Is IVF Treatment Covered Under Health Insurance?

in vitro fertilization, also known as ivf, is the most widely practiced assisted reproductive technique in india and worldwide. If the statistics are to be believed, more than 8 million babies have been born through IVF treatment since the start of the procedure. According to Financial Express, between 2 and 2.5 lakh IVF treatments are performed every year in India alone. and india has the potential to take this number up to 5-6 lakh per year.

IVF treatment is a medical boon for couples who are unable to conceive naturally due to issues such as a blocked fallopian tube, ovulation disorder, degraded sperm quality, or lower sperm count. IVF can be performed with the partner’s eggs and sperm or with donor eggs or donor sperm. In IVF, the eggs and sperm are combined in a petri dish and fertilized. once the fertilized egg develops into an embryo, it implants in the female’s uterus, where pregnancy occurs for the next nine months.

Reading: Which insurance companies cover infertility

There is no greater joy than the joys of parenthood. But infertility treatments, including IVF, aren’t always easy on the pocketbook. not everyone can take advantage of the treatment without thinking twice due to the expenses that rob couples of this happiness most of the time. no one can guarantee a successful outcome of the procedure. if you are lucky, you can conceive for the first time. if not, you may need a few more cycles, from the first step. IVF is expensive, and the greater the number of cycles, the higher the cost. therefore, many couples affected by infertility seek a health insurance plan that covers the costs of infertility treatment.

This content is intended to help you understand the costs of IVF treatment in India and whether IVF treatment in India is covered by insurance.

ivf treatment cost in india

is ivf treatment in india covered by general health insurance policies?

not. General health insurance policies in India do not generally cover IVF procedures. however, there are some that do. As of March 2022, the only general health insurance that covers IVF treatment expenses is Bharatiya Mahila Bank’s BMB Nirbhaya plan. But, the coverage is only limited to women of different financial statuses. Under this scheme, women can avail of cashless facilities and maternity cover for the first two children.

Most general medical insurance providers cover only the costs of hormonal evaluation and medical tests, ot expenses, and anesthetic procedure charges. the rest of the treatment expenses as well as the medical expenses are borne by the couple separately. As a result, the number of companies providing cover for IVF treatment in India is very low. But as the number of couples undergoing IVF increases with each passing year, health insurance companies are considering IVF coverage in their insurance policies. In a report published by Insurance Dekho, Royal Sundaram General Insurance Chief Product Officer Nikhil Apte said: “We are looking to include IVF treatment in health plans and to prevent fraud we will look to people who have been with us for six years. include the sublimit and link it to maternity coverage.”

types of IVF coverage

Before learning about health insurance plans with IVF coverages, we need to understand the four types of IVF coverages that a health insurance policy can provide. these are:

  • full infertility insurance coverage
  • insurance only for diagnosis of infertility
  • insurance for diagnosis of infertility and treatment of limited fertility
  • drug coverage which may include prescriptions for fertility drugs
  • You need to know exactly what your health insurance plan covers. To get a better understanding, you can talk to your insurance provider and get more information about the schemes. Let’s understand the four types in a little more detail.

    infertility treatment

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    If your insurance policy covers full IVF treatment, it is essential to read and understand the procedures covered. Common treatments for infertility include:

    • in vitro fertilization (IVF)]
    • intrauterine insemination (iui)
    • assisted hatching
    • intracellular sperm injection (icsi)
    • preimplantation genetic diagnosis (pgd)
    • ovarian hyperstimulation syndrome (ohs)
    • frozen embryo transfer (fet)
    • gamete intrafallopian transfer (gift)
    • diagnosis of infertility

      diagnosis of infertility includes the following:

      • hormone profile tests
      • semen analysis
      • genetic testing
      • image tests for both men and women
      • tests to detect DNA abnormalities
      • ovarian reserve test
      • hysterosalpingography
      • hysteroscopy
      • laparoscopy
      • india insurance policies covering ivf and other infertility treatments

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

        1. nirbhaya of bharatiya mahila bank

          Nirbhaya by Bharatiya Mahila Bank

          ivf treatment coverage under nirbhaya is available to women with limited financial status who have opened an account with bharatiya mahila bank. the policy covers infertility treatment, hospitalization expenses and maternity coverage without imposing a financial burden on women. The sum insured is between INR 1 lakh and INR 5 lakh, and the premium for INR 1 lakh insurance coverage starts at INR 1,745 for women aged 22 and above. the nirbhaya policy also includes coverage for gynecological health checkups from the fourth year and maternity coverage from the third year. additionally, the policy also covers expenses for spontaneous abortions.

          1. magma hdi onehealth insurance policy

            Magma HDI OneHealth Insurance Policy

            onehealth insurance policy is the flagship health insurance plan of magma hdi general insurance company.

            The policy offers comprehensive coverage, including the cost of hospitalization, nursery treatment, donor expenses, pre- and post-hospitalization for IVF treatment. onehealth covers medical expenses related to IVF treatment performed in a clinic duly registered in accordance with applicable law* and with the written medical advice of an infertility specialist. the insured person is eligible for coverage only up to age 40.

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            onehealth insurance policy provides ivf treatment coverage up to inr 50,000 even on a total plan sum insured of inr 200,000. there is a waiting period of 3 years from the start date of the policy before you can enjoy this benefit.

            1. digit health care plus policy

              Digit Health Care Plus Policy

              Digi Health Care Plus Policy is a health insurance policy recently introduced by Go Digi General Insurance Limited, which includes many features at competitive prices. digit medical insurance for fertility treatment includes ivf, iui, zift, icsi, etc. In addition, the plan offers infertility treatment coverage as an additional coverage that one can opt for. Under this policy, the insurance company will pay medical expenses if you are hospitalized on the advice of a specialist doctor for any infertility treatment.

              The sum insured for IVF coverage by Digit Health is limited to a percentage of the sum insured or a certain amount.

              what to look for in infertility treatment insurance policies?

              Infertility treatments are complex and therefore require comprehensive health insurance coverage. When shopping for health insurance plans that cover IVF, look for the following terms and conditions in the plans you review:

              • eligibility (this depends on your age, gender, lifestyle, occupation, and/or medical history)
              • sum insured (coverage offered by the health insurance plan for IVF procedures)
              • waiting period (none of the insurance policies to date allow IVF treatment from day one)
              • validity (number of times one can take advantage of IVF expenses in their health insurance plan)
              • sub-limits and copays (your sum insured may be restricted and you may be required to participate in part of the claimable amount)
              • exclusions
              • premium
              • The treatment of infertility is not only a medical necessity but also a social necessity. If you’re planning IVF and looking for policies that might cover the cost of your treatment, we suggest you do your research first. Learn as much as possible about treatment approaches, so when choosing an insurance provider, choose the right one that meets your requirements.

                Is IVF Treatment Covered Under Health Insurance?

                If you’re looking forward to the joy of parenthood, there are other financing options available that can cover the cost of medications, follow-up, diagnostic tests, and even childbirth. At Pristyn Care, we organize zero-cost EMI loan options for all couples considering IVF.

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