What are assisted reproductive services and are they covered by health insurance?
Assisted reproductive services such as In Vitro Fertilisation (IVF) and Gamete Intra Fallopian Transfer (GIFT) are treatments used by those finding it tough to conceive. While assisted reproductive services can be expensive, some of the cost is partially offset by Medicare and private health insurance.
Will my health insurance pay for assisted reproductive services?
Private health insurance will cover part of the costs of assisted reproductive services, providing you choose a policy that includes these services. You will normally have to serve a 12 month waiting period before you become eligible to receive benefits
Assisted reproductive services involve both in and out of hospital procedures. Your private health insurance only covers those that require admission to hospital. A Medicare rebate may be available for some out of hospital procedures such as specialist consultations, blood tests, ultrasounds and counselling, if you have a referral from your GP.
Your private health insurance will cover in hospital procedures such as the collection of eggs and the transfer of embryos, as these require you to be admitted to hospital as a day surgery patient. As for the medications you will require as part of your treatment, some will be covered by Medicare and some by your health fund.
What IVF costs are covered?
|IVF service||Type of private hospital cover||Medicare|
|Retrieval of eggs||Hospital||Yes (item 13212)|
|Embryo transfer||Hospital||Yes (item 13215)|
|Frozen embryos||Hospital||Yes (item 13218)|
Which policies cover assisted reproductive services?
|Fund||Which policies cover assisted reproductive services?||More info|
|Assisted reproductive services will be covered under Top Hospital cover, and there is a 12 month wait period. ahm provide cover for reproductive services and cover all agreed hospital charges in a partner private hospital in a shared or private room. In a public hospital we'll pay all accommodation charges for a shared room and benefits towards a private room.|
|Australian Unity||Australian Unity provides cover for pregnancy and related services including fertility treatments such as IVF and GIFT, and private midwifery on its Platinum Hospital policy.|
|IVF and assisted reproductive services are covered under the Bronze Hospital (Public hospital cover as a private patient only), Gold Hospital, Everyday Family Package and Premium Family Package.|
|The Premium policy covers assisted reproductive services such as IVF and GIFT.|
|The High Hospital policy covers pregnancy related and assisted reproductive services. Be aware that there is a 12 month waiting period for pregnancy and assisted reproduction related services.|
|Both the Gold and GoldStar Hospital provide cover for assisted reproductive technology. This includes cover for expenses including accommodation, theatre and ward fees. You may also be able to make claims for your doctors' and anaesthetists' fees. If you have either Super Options or Premium options as your extras package, you will be able to claims for expenses associated with IVF drugs. The are 12 and 36 month waiting periods for assisted reproductive technology and IVF drugs respectively for new members.||More info|
|Assisted reproductive services are covered by Top Hospital. This policy provides cover for inpatient services relating to egg retrieval and implantation including IVF and GIFT. There is a 12 month waiting period. Outpatient specialist fees related to reproductive services aren't covered.|
|Both Top Hospital and Top Hospital with excess provide cover for assisted reproductive services such as IVF and GIFT. Basic Hospital provides restricted cover.|
|ACA Health||Assisted reproductive services covered under Deluxe Hospital, Private Hospital and Basic Hospital policies.||More info|
|Budget Direct||IVF and related services are covered on the Top Hospital policy and also by the Public Hospital policy as a private patient in a public hospital.||More info|
|Bupa||Top hospital and Growing family are the covers that will include IVF in a private hospital.||More info|
|CBHS||CBHS members may be able to claim most or a part of their IVF expenses, as assisted reproductive services such as IVF can be covered under private hospital cover. ART services are covered on the Prestige StepUp Package, with restricted cover available on the KickStart Package, and the Limited and Basic Hospital policies. These services have a 12 month waiting period.||More info|
|Cessnock District Health Fund||There is a Benefit Limitation Period of two years for assisted reproductive services including IVF and GIFT.||More info|
|cua||Assisted reproductive services are covered on the Private Hospital 100% (nil or $250 excess), Private Hospital 90% and Private Hospital 75% policies.||More info|
|Defence Health||Assisted reproductive services covered under ADF Total Package and Premier Hospital policies.||More info|
|Frank||IVF and related services are covered by Basic Hospital, Basic Hospital and Best Hospital policies.||More info|
