to this stress, making it even more difficult for couples to cope.
4. Access to Care: Insurance coverage for IVF can help improve access to care for couples struggling with infertility. By making IVF treatment more affordable, insurance coverage can help ensure couples can access the care they need to start a family.
5. Improved Outcomes: Insurance coverage for IVF can also improve treatment outcomes by allowing couples to afford multiple cycles of treatment if necessary. This can increase the chances of a successful pregnancy and reduce the need for more invasive and expensive fertility treatments.

Now that you know the importance of IVF insurance, you must be curious to know if IVF is covered under insurance in India. Which are the best health insurance plans that cover IVF treatments? Most insurance companies do not cover IVF treatment. However, there are a few that do have IVF insurance, but the extent of coverage may vary depending on the insurer and the policy. Here are some of the different types of coverage for IVF treatment:

1. Full infertility insurance coverage
2. Only infertility diagnosis coverage
3. Medication coverage of fertility medicines
4. Infertility diagnosis and limited fertility treatment coverage

Here are some of the health insurance companies that cover IVF and similar types of fertility treatment:

Private Insurance

1. Digit Health Insurance: Digit health insurance policy covers infertility treatment for both men and women.
   1. It offers IVF insurance for procedures such as
      1. Intrauterine Insemination (IUI)
      2. Gamete Intrafallopian Transfer (GIFT)
      3. Intracytoplasmic Sperm Injection (ICSI) 
   2. The minimum and maximum sum insured for infertility treatment is ₹10,000 to ₹3 crores.
   3. There is no minimum age to avail of this insurance plan. However, this insurance is restricted to individuals aged 40 and above. 
   4. The waiting period to avail of the policy ranges from 2 to 4 years. 
   5. This insurance can be availed only once. 
   6. The insurance can be claimed by cashless or reimbursement method. 
      1. In the cashless method, the insurance company directly pays your medical bills. 
      2. However, for the reimbursement process, you will have to settle the bills first and then apply for the reimbursement process by applying for the claim to the insurance company and sharing all the medical bills and other related documents.
2. Magma HDI One Health Insurance Policy: This insurance policy covers medical expenses incurred by the insured individual during the policy period for the IVF treatment.

   1. The sum insured by Magma HDI One Health insurance ranges from ₹ 2 lakhs to ₹ 1 crore. 

   2. The company has tied up with more than 7200 hospitals.

   3. The insured person can undergo IVF treatment before the age of 40. 

   4. The waiting period to avail of the policy is 3 years. 

   5. The insurance does not provide coverage if the insured person uses a third-party surrogate/gestational carrier during pregnancy. 

   6. It does not cover any expenses for consultation, diagnostic tests/procedures, or other expenses for the diagnosis of infertility.

   7. The insurance can be claimed by cashless or reimbursement settlement.

3. Care Classic Health Insurance Plan: At Care Health Insurance, the expenses incurred for IVF treatment are covered under the Care Classic Health Insurance Plan. 

   1. This policy offers reimbursement only for assisted reproductive treatment. 

   2. This benefit of up to 2 lakh can be availed per policy year for sum insured options above 5 lakhs. 

   3. The plan has a waiting period of 3 years.

   4. The minimum age for the plan is 18 years, and the maximum age is 65 years. 

   5. The company has tied up with more than 8350 hospitals in different cities of India.

   6. The insurance can be claimed by reimbursement or cashless settlement.

Government Scheme

1. Central Government Health Scheme (CGHS): The Department of Health and Family Welfare has declared that CGHS can be used to reimburse IVF treatment. 
   1. An amount of ₹65,000 per cycle or the actual cost can be reimbursed, including monitoring costs during the IVF procedure and the cost of drugs and disposables. 
   2. The reimbursement of expenses incurred on IVF treatment will be allowed for a maximum of 3 fresh cycles. 
   3. The eligibility criteria for women undergoing IVF treatment procedures should be between 21 and 39 years. 
   4. The IVF procedure will be allowed in a government medical institute or a private medical institution on the recommendation of the head of the department of gynaecology and obstetrics of a government medical institution. 
   5. As the treatment of IVF is a planned procedure, reimbursement can be considered by the departments/ministries only if the person has obtained earlier approval for undergoing the IVF treatment.

Choosing the best IVF insurance plan requires careful consideration of various factors. Here are some tips on choosing the best IVF insurance plan in India:

1. Check Coverage Limits: The first and foremost factor to consider is the coverage limit. Check whether the IVF insurance plan covers the entire cost of treatment or has a cap on the amount it will cover. Make sure you understand the coverage limits and any associated out-of-pocket costs.
2. Check Eligibility Criteria: Many IVF insurance plans have eligibility criteria that must be met before coverage will be provided. Check whether you meet these criteria and ensure that you have any required documentation.
3. Check Waiting Periods: Many IVF insurance plans have a waiting period before coverage begins. This waiting period can vary from a few months to a year or more. Make sure you understand the waiting period and how it will impact your treatment timeline.
4. Check Network Hospitals: IVF insurance plans usually have a network of hospitals where treatment can be availed. Check the list of network hospitals to ensure that there is a hospital near you that provides quality IVF treatment.
5. Check Co-payment and Deductibles: Some IVF insurance plans have a co-payment clause or deductibles that require you to pay a certain percentage of the cost of treatment. Check the co-payment and deductibles to understand how much you will need to pay out-of-pocket.
6. Check Additional Benefits: Some IVF insurance plans offer additional benefits such as coverage for pre and post-hospitalization expenses, diagnostic tests, and medication costs. Check these additional benefits to ensure that you are getting the best value for your money.
7. Read the Fine Print: It is important to read the fine print of the IVF insurance plan to understand the terms and conditions, exclusions, and limitations of the coverage. Make sure you understand the policy document before signing up for the plan.

There are several alternate financing options available for IVF treatment. Some of the options are:

1. Personal loan: Several banks provide personal loans at reasonable interest rates for IVF treatment. 
   1. The tenure of the personal loan can range from 1 to 5 years. 
   2. To avail the of the loan all you have to do is provide documents proving your identity, income, and address. 
   3. Later, you can repay the loans with equated monthly installments (EMI). You can pay the amount by cheque or instruct the band to debit EMI from your account. 
   4. The amount of the loan can vary across banks, for example, HDFC Bank provides loans up to ₹40 lakhs. However, it is essential that you compare the rate of interest, repayment terms, and other information before choosing a loan. 
2. Crowdfunding: Crowdfunding platforms like filaantro, Ketto, etc., help people to raise funds for medical treatment, including IVF treatment. With the help of these platforms, people can create a campaign and share it with their family, friends, and social network to seek financial support.

In India, the availability of insurance coverage for in-vitro fertilisation (IVF) treatment is limited, but IVF is covered by insurance. Companies like Digit Health, Magma HDI One Health insurance policy, and Care Classic Health Insurance Plan do cover insurance for IVF. The eligibility criteria, coverage amount, and terms and conditions of IVF insurance may vary from one insurer to another. It is important to carefully compare and evaluate different IVF insurance options before choosing one. 

If you still have any doubts about whether IVF is covered by insurance in India, and other related questions, please contact our personal care team at HexaHealth. They will resolve all your queries regarding IVF treatment options and guide you towards choosing the best one for you. You can also visit our website HexaHealth if you want to learn more about IVF insurance or insurance for other conditions.