Does Health Insurance Cover Infertility Treatment?


4 min read

Updated on Jul 13, 2022

Becoming a parent for the first time is one of the most amazing experiences and the joyous feeling of holding your baby is unparalleled. Sadly, this joy eludes some couples due to the problem of infertility. Infertility has emerged as a very common and major cause of concern for most couples in the last decade or so. The health insurance sector has tried to thus create plans to extend a financial protection in such cases by introducing insurance cover for infertility. However more clarity is required to answer the query does health insurance cover fertility treatments?

In this article, we are going to find out if infertility is covered under health insurance plan, and what all infertility processes are included under such coverage. To start with, let us understand the meaning of infertility.

What is infertility and what are its causes?

When a couple is unable to conceive a child despite having regular intercourse for over a year without the use of any contraceptives, the condition is called Infertility. Thus, infertility is the condition where a couple can’t conceive despite trying regularly for 12 months.

Both male and female can experience infertility and can be the cause of not being able to conceive. Since fertility declines with the age of a woman, so a women above the age of 35 is considered infertile if she couldn’t conceive within 6 months of unprotected sex. And in men the problems in the ejection of semen or low sperm count can be the reason for inability to conceive.

There is of two kinds of infertility:

  • Primary infertility
  • Secondary infertility

Primary infertility is when a couple is not able to conceive even after 1 year of unprotected sex, while secondary infertility refers to when the couple has conceived once but couldn’t conceive the again even after regular try.

Causes of Infertility

Infertility can be due to many conditions. Here are some of the common causes of infertility:

  • Obesity
  • Inactive/sedentary lifestyle
  • Diseases like diabetes
  • Smoking cigarette
  • Excess consumption of alcohol
  • Being stressed all the time
  • Irregular sleep
  • Eating junk and unhealthy food on regular basis
  • Suffering from reproductive conditions like uterine fibroid, PCOS, etc.
  • Age
  • Infections
  • Tuberculosis
  • Use of regular contraceptives
  • undergoing surgical abortion
  • Generic problems

Is treatment for Infertility covered under health insurance?

Does health insurance cover fertility treatment? This is one of the common questions that most people ask insurance companies/agents.

Treatment for infertility is highly-priced in India and in most countries across globe. IVF, which is a common treatment for infertility is priced between INR 1 lakh to INR 4 lakh and still has no guarantee of being 100% successful. Most couples looking for infertility treatment ask – is ivf covered by insurance? However, it is very unfortunate that at present most health policies do not offer coverage for treatment of infertility.

However things are slowly changing for good and some companies have started offering health insurance that covers infertility treatments. Some of them offer infertility cover in the base policy, while others include it as add-on coverage. Further, some companies combine infertility cover with maternity coverage.

However, depending on the plan, the coverage offered for infertility differs. Every plan doesn’t provide comprehensive coverage or provide coverage for infertility treatment. Thus, it is important to compare insurance policies to understand the expenses covered by different plans before choosing the best one.

Also, it is important to know that infertility coverage in a policy might have an extended waiting period and capping. So, comparing different policies is very important so that you can find the best plan offering maximum infertility coverage.

Treatment of Infertility covered under most medical insurance policies

Below some of the procedures or treatments of infertility that a health insurance policy should cover:

  • IVF or In Vitro Fertilization – In this procedure, eggs are collected from the ovaries of female and are united with the sperm of the partner in a lab to create an embryo, which is later planted in the uterus of the female.
  • IUI or Intrauterine Insemination – In this process, the sperm of the male is inserted directly in the female uterus when she is ovulating.
  • GIFT or Gamete Intra-fallopian Transfer – Here, eggs of female are mixed with sperm of male in the lab and later it was planted in the fallopian tubes.
  • ICSI or Intracytoplasmic Sperm Injection – Here, a single sperm of the male partner is injected to a single egg of the female in the laboratory, which is then placed in the uterus later.

Things to know before purchasing insurance policy for infertility coverage

An insurance policy offering coverage for infertility might have certain terms and conditions. So, it is important to have a check on the following things before buying a health insurance that covers infertility treatments:

  • Eligibility criteria for the coverage
  • Cost of infertility diagnosis as per the policy
  • Process of Infertility treatment as per the policy
  • Waiting period before you could undergo the treatment
  • Medicine costs covered under the policy
  • Know about the number of times that you can raise claims
  • Check for add-ons coverage
  • Check for infertility treatment costs

To Conclude

As per data, 10-14 % of Indian couples face infertility issues making it one of the major health issues that concerns couples.

This is why millions of couples in the country who are unable to conceive due to infertility seek IVF insurance. And this has caused a high demand for infertility coverage in India. There are many companies offering coverage for infertility. However, it is important to check and compare different policies before purchasing the one that suits your needs.

Feb 02, 2022
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PayBima Team
PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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