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Health Insurance Coverage for Fertility Treatments Research Team | Posted On Monday, July 29,2019, 05:43 PM

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Health Insurance Coverage for Fertility Treatments



What is Health Insurance?

Health insurance refers to insurance cover that pays for the medical and surgical expenses of the insured. The insured/family can directly settle the medical bills through cashless facility at network hospitals or can spend for availing treatment at hospitals and get reimbursed at a later time.

It is a comprehensive insurance product that takes care of all the medical needs of the policyholder and covers Day care treatment, domiciliary and in-patient treatment.

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Health Insurance Coverage for Fertility Treatments

Need for Health Insurance:

The cost of medical treatment is rising at an alarming rate. Individuals, who haven’t saved enough for health and treatment, might face difficulties while arranging funds at the eleventh hour. An easy way to retain peace of mind as well as ensure you receive proper medical attention in emergencies is to avail a health insurance policy.

A health insurance policy covers a large number of critical illnesses and surgical procedures and makes sure the policyholder receives timely and adequate treatment, regardless of the actual medical costs. Health insurance policy benefits the buyer both health-wise and money-wise.

See Also: Exclusions of Health Insurance Policy

What is Fertility Treatment?

It is a type of medical treatment used primarily to assist in issues related to the birth of a baby and to address infertility. It includes treatments like IVF (In-vitro fertilization) cryopreservation of embryos, ovulation induction, usage of fertility medication and procedures like ICSI (Intracytoplasmic sperm injection).

The cost of fertility treatment in India depends on the fertility workup. So, the cost varies across people. However, these are specialized treatments and are of quite a high cost. Many infertile couples are now opting for fertility treatment. For example, cost of IVF treatment in India normally ranges from Rs 1 Lakh to Rs 1.25 Lakh per cycle, and includes the cost of diagnosis, tests and surgical procedures.

See Also: Health Insurance Benefits

Does Your Health Insurance Cover Fertility Treatment?

Having health insurance for your family is of utmost importance, to safeguard finances against the rising costs of medical care. Currently, health insurance in India does not cover the cost of IVF and fertility-related expenses. However, some of the insurers are now coming up with health insurance policies covering IVF treatment with a limited sum assured.

The health insurance plan offers coverage for medical expenses incurred for fertility treatment. The insured enjoys the insurance cover provided he avails the treatment within the policy tenure, under the medical guidance of a specialist and the treatment must be availed at a registered clinic.

These policies come with a pre-specified waiting period of about 3 years, from the date of purchase of the health insurance policy. There are other restrictions as well like health insurance does not cover the cost of treatment received after the age of 40 years or expense for consultation, diagnostic tests and so on.

See Also: Why Does One Need Health Insurance Policy?

IRDA Guidelines to Ensure Health Insurance Coverage for Fertility Treatments:

IRDA is currently considering including the cost of fertility treatment under health insurance and offering insurance cover for the same. However, IRDA must then include infertility as a disease in health insurance policies. As per reports, a case has been filed under the Punjab and Haryana court, seeking justice against an insurance company for claiming to cover fertility treatment.

The court has written a letter to IRDA to consider the plea and shed some light on the matter. The matter is still in court (sub judice) and a decision will be taken soon. The decision will clear confusion on whether the infertility treatment is added to health insurance cover or not. 

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