GUIDES & RESOURCES

Health Insurance For IVF

In this article, we’ll explain more about IVF and private health insurance, including what services may be covered, the waiting periods that might apply, and how to find suitable health policy that covers this treatment.
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Assisted reproductive treatments (ART) are services designed to help treat infertility1. These treatments include the procedure known as in vitro fertilisation (IVF). In Australia, some of the costs of IVF services are covered by Medicare, as well as private health insurance policies2.

However, there can also be significant out-of-pocket costs, so it’s essential to understand what you’re covered for if you’re considering IVF treatment.

In this article, we’ll explain more about IVF and private health insurance, including what services may be covered, the waiting periods that might apply, and how to find suitable health policy that covers this treatment.

How is infertility defined?

Infertility is defined as the inability to conceive after one year of regular, unprotected intercourse1. It can be caused by a wide range of factors, ranging from genetic and medical reasons to surgical or trauma-related causes. These factors can affect either the male or female, or both partners.

What is IVF?

IVF stands for in vitro fertilisation. It’s an assisted reproductive treatment in which fertilisation of an egg occurs outside of the body, by adding sperm from the male partner or a donor1.

IVF is one of the procedures used to treat infertility which is more commonly covered by private health insurance.

Is IVF covered by private health insurance?

Not all health insurance policies cover IVF treatments, and those that do may vary in terms of which services are covered and to what extent1. Before embarking on any IVF services, it’s important to understand exactly what you’re covered for and how your health insurance plan works when it comes to IVF.

Medicare also covers a proportion of the costs associated with a cycle of IVF3. The difference between the Medicare benefit and the amount charged by the clinic is known as the ‘out-of-pocket costs’, which vary depending on the required treatment, which clinic you attend, and whether you’ve reached the Medicare Safety Net threshold4.

What waiting periods apply to IVF treatments?

Health funds that cover IVF treatments will generally apply a 12-month waiting period to assisted reproductive services1. After you’ve completed 12-months of membership on your policy, you’ll be eligible to receive the benefits that apply to IVF treatments.

What is a Benefit Limitation Period?

A Benefit Limitation Period is a feature included by some hospital cover policies, which refers to an initial membership period during which only a minimal benefit is paid for certain treatments1.

This period can range from one to three years, and may apply to IVF treatments - be sure to check your policy for more information before proceeding with treatment.

Which IVF services may be covered by health insurance?

When it comes to IVF treatment, only in-patient services that have a valid Medicare item number are eligible for a benefit from your health fund1. An in-patient service is where you’re formally admitted to hospital as a private patient.

However, it’s important to note that in the absence of a Medicare item number, your health insurer may not cover any of the cost of the treatment. Before being admitted, the hospital should inform you about any costs associated with the procedure.

If assisted reproductive services are covered by your policy, your fund will cover the cost of hospital accommodation and theatre fees associated with the egg collection1. This is the main surgical procedure in an IVF cycle and is also known as egg pick-up, oocyte pick-up (or OPU), or egg harvesting.

Your fund will also pay a benefit towards the fees charged by the anaesthetist and treating doctor, however you may have to pay part of the medical fees yourself1. These additional fees are those charged above the Medicare Benefits Schedule fee, known as the ‘gap fee’. Your doctor will be able to provide more information on these fees.

If you’re admitted as an in-patient for the embryo transfer procedure, you’ll be eligible for the same benefits outlined above1.

What’s not covered by private health insurance?

IVF treatment covers many different aspects, with some services taking place outside of hospital (i.e. as an out-patient). These services include1:

  • Consultations with your clinic and doctor
  • Scans and ultrasounds
  • Certain diagnostic procedures
  • Pathology services

While some of these services may be covered to some degree by Medicare, others will be out-of-pocket expenses payable by you1. In addition, there are also costs involved with egg transportation, testing and freezing which you may need to pay yourself.

IVF drugs are another component of IVF treatment, and not all of them receive a Medicare benefit1. IVF-related drugs that aren’t covered by Medicare include the following:

  • Lucrin
  • Provera
  • Synarel
  • Orgalutran
  • Progesterone pessaries

Some health funds will cover some of the cost of certain IVF drugs - make sure you’re aware of what benefits may be payable towards the IVF drugs required for your treatment.

Finding the right health insurance for infertility and IVF

If you’re considering IVF treatment to assist with infertility, having a health insurance policy that helps cover the cost of these services can provide significant peace of mind.

iSelect makes it easy to compare policies and providers, so you can find a health fund that gives you the cover you need. Call our friendly team on 13 19 20 to learn more about health insurance for IVF.

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Sources:
1. http://www.ombudsman.gov.au/publications/brochures-and-fact-sheets/factsheets/all-fact-sheets/phio/assisted-reproductive-services
2. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Assisted-reproductive-technology-IVF-and-ICSI
3. https://www.varta.org.au/sites/varta/files/Costs%20of%20IVF%20-%20brochure.pdf
4. https://www.humanservices.gov.au/individuals/services/medicare/medicare-safety-net/you-need-know

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