Health Insurance For IVF

In challenging situations like these many hopeful parents turn to assisted reproductive treatments (ART) including IVF to help them to grow their families.  

Finding the right assisted reproductive treatment is a task in itself. 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 suits you and your family. 

Assisted reproductive treatments (ART) are services designed to help treat infertility. 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 certain Private Health Insurance policies.¹ 

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. 

Is IVF covered by Private Health Insurance?

Yes, certain policies include cover for IVF. Not all Health Insurance policies cover IVF treatments, and those that do may vary in terms of which services are covered and to what extent.  

To be covered for IVF under your Private Health Insurance, you will need a higher level or tier of Hospital Cover. According to the Commonwealth Ombudsman of Private Health Insurance, assisted reproductive services are primarily included in Gold hospital policies, but some insurers may also include them in some Silver or Bronze policies.²

Before embarking on any IVF services, it’s important to understand if your policy covers IVF and if so, exactly how your Health Insurance plan works when it comes to IVF. 

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 fund.³ 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. 

You can find a detailed list of assisted reproductive treatments under the Medicare Benefits Schedule (MBS) here. 

Which IVF service costs may be covered by Health Insurance?

If assisted reproductive services are covered by your policy, your fund will likely cover the cost of hospital accommodation and theatre fees associated with the egg collection.⁴ 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 may 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 yourself.⁵  

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 an embryo transfer procedure, you’ll be eligible for the same benefits outlined above. 

How much does IVF cost? 

IVF costs depend on what kind of treatment you receive, which will be unique to each couple or hopeful parent who wishes to conceive a child with the help of IVF. 

According to Monash IVF, the average fertility treatment service can range between $9,000 (for a single IVF cycle) to $14,000 (if you use a frozen embryo and need to treat male infertility).⁶  

Please note that these costs are estimated by Monash IVF before any rebates are applied.

What waiting periods apply to IVF treatments? 

Health funds that cover IVF treatments will generally apply a 12-month waiting period to assisted reproductive services.⁷ 

After you’ve completed 12-months of membership on your policy, you’ll be eligible to receive the benefits that apply to IVF treatments. 

It’s very rare for providers to offer 6-month or no waiting periods for IVF.  

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 treatments.⁸ 

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

What IVF treatments are not covered by Private Health Insurance?

IVF refers to a range of different treatments, with some services taking place outside of hospital (i.e. as an out-patient) which means they will not be covered by your Private Health Insurance. These services include:⁹ 

• 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 you’ll have to cover fully yourself. 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 benefit. IVF-related drugs that aren’t covered by Medicare include the following:¹⁰ 

• Lucrin 
• Provera 
• Synarel 
• Orgalutran 
• Progesterone pessaries

Some health funds will cover some of the cost of certain IVF drugs, so make sure you’re aware of what benefits your fund may pay towards the IVF drugs required for your treatment. 

How is infertility defined? 

Infertility is defined as the inability to conceive after one year of regular, unprotected intercourse.¹¹ It is generally considered a pre-existing condition and as a result is subject to a 12 month waiting period.  

Infertility can be caused by a wide range of factors, ranging from genetic and medical reasons to surgical or trauma-related causes, affecting either the male or female, or both partners.¹² 

What does IVF stand for? 

IVF stands for in vitro fertilisation and it’s defined as an assisted reproductive treatment in which fertilisation of an egg occurs outside of the body, by adding sperm from the male partner or a donor.¹³ 

IVF is one of the procedures used to treat infertility which is more commonly covered by Private Health Insurance.¹⁴ 

Is IVF covered by Medicare? 

Medicare covers a proportion of the costs associated with a cycle of IVF.¹⁵ 

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 threshold.¹⁶ 

Finding the right Health Insurance for infertility and IVF 

If you’re trying for a baby, you’ve already got a lot on your mind. At the same time, having a Health Insurance policy that helps cover the cost of appropriate services and treatment can provide significant peace of mind. 

iSelect makes it easy to compare a range of policies and providers, so you can find a health fund that gives you the cover you need. Call our friendly team on 1800 784 772 to learn more about Health Insurance for IVF and they can try and help you find cover that suits you without any added stress. 

^{Sources:
1 Commonwealth Ombudsman - Infertility and Assisted Reproductive Services 
2 Commonwealth Ombudsman of Private Health Insurance - Product Tiers 
3 Commonwealth Ombudsman of Private Health Insurance - Infertility and Assisted Reproductive Services
4 As above. 
5 As above.
6 Monash IVF - What IVF costs are covered by private health insurance? 
7 Commonwealth Ombudsman of Private Health Insurance - Infertility and Assisted Reproductive Services 
8 As above. 
9 As above. 
10 As above. 
11 Commonwealth Ombudsman of Private Health Insurance -  Infertility and Assisted Reproductive Services
12 World Health Organisation - Infertility
13 IVF Australia - IVF Treatment and Process
14 IVF Australia - Health Fund Cover
15 Australian Government, Services Australia - Medicare services for conceiving, pregnancy and birth 
16 Australian Government, Services Australia - Medicare Safety Nets, What are the thresholds?}