Considering contraceptive surgery? Learn how health insurance covers hysterectomy, vasectomy, tubal ligation and other related treatments.
Sterilisation is a form of surgical birth control to semi-permanently prevent conception. These procedures can sometimes be reversed later, but only at additional expense, and there is a definite possibility that you will not regain full fertility. Both men and women undergo voluntary medical sterilisation, often known as contraceptive surgery, for a variety of reasons:
- To avoid the risk of unwanted pregnancy without needing to rely on contraception
- To minimise certain health risks
- If they are at high risk of bearing children with congenital abnormalities and want to eliminate the risk of conception
- To assist with family planning
In general, if someone never wants to have children then sterilisation can be an effective option. The two most widely used methods of voluntary sterilisation are:
- Tubal ligation. This procedure involves the surgical severing and/or blocking of a woman’s fallopian tubes. This prevents the passage of eggs to the uterus and renders pregnancy near impossible.
- Vasectomy. Similar to tubal ligation, a vasectomy involves a man having his vas deferens severed or sealed. This prevents him from impregnating women but has no major impact on sexual functioning. The procedure does not require hospitalisation and can usually be performed in 30 minutes or less.
In Australia it is illegal to undertake either of these procedures on persons under the age of 18 unless it is a clear medical necessity. Needless to say, no health insurance will cover illegal procedures.
Private health funds will cover vasectomies, tubal ligation and hysterectomies in varying ways, depending on the level of cover you have purchased and the conditions of the policy. Things to consider are:
- Your level of cover. Because sterilisation is an elective procedure, vasectomies and tubal ligation are typically covered under higher tier hospital policies. Check your health insurance product disclosure statement (PDS) or contact your fund to find out if a given policy covers it.
- Your hospital cover. Vasectomies do not usually require hospitalisation, but tubal ligation does and hysterectomies in particular require spending several days in hospital. Hospital stays will incur additional costs. To find out how a private health fund covers these and the limits which may apply, look at the hospital cover section of the policy. It is possible that your health fund will cover the surgery itself but will not cover the hospital stay and related costs.
- What sterilisation covers. Sterilisation typically refers to tubal ligation and vasectomies. Sterilisation is the term to look for if you want a private health fund to cover your contraceptive surgery, and it is a good idea to familiarise yourself with the terms and conditions surrounding it.
- What gynaecological services covers. In both the hospital and general cover sections you may find that a policy includes gynaecological services. Typically this refers only to medically necessary services, like emergency hysterectomy, and not elective ones like tubal ligation.
- What fertility and infertility services mean. Fertility and infertility services, although related to sterilisation, are not connected to the contraceptive surgeries on offer and do not cover vasectomies or tubal ligation (which are sterilisation) or hysterectomies (which is a gynaecological service). However they do refer to vasectomy or tubal ligation reversal surgery, which is a procedure to undo sterilisation.
If you think you might want to undo your vasectomy or tubal ligation in the future then do not get it at all. Reversal surgery does not guarantee that you will recover full functionality, and in some cases will be completely ineffective. The high costs and indeterminate success rates of sterilisation reversal procedures means that private health funds will typically only cover them as on more comprehensive policies.
Because vasectomies and tubal ligation are not emergencies and Medicare offers relatively good benefits for them, it is not usually worth choosing a fund on the basis of whether or not they cover these. It may still be worth considering if:
- You only want to see a particular practitioner for your vasectomy or tubal ligation.
- You don't want to wait for a bulk-biller to fit you in.
- You are considering an elective hysterectomy for reasons such as a family history of cervical cancer.
To claim a vasectomy or tubal ligation with a private health fund:
- Make sure your chosen doctor is approved by the health fund.
- Book an appointment and confirm that they work with your fund.
- Pay them in a way approved by the insurance plan. This may be by simply swiping a health fund membership card, giving them your details, or paying up-front and then claiming it back later.
Claiming a hysterectomy can be more complicated as it depends on your reason for having the procedure and the methods used by the surgeon.
Before getting waist-deep in the world of contraceptive surgery, study your health insurance policy and look for these details in particular.
These are the conditions where your policy will not pay a benefit.
- No payout for procedures done outside of Australia.
- No cover for additional costs like hospital meals or administrative fees.
- No cover if the treatment isn’t curing a specific problem. Hysterectomies, for example, might not be covered if undertaken to reduce the future odds of cervical cancer because that is not an immediate problem. On the other hand, tubal ligation might still be covered even though it’s non-essential because it is ‘curing’ the ‘problem’ of fertility.
These are the maximum amounts that your insurance policy will pay out. There are typically a variety of different maximums active simultaneously:
- A maximum amount that the insurance fund will ever pay for any procedure
- A maximum dollar amount or number of treatments that can be claimed in a year
- A maximum number of procedures or dollar limit of treatments per person
- A maximum number of benefits that can ever be claimed over the course of the entire policy
You must pay the total flat sum of all applicable excesses when making a claim. Typically there will be more than one:
- A standard excess that applies to all claims made by any customers of that fund
- An extras excess for claiming ancillary cover features
- Hospital excess to cover the fund’s additional expenses associated with your hospital visit
- A special excess which applies depending on special circumstances, pre-existing conditions etc.
Having a vasectomy or tubal ligation procedure is easy and relatively inexpensive, but it should also be considered very carefully first. Covering sterilisation with public or private health insurance is simple, but undoing it can be much more complex and expensive.
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