Is IVF Covered In Health Insurance?

The love and happiness that a kid offers to a family are immeasurable. In today's age of modern medical technologies, infertility is no longer an impediment to starting a family. In Vitro Fertilization, or IVF, is one such process that assists couples in realizing their ambition of starting a baby. However, the procedure is not inexpensive. It has a variety of components and may need to be taken many times, adding up the costs. This is where having health insurance coverage that includes IVF might come in handy since it will cover the costs of the process.

Health Insurance Covers for IVF Treatment in India

The Medical insurance sector in India provides an umbrella cover for costs borne by the insured customers for their chronic and serious ailments and when it comes to maternity illness or pre and post pregnancy complications/conditions, there still seems to be cloudy areas which remain out of scope of insurance coverage. In-vitro fertilisation or IVF as it is generically referred to amongst the masses happens to be one such realm that’s largely an unexplored domain. The health condition seems excessively exorbitant to most healthcare providers and not every female would be needing it in her course of maternal journey. Therefore, the ones needing it have to bear the treatment expenses out of their own pockets. However, some health insurance companies did take notice of the rising inflation and a proportionate spike in the cost of IVF treatment, hence they launched health plans catering to IVF coverage. The covers include costs pertaining to the entire process of IVF related consultations, treatment process, medical lab tests, hormonal assessment tests, IVF cycle, surgical procedure etc. the scope of coverage benefits shall also be subject to T&C set by one insurance company to another.

Understanding IVF Therapy

In simple terms, IVF denotes fertilisation of male sperm and female egg outside the biological bodies of the mating individuals. When the sperm and the egg fertilise successfully in the lab conditions, the resulting embryo is transferred to the mother’s uterus for furtherance of the growth and development. Tapping into the potential demand for the ever rising need of IVF process in India, many health providers started offering IVF related coverage in their health insurance plans for couples who are unable to conceive naturally. ‘Test tube baby’ is how we commonly address the IVF process in India. While its duration period lasts usually for about 3-4 weeks, specialists in fertility matter perform the end-to-end IVF therapy and supervise its treatment.

Eligibility Criteria For IVF Therapy

Following are some of the widely practised eligibility criteria for IVF therapy:

• Age Limit: In India, all legal norms follow the guidelines laid out under the legal framework of the IVF governing act known as The Assisted Reproductive Technology Act Of 2021 (ART Act). And as mandated by this ART Act, in order to avail IVF therapy medical services, women’s permissible age limit should be 21-50 years old while that of the men needs to be 26-55 years. The age limit exists due to declining quality of the female eggs produced by the ovaries as her age exceeds forties.  
• Physical Condition: Being plagued with physical conditions such as obesity, hypertension, etc can be detrimental to a female’s chances of successful conception as medical history representing an existing ailment/condition can cause failure of IVF therapy.   
• Sum Insured: This factor is governed by the health provider, health plan and the coverage benefits that you choose. 
• Waiting Period: In case of pre-existing illnesses, most health providers have a clause of waiting period that extends from 24 to 48 months during which an insured customer cannot file claim thus, it’s most judicious to buy a plan that offers least waiting period to reap the best IVF insurance benefits seamlessly.
• Validity Period: Your policy’s validity term rules the number of times IVF treatment; associated no. of IVF cycles; its costs etc can be availed within a given policy period. 
• Premium Amount: A prospective insured must seek absolute clarity from his health insurance provider on how much premium amount has to be deposited per policy year or per month for IVF insurance benefits.
• Exclusion Caveats: Every health plan comes with its preset underwriting clauses; terms and conditions and exclusion caveats thus, it is always advised to a customer to review the policy’s exclusion clauses carefully to avoid rejections or claim issues later on.

Health Insurance Companies And Plans Covering IVF Therapy

Enumerated below are some of the best curated healthcare plans that provide IVF insurance coverage:

• Care Classic-Zone Based By Care Health Insurance: The plan not only offers affordable pan-India coverage benefits to its insured customers but it also offers assisted reproductive treatment for SI of less than 5 lakhs once a block in every 3 years to 2 lakhs per year and medical services of OPD cover; doctor’s consultation, lab diagnostics 
• Health Absolute Plan by Future Generali: The plan offers 2 subtypes- Platinum and Signature.The floater plan provides general healthcare coverage to about 15 family members of the same unit and in addition offer maternity benefits to cover for the medical needs of the baby girl and her mother.The plan also provides coverage under assisted fertility treatment.
• Indira Plan By Indira IVF Centre: This maternity health plan provides psychological, nutritional and medical consultation to expecting couples who are under 35 years of age. It offers cashless claims for 2 intrauterine semination and 2 IVF procedures.

Take Away

An IVF procedure is not only costly, but it may also need to be repeated if the first attempt fails. This is why, to give enough financial assistance, it is necessary to have health insurance coverage. Because this isn't a typical procedure, it's crucial to shop around for several insurance plans to locate one that covers all you need. The need for infertility treatment coverage under health insurance has grown as the number of persons affected by infertility has increased. Because infertility treatment is covered by a variety of health insurance policies in India, it's important to compare health insurance plans to pick the best one for your needs.

Do read - Understanding The Star Health And Allied Insurance Claim Process

FAQs

Ques 1. Why is IVF treatment not offered medical coverage by general health insurance plans?

Ans. Most insurance companies do not consider IVF treatment and fertility related services as absolutely necessary medical procedures because not every woman needs it. Therefore, health providers generally do not include IVF services under the purview of health insurance plans.

Ques 2. What is the cost of availing IVF treatment in India?

Ans. There is no standard in terms of cost borne on IVF treatment in India as it depends on a variety of factors and from one state to another. But, it can cost you around Rs 70,000 to Rs 1,25,000 as a general price range. 

Ques 3. What are the important pointers to be kept in mind while purchasing IVF insurance?

Ans. As an aware prospective customer, you are advised to thoroughly review and compare different health plans entailing an array of factors to take a note of such as- caps, limits, waiting period before selecting one IVF plan. Seeking guidance from your insurance company’s experts and IVF clinics is best recommended.