|gmf||Assisted reproductive services including IVF are covered by the Smart Saver Twin pack, Healthy Saver Hospital, Top Hospital and Ultimate Package. Assistive reproductive services including IVF have a two month waiting period.||More info|
|HBF||Assisted reproductive services including IVF are covered by the Smart Saver Twin pack, Healthy Saver Hospital, Top Hospital and Ultimate Package. Assistive reproductive services including IVF have a two month waiting period.||More info|
|Health Care Insurance||Cover for assisted reproduction technology such as IVF and GIFT have a 12 month waiting period.||More info|
|Health Partners||Assisted reproductive services are covered under Gold Hospital and Silver Hospital.||More info|
|Latrobe Health||Assisted reproductive services provided in hospital to assist conception such as IVF and GIFT are covered under Top Hospital.||More info|
|Medibank||Fertility treatment including IVF and GIFT programs are covered by Top Hospital.||More info|
|Mildura Health Fund||A waiting period of 12 months for assisted reproductive services including IVF.||More info|
|Navy Health||Premium Hospital and Healthy Hospital 200 + 500 cover assisted reproductive services such as IVF. Maternity (or admissions related to the management of) and IVF procedures attract a 12 month waiting period.||More info|
|onemedifund||Private Plus Hospital covers assisted reproductive services such as IVF with a 12 month waiting period.||More info|
|Peoplecare||To claim for IVF services in a hospital, you’ll need to have Mid or Premium Hospital cover. All pregnancy and birth related services have a 12 month waiting period.||More info|
|Phoenix Health Fund||Top Hospital $500 Excess covers fertility treatment such as IVF and GIFT programs.||More info|
|Police Health||Assisted reproductive services like IVF are covered by the Top Hospital policy.||More info|
|Queensland Country Health Fund||Top Hospital provides cover for assisted reproductive services such as IVF. Intermediate Hospital cover provides restricted cover for assisted reproductive services.||More info|
|Reserve Bank Health Society||Under Gold Hospital cover, you can claim for 90% of the cost of IVF, up to $2,800 (lifetime limit).||More info|
|RT Health||Under the Step Up Hospital you're only covered when you're treated in a public hospital for assisted reproductive services and treatments such as IVF.||More info|
|St.LukesHealth||The in-hospital costs associated with IVF and other assisted reproductive services will be covered by St.LukesHealth less any excess that applies to your policy, providing you have served the 12 month pre-existing waiting period.||More info|
|Teachers Health Fund||Infertility treatments are covered by Top Hospital, with restricted cover available under Mid and Basic hospital.||More info|
|TUH||Cover provided for infertility investigations, assisted reproductive services under Ultimate Choice and Easy Choice policies||More info|
|Westfund||Platinum and Gold policies include cover for IVF.||More info|
How much does IVF cost?
IVF treatments are expensive, particularly as there is no guarantee of success, meaning they may need to be carried out several times. The average total cost for a standard IVF cycle is anywhere from $8,000 to $10,000. This includes consultations, investigations, treatment and medications.
Of that total amount, roughly half is reclaimable, with the majority coming from Medicare rebates and a smaller percentage from your private health cover for day hospital expenses and some medications. The total figure is an average estimate only, as any additional tests or treatments required (e.g. Pre-Genetic Diagnosis [PGD] to ensure the embryo is free from genetic diseases) will add to the cost if not covered by Medicare or private health.
As the success rate for IVF treatment is only around 25%, the average couple theoretically needs to undertake the process at least three times to achieve success, so you run the risk of paying this cost three times. However, there is such a large number of reasons for why parents undertake IVF and depending on your circumstances, the success rate may be higher.
Below the table provides an estimate of your out of pocket costs services with IVFAustralia:
|Treatment costs correct at 1 April 2016||Cycle payment||Estimated out of pocket costs 1st cycle in a calendar year (safety-net not reached)||Estimated out of pocket costs subsequent cycles in a calendar year (safety-net reached)|
|Frozen embryo transfer (FET)||$3,435||$2,165||$1,935|
|Intrauterine Insemination (IUI)||$2,360||$1,831||$1,690|
|Ovulation Induction (OI)||$700||$700||$700|
|Embryo or sperm freeze||$450 (includes six months storage)||Nil|
|Surgical sperm collection||$850||Yes|
Source: IVF Australia
Based on prices from July 2016
What are the different types of ART?
There are several types of assisted reproductive services including:
- In Vitro Fertilisation (IVF). IVF involves removing eggs from the ovaries, fertilising them with semen, incubating the dividing cells in a laboratory and then returning the embryos to the uterus.
