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Health Insurance For IVF

Name: Health Insurance For IVF
Creator: Savvy
Published: 2023-03-27T17:02:58+10:30

Compare health insurance policies which offer cover for IVF treatment through Savvy today.

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Written by , updated on July 6th, 2023

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Research has revealed that in 2021, more than one in 18 babies born in Australia were conceived with the help of IVF. For women aged over 35, this figure increases to more than one in ten being the result of assisted fertility treatments. If you need this expensive treatment, it can be crucial to have adequate private health insurance to help cover some of the costs.

You can compare private health insurance policies which offer top cover for fertility treatments through Savvy. You’ll be able to get free, no-obligation quotes from a panel of Australia’s leading health insurers and consider them side-by-side to help you make an informed choice about which offers the best value private health insurance for you. Compare the cost of increasing your health cover or swapping health funds in one place through Savvy today.

What is health insurance for IVF treatment?

Health insurance for IVF treatment can assist couples with the high cost of getting medical assistance to have a baby. However, it isn’t a simple area to cover with health insurance, as it may involve a range of treatments which fall under different types of cover.

IVF treatment can take place in several settings, including:

a public or private hospital
a day surgery unit
a doctor’s clinic
an outpatient fertility clinic

What is IVF?

In vitro fertilisation (IVF) treatment involves the collection and fertilisation of an egg outside of the body to create an embryo. This embryo is then transferred back into the female uterus to grow to maturity through the pregnancy process. IVF can either be used as a treatment for infertility, or as a way to reduce the transmission of genetic or chromosomal disorders.

With so many different steps involved in IVF treatment, the process can be very expensive, often costing thousands of dollars per cycle. Many couples have to go through numerous cycles before they successfully conceive and have a baby.

Because IVF treatment cover is so expensive, it's only offered by a limited number of health insurers. It's necessary to buy the top level of hospital cover available to have coverage for IVF treatments. However, even if you pay for the best health insurance cover on a gold hospital policy, you should still expect to pay out-of-pocket costs when you have IVF treatment.

What aspects of IVF treatment can be covered by private health insurance?

The following elements of IVF treatment can be covered under a hospital cover private health insurance policy:

only procedures performed while you're an in-patient will be included under your hospital cover
only procedures which have a Medicare item number will be partially or wholly covered by your insurance
these may include the cost of hospital accommodation and theatre fees associated with egg collection and the embryo transfer process
your hospital cover health insurance may also assist with the fees charged by your anaesthetist and fertility specialist doctor when you're an in-patient in a day-surgery unit or fertility clinic. Medicare may cover some of the cost of medical fees, but you may have to pay the gap

What aspects of IVF treatment won’t be covered by my hospital cover insurance?

consultations at your fertility clinic and with your specialist doctor and GP
scans, ultrasounds and other tests which may be performed when you’re an outpatient
diagnostic procedures and tests to find out the cause of the infertility
pathology services including blood and semen tests
costs involved in egg transportation, testing, freezing and storage
IVF drugs used for hormone stimulation which aren’t covered by Medicare

What may be covered during my IVF treatment by an extras cover policy?

An extras policy may assist with the cost of some medications which are required by the IVF process, such as hormone treatment to stimulate ovulation. If these required medications aren’t listed on the Pharmaceutical Benefits Scheme, your extras policy may assist you with the cost of paying for these medications and prescriptions.

An extras policy may also assist you with the cost of mental health counselling to help you and your partner manage the stress that can be involved with IVF treatment.

Is IVF covered by Medicare?

Some procedures associated with IVF and other fertility treatments can be partially covered by Medicare. If you exceed the Medicare Safety Net Threshold during any financial year, the amount that Medicare will assist you will increase. Procedures which attract a Medicare subsidy include:

the collection of eggs
the transfer of embryos
the freezing and storing of embryos

However, the extent to which these processes may be covered by Medicare will vary according to where you live, where the procedures are performed (whether as an in-patient or out-patient) and the type of treatment you require.

It's worth noting that some state governments are now offering financial assistance to those seeking IVF treatment. For example, as of October 2022, residents of NSW who have paid for fertility treatment can apply for a $2,000 rebate as a one-off assistance with the cost.

How much will IVF treatment cost?

According to one leading IVF clinic based in NSW, you should expect to pay at least $10,500 for an IVF cycle (as of March 2023). How much of this cost you can claim on your private health insurance will depend on the health cover you decide to buy.

Indicative costs of IVF*:

Treatment procedure	Full payment cost	Estimated out-of-pocket cost for initial cycle	Estimated out-of-pocket cost for subsequent cycle
First IVF cycle	$10,532	$5,483	$4,898
ICSI cycle	$11,332	$5,788	$5,203
Frozen embryo transfer	$3,930	$2,423	$2,356
Intra-uterine insemination	$2,676	$2,116	$1,968
Ovulation induction	$950	$436	$311
Embryo freeze (6 months)	$625	$625	N/A
Sperm freeze (6 months)	$475	$475	N/A
Surgical sperm collection	$675 to $850	$675 to $850	N/A

Some couples may be successful in their first IVF cycle, while others may require multiple cycles before a successful pregnancy is achieved.

*Costs correct as of March 2023, but may be subject to change.

How do I compare health insurance policies which cover IVF treatment?

