How to Get IVF Covered By Insurance?

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How to Get IVF Covered By Insurance

Table of Contents

Are you trying to conceive through IVF? How to get IVF covered by insurance must have popped up in your mind. If your health plans do not cover insurance for IVF, you can opt for one via other means such as asking for employee benefits, purchasing non-group insurance, participating in infertility clinical trials, etc.

Even though the additional work may seem tiring, the effort will make all the difference in your journey of conception. We have brought to you some answers on “how to get IVF covered by insurance?

  1. Ask for Employee Benefits
  2. Get an Insurance
  3. Purchase Non-group Insurance
  4. Participate in Clinical Research Trials
  5. Work for Companies That Provide Infertility Coverage

How Do You Go Through These methods?

1. Asking for Employee Benefits

Asking your employer for insurance for your infertility treatment might seem like a bold move if they don’t already have one. Usually, insurance brokers will advise employers to avail insurance for infertility treatments but they don’t realize this. Employers can ask their brokers to:

  • Replace a current plan with a plan that provides IVF benefits.
  • Provide two health plans, one that offers IVF and one that doesn’t.
  • Search for an IVF rider benefit that they can add to the existing plan.

The estimated cost of a singleton pregnancy is ₹21,458 whereas multiple pregnancies cost around ₹104,831 to ₹407,199. Asking for insurance on infertility might be a good idea because of the following reasons:

  • Employers will learn that there is a need to cover IVF.
  • The more people who sell IVF insurance from the company, the more they understand their unlimited scope for the coverage provided.
  • Employers will look into what kind of coverage, benefits, or insurance plans other companies are offering.
  • Employers are either fully insured or self-insured. Self-insured employers will be motivated to offer IVF coverage once they understand the cost savings of the benefits.

2. Asking Your Insurer for Coverage

Your personal story will make your courage request letter memorable. Add in some additional research and a letter from your doctor to make it convincing so that the insurance company knows that you are a good investment with a success chance. Along with that they also need to be convinced that your infertility treatment is medically required and will save them money.

3. Purchase Non-group Insurance

Non-group insurance plans have a hefty monthly premium but it is significantly lower than the amount you would pay out of the pocket for a full IVF cycle. States have an insurance department or a designated organization to help you navigate through all the available insurance plans.

4. Participate in Clinical Research Trials

Clinical research spots will be vacant when fertility centres seek clinical trials. You can apply for a spot as these trials contain discounts even though they may vary from clinic to clinic. You can search online for such trials and filter them by location and condition. Make sure you read the agreement if you are selected. Understand your responsibilities and what the clinic is offering.

5. Work for Companies That Provide Infertility Coverage

Do not make the error of assuming you will have insurance coverage for infertility treatments even if you live in a state with a mandate on infertility. Self-insured employers can opt to not provide this benefit. If you work for a company that is headquartered in a state with IVF mandates, you will receive IVF benefits no matter where you live.

The Bottom Line: How to Get IVF Covered By Insurance?

Despite the challenges of infertility, feeling secure about the impending costs of IVF treatment will make you feel empowered. IVF comes with a loss of emotional and psychological stress and the road might not be easy. And on top of that, if you end up worrying about how to get IVF covered by insurance, your journey might be an easy one. Choose an insurance plan or method that will lead you closer to your goal of a healthy family.

How to Get IVF Covered By Insurance FAQs

1. What should you check before getting health insurance for infertility treatment?

Here’s what you need to know before getting infertility health insurance:
  • Check the criteria for eligibility
  • Check for infertility diagnosis cost
  • Check the procedures of infertility treatment
  • Check the sub-limits and extent of coverage for the infertility treatment
  • Check the waiting period for the coverage of the infertility treatment
  • Check that is the cost of medicine for the treatment is being covered
  • Check the number of claims you can raise
  • Check if any infertility treatments costs are available as an add-on coverage
  • 2. Whom should you speak to regarding infertility health insurance?

    Decided to get an IVF but worried about the costs? Here’s what you need to do if you are planning to seek infertility treatment insurance:
  • Seek employee benefits from the HR department of your workplace. Someone will walk you through your options.
  • You may also contact your health plan’s member services department.
  • The fertility clinic in which you will undergo IVF will have a network of health insurers who will be able to help you. You can get in touch with their insurance company directly too.
  • 3. What should you carry to get insurance for infertility treatment?

    Make sure you carry this information when you go to seek insurance for your infertility treatment:
  • Name of the insured person
  • Patient ID, employee ID, or SSN
  • Patient's DOB and name
  • Group code or number
  • Insurance plan name
  • Employer’s name
  • 4. What tests and procedures are covered under the insurance for infertility treatments?

    Here’s a list of all the tests and procedures that will be covered under infertility treatment insurance:
  • Intracytoplasmic Sperm Injection (ICSI)
  • Intrauterine Insemination (IUI)
  • Zygote Intrafallopian Transfer (ZIFT)
  • In Vitro Fertilization (IVF)
  • Gamete Intrafallopian Transfer (GIFT)
  • 5. What IVF service will be covered under insurance?

    According to the law, infertility insurance needs to cover 3 cycles of IVF that include preparatory medications for ovarian stimulation to the embryo transfer process both frozen and fresh.
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