Is IVF Treatment Covered Under Health Insurance?

In-vitro Fertilization, also known as IVF, is the most commonly practiced assisted reproductive technique in India and globally. If statistics are to be believed, more than 8 million babies have been born through IVF treatment since the procedure’s inception. According to the Financial Express, 2-2.5 lakh IVF treatments are done every year in India alone. And, India has the potential of taking this number up to 5-6 lakh per year.

IVF treatment is a medical boon for couples who cannot conceive naturally for issues like a blockage in the fallopian tube, ovulation disorder, degraded sperm quality, or lower sperm quantity. IVF can be done using the eggs and sperm of the couple or by using 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 is implanted into the uterus of the female, where the pregnancy takes place for the next nine months.

There is no bigger joy than the joys of parenthood. But infertility treatments, including IVF, do not always come easy on the pocket. Not everyone can avail the treatment without a second thought due to the expenses that rob couples of this happiness more often than not. Nobody can guarantee a successful outcome from the procedure. If you are lucky, you can conceive for the very first time. If not, you may require a few more cycles, all the way from the very first step. IVF is expensive, and the higher the number of cycles, the higher the cost. Hence, many couples affected by infertility look for a health insurance plan that covers infertility treatment costs. 

This piece of content is intended to help you understand IVF treatment costs in India and if IVF treatment in India is covered under insurance.

Cost of IVF treatment in India

CityAverage cost of IVF treatment (in INR)
Delhi 1,25,000 – 1,50,000
Bangalore1,40,000 – 1,80,000
Hyderabad1,40,000 – 1,80,000
Chennai1,40,000 – 1,80,000
Kolkata1,40,000 – 1,80,000
Pune1,40,000 – 1,80,000
Gurgaon1,40,000 – 1,80,000

Is IVF treatment in India covered under insurance by general health insurance policies?

No. The general health insurance policies in India usually do not cover IVF procedures. However, there are a few that do. As of March 2022, the only general health insurance covering IVF treatment expenses is the BMB Nirbhaya Scheme by Bharatiya Mahila Bank. But, the coverage is only limited to women of different financial statuses. Under this scheme, women can avail cashless facilities and maternity coverage for the first two children.

Most general health insurance providers cover only the hormonal assessment and medical testing costs, the expenses of the OT, and the charges of the anesthetic procedure. The rest of the treatment expenses as well as the medical costs are to be borne separately by the couple. As a result, the number of companies providing coverage for IVF treatment in India is very few. But as the number of couples undergoing IVF is increasing with every passing year, health insurance companies are pondering IVF coverage in their insurance policies. In a report published by Insurance Dekho, Chief Product Officer of Royal Sundaram General Insurance Nikhil Apte said, “We are looking to include IVF treatment in the health plans and to avoid frauds we will go for people who have been with us for six years, include sub-limit and link it to maternity cover.”

Types of IVF coverages

Before we learn about the health insurance plans with IVF covers, we should understand the four types of IVF coverages that a medical insurance policy might provide. These are:

  • Full infertility insurance coverage
  • Insurance for infertility diagnosis only
  • Insurance for infertility diagnosis and limited fertility treatment
  • Medication coverage which may include fertility drug prescriptions

You need to know what is exactly covered in your health insurance plan. To have a better understanding, you can speak to your insurance provider and gain more insight into the schemes. Let’s understand the four types in a bit more detail.

Infertility treatment

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

  • In-vitro fertilization (IVF)]
  • Intrauterine insemination (IUI)
  • Assisted hatching
  • Intracellular sperm injection (ICSI)
  • Preimplantation genetic diagnosis (PGD)
  • Ovarian hyperstimulation syndrome (OHSS)
  • Frozen embryo transfer (FET)
  • Gamete Intrafallopian Transfer (GIFT)

Diagnosis of infertility

Diagnosis of infertility include the following:

  • Hormonal profile testing
  • Semen analysis
  • Genetic testing
  • Imaging tests for both male and female
  • Tests for DNA abnormalities
  • Ovarian reserve testing
  • Hysterosalpingography 
  • Hysteroscopy
  • Laparoscopy

Insurance Policies in India that cover IVF and other infertility treatments

Here are a few health insurance policies that cover IVF and similar kinds of fertility treatments:

  1. Nirbhaya by Bharatiya Mahila Bank

Nirbhaya by Bharatiya Mahila Bank

The IVF treatment coverage under Nirbhaya is available for women under limited financial statuses who have opened an account in Bharatiya Mahila Bank. The policy covers infertility treatment, hospitalization expenses, and maternity coverage without putting a financial burden on women. The insured sum is between INR 1 lakh to INR 5 lakh, and the premium for the insurance coverage of INR 1 lakh starts at INR 1,745 for women who are 22 years old and above. The Nirbhaya policy also includes coverage for the gyne health check ups from the fourth year and maternity coverage from the third year. Additionally, the policy also covers the expenses for miscarriages.

  1. Magma HDI OneHealth Insurance Policy 

Magma HDI OneHealth Insurance Policy

The OneHealth Insurance Policy is the flagship health insurance plan from Magma HDI General Insurance Company.

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

The OneHealth Insurance Policy offers IVF Treatment cover of up to INR 50,000 even on an overall plan sum insured of INR 2,00,000. There is a waiting period of 3 years from the policy inception date before one can enjoy this benefit.

  1. Digit Health Care Plus Policy

Digit Health Care Plus Policy

The Digi Health Care Plus Policy is a recently introduced health insurance policy from Go Digit General Insurance Limited, which packs in many features at competitive prices. Digit Health Care insurance for fertility treatment includes IVF, IUI, ZIFT, ICSI etc. In addition, the plan offers infertility treatment cover as an add-in cover that one can opt for. Under this policy, the insurance company shall pay medical expenses if you are hospitalized on the advice of a medical specialist for any infertility treatment. 

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

What to look for in insurance policies for infertility treatments?

Infertility treatments are complex and hence require comprehensive health insurance coverages. When purchasing health insurance plans that cover IVF, look out for the following terms and conditions in the plans you examine:

  • 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 allows IVF treatment from day one)
  • Validity (number of times one can avail IVF expenses on their health insurance plan)
  • Sub-limits and Copayment (your sum insured might be restricted, and you might need to participate in part of the claimable amount)
  • Exclusions
  • Premium

Infertility treatment is not just a medical need but also a societal necessity. If you are planning IVF and looking for policies that can cover your treatment cost, we suggest you do thorough research first. Learn as much as possible about the treatment approaches, so when you choose an insurance provider, you pick the right one that meets your requirements.

if you are someone looking forward to experiencing the joy of parenthood, there are other financing options available that can cover the cost of the medicines, monitoring, diagnostic tests and even the child birth. At Pristyn Care, we arrange zero-cost EMI loan options to every couple considering to choose IVF.

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