Some of the aspects to compare when you’re considering the best gold or silver plus hospital cover health insurance policies which include IVF are:

Cost – while you may want the cheapest health insurance policy available, there are many other important considerations to take into account when comparing policies that offer a similar level of cover, such as comparing gold hospital cover policies
Coverage – compare how much you will be able to claim back on the policy for your IVF treatment and which costs it covers
Benefit limits – look at the total amount you can claim back for fertility treatments per year
Waiting periods – you should expect to have a waiting period when you first take out any top-tier hospital cover policy. This can range from one year up to three years, with 12 months being the average waiting period for IVF treatment
Excess – you may be required to pay an excess if you are admitted to hospital. You can often choose the level of excess you pay, ranging from zero to a maximum of $750. Higher excesses will generally lead to cheaper premiums
Co-payments – some top tier gold hospital cover policies may also require you to make a co-payment for each night you spend in hospital
Reset date – most health funds have annual extras benefit limits which reset on a certain date, which is commonly either 1st January or 1st July. You should check your fund’s reset date if you’re considering IVF treatment, as you may be able to claim some costs over more than one financial year

By comparing different hospital cover policies through Savvy, you may be able to get a clearer idea of which health fund offers the most benefits if you’re undertaking fertility treatment. You can also request a call-back from a health insurance specialist, who may be able to assist you with your choice of health fund to cover your IVF treatment. Start the process through Savvy today.

Types of health insurance

Hospital cover

This can help you pay for medical treatment if you need to be admitted to hospital. It can help cover the cost of your admission or accommodation and the fees charged by doctors, surgeons and anaesthetists. It can also cover other costs associated with a stay in a private hospital.

Extras cover

This helps cover the costs of health care treatments outside a hospital setting which aren’t covered by Medicare. This can include major and minor dental treatment, orthodontics, hearing aids, physiotherapy, glasses, contact lenses and podiatry (in most cases with annual limits).

Cover for singles

This is a standard health insurance policy designed for a single person, rather than being tailored to cater to the needs of a couple or family. It may include hospital cover plus extras, or either of these types of insurance on their own, depending on what you're after for your health cover.

Cover for families

A family health insurance policy is designed for a family unit including dependent children who may reach up to 31 years of age with some insurers. It offers private health insurance suitable for the whole family and may include shared limits for all members included in your policy.

Cover for seniors

A health insurance policy aimed at seniors is designed to appeal to people who are in the second half of their life. These are often specific Silver Plus policies that offer the same cover as other health insurance policies, with the exception that pregnancy and childbirth cover may not be included.

OVHC

Visitors who are in Australia on a temporary basis for travel, work or study may be able to take out Overseas Visitors Health Cover (OVHC). Many visas issued in Australia come with a requirement to take out this type of insurance, which covers visitors who may not be covered by Medicare.

Ambulance cover

Ambulance cover is generally available either packaged into your private health insurance or on its own as a separate policy or subscription. By having this protection, you could be covered for all eligible ambulance travel in Australia (subject to your insurer's terms and conditions).

Basic hospital cover

The cheapest and most barebones form of private hospital insurance, this can include cover for rehab, in-hospital psychiatric services and palliative care. Having this policy will enable you to avoid paying the Medicare Levy Surcharge (MLS) and Lifetime Health Cover (LHC) loading.

Bronze hospital cover

Bronze hospital cover is a step up from basic insurance, including 18 further clinical categories such as ear, nose and throat, bone, joint and muscle, digestive system, joint reconstructions, gynaecology and chemotherapy, radiotherapy and immunotherapy for cancer.

Silver hospital cover

Silver hospital cover is the second-most expensive type of policy and offers the second-most clinical categories. On top of what's offered by basic and bronze cover, it also includes heart and vascular system, lung and chest, blood, hearing device implantation and dental surgery.

Gold hospital cover

The highest level of private hospital insurance available in Australia, gold policies can offer cover for pregnancy and birth, weight loss surgery, assisted reproductive services and insulin pumps on top of all the categories provided by silver, bronze and basic hospital insurance.

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Frequently asked questions about health insurance for IVF

What is the Medicare Safety Net?

The Medicare Safety Net is a threshold for the amount you have to pay in out-of-pocket expenses in any one financial year. Once you reach the threshold, you may be entitled to receive 100% of the schedule fee for out of hospital services, including medications.

If I change health funds, will I have to serve the waiting periods again?

If you increase your level of health cover, say from a silver policy to a gold hospital cover policy, then you may have to serve additional waiting periods for those areas of treatment you have not previously had cover for. However, if you’re swapping policies at the same level – for example from one gold policy to another, then you should not have to re-serve any waiting periods.

Is there a limit on the gap fees which can be charged for IVF treatment?

No – it’s up to fertility clinics and specialists to set their own charges. There aren’t any government regulations which restrict how much can be charged for fertility treatments. Prices do vary considerably around the country, so it's important to consider which specialist you see or whether it’s worth getting private health insurance which covers IVF treatment.

What is ICSI when it’s used as part of IVF treatment?

Another common process which is also covered by assisted reproductive treatment (ART) funding is ICSI, which is intracytoplasmic sperm injection. This involves injecting a single sperm into the centre of an egg. This process also involves a series of steps which are carried out over several weeks, just like the traditional IVF process.

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