- Gamete Intra Fallopian Transfer (GIFT). GIFT is similar to IVF, except that when the eggs are removed from the ovaries, they are immediately placed into one of the Fallopian tubes along with the male sperm in a procedure known as a laparoscopy.
- Zygote Intra Fallopian Transfer (ZIFT). ZIFT is a combination of IVF and GIFT, where the eggs are fertilised in the laboratory before being placed in the Fallopian tubes (a zygote is a fertilised egg).
- Intracytoplasmic Sperm Injection (ICSI). ICSI is similar to IVF except that when the eggs are removed from the ovaries, a single egg is injected with a single sperm and once the embryo has formed, it is returned to the uterus.
- Embryo Replacement. Embryo replacement is where unused embryos are removed and frozen at an earlier time and then thawed and replaced in the uterus during normal cycles when pregnancy is desired.
- Blastocyst Culture. Blastocyst culture is similar to embryo replacement, except that the embryo is cultured in the laboratory for a longer period after thawing until it reaches the multicellular stage, at which time it is transferred to the uterus.
If you have any other health insurance terms you're confused about, head over to our health insurance glossary.
Medicare rebate: What isn’t covered by private health insurance?
The majority of costs associated with IVF and other assisted reproductive services are covered by Medicare, which picks up the tab for out-of-hospital services such as specialist consultations (Medicare Benefits Schedule) and provides an additional rebate if you exceed an annual threshold (Extended Medicare Safety Net).
If you have private health insurance, you can reduce your costs even further, as this will pay for some medications and for in-hospital services such as egg collection and embryo transfer.
The Medicare rebate does not apply to things such as:
- Ovulation induction (unless part of an insemination procedure)
- Hospital/day surgery related services
- Procedures without a Medicare item number
- Cycle monitoring outside of approved clinics
The Extended Medicare Safety Net (EMSN) threshold has also been increased from $1,248.70 to $2,000, meaning you will now need to spend more on out-of-pocket medical expenses to become eligible for the additional Medicare benefit.
Private health insurance will not cover the cost of outpatient services such as initial consultations with GPs and specialists, scans, ultrasounds, pathology services and some diagnostic procedures. Additional costs for egg transportation, testing and freezing are also usually not covered.
Private health may provide cover for some of the IVF related drugs you will need that aren’t covered by Medicare, but this will depend on your policy and the level of cover it provides. As a general rule, private health can only be expected to cover what happens inside the hospital, such as the egg collection and embryo transfer procedures and possibly hospital accommodation if a longer stay is required.
What is involved in a cycle of IVF?
A standard IVF cycle involves a series of steps over several weeks including:
- Ovary stimulation to produce eggs for collection
- Blood tests and ultrasounds to collect eggs at the correct time
- Transferring and implantation of embryos after successful fertilisation
- Pregnancy test
- Mid and post-cycle counselling
- Specialist consultations
- Specialist nursing care
- Scientific and embryology services.
Questions you should ask before choosing an IVF clinic
It is important to choose the right fund if you're considering using assisted reproductive services and you should ask a potential clinic questions such as:
- What credentials and training do their staff have?
- Are they members of any recognised associations or medical bodies?
- What is their overall success rate?
- What is their success rate for the procedure you are considering?
- What are their clinic and lab hours (can be important if you are working)?
- Can they freeze extra embryos for later use?
- What does each cycle cost, including drugs?
- Do you have to pay upfront or can you pay in instalments?
- Are counselling services available?
- Do they have patients you can speak with who have completed their program, successfully or otherwise?
Have questions about health insurance? Check out our comprehensive list of frequently asked health insurance questions.
Are there any waiting periods for assisted reproductive services?
Most private health funds apply a 12 month waiting period to assisted reproductive services. That means you will have to wait a year after taking out your policy before you can begin claiming benefits. This 12 month waiting period is applied to all pre-existing medical conditions, This is done to protect the health fund and its members from those who would take out cover, have the treatment and then cancel their policy, leaving the fund out of pocket and forcing up the cost of premiums for long-term members.
Depending on the health fund, there may also be a Benefit Limitation Period, where only a minimum benefit amount is paid for some types of treatment for an initial period of membership (can be anywhere from one to three years). So when shopping for health cover for assisted reproductive services, it’s important to read the Product Disclosure Statement (PDS) carefully so you know exactly how much cover you’re getting and how long you may have to wait for it.
Compare your health insurance options for assisted reproductive services