Does Health Insurance Cover Infertility Treatment?

What is infertility?

Infertility refers to the medical condition where a couple cannot achieve pregnancy despite a year of having sexual intercourse without using birth control. It is the inability of a couple to conceive within 12 months despite having unprotected sex. Both men and women can suffer from infertility. In women aged 35 years and above, the inability to achieve pregnancy within 6 months of trying is also considered infertility as the fertility in women declines with age.

Infertility can be of two types - Primary infertility and Secondary infertility. Primary infertility refers to the situation where you are unable to conceive even after having unprotected sexual intercourse for at least 1 year. On the other hand, secondary infertility is the situation where you have achieved pregnancy once but are unable to get pregnant again.

Unfortunately, about 27.5 million couples in India suffer from infertility that includes 1.5% more men than women. Doctors fear that these numbers are only going to increase in the years to come.

Causes of Infertility

There are multiple reasons that can lead to infertility. Take a look at some of the most common causes of infertility in people:

Sedentary lifestyle/ obesity
Diabetes
Smoking
Excessive alcohol consumption
Stress
Irregular sleep patterns
Unhealthy eating habits
Women reproductive diseases/conditions, such as PCOS, uterine fibroid, etc.
Men reproductive illnesses/conditions, such as lower sperm count & quality, ejaculation issues, etc.
Advancing age of women
Infections & tuberculosis
Frequent use of emergency contraception
Surgical abortion
Pollution
Genetic reasons

Is Infertility Treatment Covered by Health Insurance?

Infertility treatment is expensive in India and abroad. For instance, an IVF treatment can cost somewhere between Rs 1 lakh to Rs 4 lakh with no guarantee of success. Nonetheless, most health insurance plans do not cover the cost of infertility treatment.

But in the last few years, some insurance companies have introduced infertility treatment cover under their health insurance plans or plan to do so soon. While some of them are offering infertility treatment cover in the base policy, others offer it as an add-on cover. A few insurers also plan to link the infertility treatment cover with maternity coverage or offer it under policies available with a higher sum insured amount.

However, the level of coverage for different infertility insurance plans may vary from each other. Not all plans may offer comprehensive coverage and cover all kinds of infertility treatments. It is best to compare health insurance plans and check the expenses covered by each plan before buying any one.

Moreover, a health insurance plan with infertility treatment cover may come with a long waiting period, sub-limit or capping. Thus, it is important to compare health insurance plans to find a plan that covers infertility treatment in the best possible way.

Infertility Treatment Procedures Covered under Health Insurance

An infertility insurance policy may provide coverage for the following infertility treatment procedures:

1. In Virto Fertilisation (IVF)- It involves gathering eggs from your ovaries and combining them with your partner’s sperms in a laboratory dish to make an embryo. The embryo is then planted into your uterus.

2. Intrauterine Insemination (IUI) -It involves inserting your partner’s sperms directly in your uterus when you are ovulating.

3. Gamete Intrafallopian Transfer (GIFT)- It involves mixing your eggs with your partner’s sperm on a laboratory dish and planting it in your fallopian tubes.

4. Intracytoplasmic Sperm Injection (ICSI) -It involves injecting a single sperm of your partner into a single egg of yours in a laboratory dish. The embryo is then placed in your uterus.

You can compare health insurance plans offering infertility treatment cover to know the procedures covered by different plans along with their premium.

Things to Check Before Buying Health Insurance for Infertility Treatment

An infertility treatment cover may come with a few terms and conditions. Thus, it is important to check the following things before buying health insurance for infertility treatment. Take a look:

Check the eligibility criteria to know who is eligible to opt for infertility treatment cover
Check if infertility diagnosis cost is covered under the policy
Check the infertility treatment procedures covered under the policy
Check the extent of coverage and sub-limits for various infertility treatment procedures covered under the policy
Check the waiting period for infertility treatment cover as it may range from 2 to 6 years depending on the insurer
Check if the cost of medicines used during the infertility treatment is covered
Check the number of claims that you can raise under your policy
Check if any infertility treatment expenses are available as an add-on cover

Make sure to compare health insurance plans in order to find an infertility insurance plan at an economical price.

In a Nutshell

Infertility has become a major health concern in India. According to the Indian Society of Assisted Reproduction, about 10-14% of the Indian population is affected by infertility, mostly those living in urban areas. Given the higher number of people affected with infertility, the demand for coverage of infertility treatment under health insurance has increased. Since multiple health plans available in India offer infertility treatment cover, you must remember to compare health insurance plans to find the best plan to cover your needs.