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IVF Insurance: Your Guide to Infertility Coverage

Written by Michael Lamb on Wednesday, 04 September 2013. Posted in Fertility 101

How to get assistance if you’re having trouble conceiving

IVF Insurance: Your Guide to Infertility Coverage

So you’ve taken the plunge and have decided to have a baby. Congratulations! Hopefully you’ve already taken a look at your maternity insurance options (link to previous maternity article), and are aware of some of the major issues involved in such protection (like waiting periods) and some of the benefits of obtaining a maternity insurance policy.


But one of the rising concerns in relation to maternity and pregnancy is that of infertility and artificial insemination – namely, what are the insurance options available in Hong Kong regarding such a scenario?


The good news is that there are at least two companies which provide IVF and Infertility coverage under their policies, although you may have to purchase additional forms of protection, such as an optional out-patient package, in order to receive protection against IVF.


However, having said that we’re going to delve straight in and take a look at two of the best products on the market in relation to IVF and Infertility Insurance coverage.



DKV Globality Plus and Top Plans


DKV Globality is a leading international insurance company offering a range of comprehensive product options. Of the options provided by the insurer the Plus and Top products include coverage for Maternity Care, Child Birth, Complications of Pregnancy, and Infertility Treatment.

The infertility benefit is provided under the two plans’ outpatient coverage, and will cover a portion of the costs involved with Infertility Treatment.
 

Plan

Coverage

Plus

Covers up to 50% of costs to a maximum USD 2,600, EUR 2,000, or GBP 1,680 per insured couple per lifetime

Top

Covers up to 50% of costs to a maximum USD 13,000, EUR 10,000, or GBP 8,400 per insured couple per lifetime


As you will have noticed, the above table notes that the limit for Infertility Treatment coverage is per insured couple per lifetime. While DKV offers maternity coverage to a single woman under their health insurance offerings, both partners (the husband and wife) must purchase the plan in order to receive coverage for infertility treatments. Additionally, another major limitation with the infertility benefit from DKV can be found in the 2 year waiting period placed on the coverage.

Furthermore, there are a number of significant caveats in relation to the provision of infertility coverage under a DKV health insurance policy. Firstly, the woman must be aged under 40 and the man must be aged under 50 at the time of treatment; defined as the first stimulation day in each treatment cycle or the first cycle day where insemination is being performed without hormone stimulation. Secondly the insured’s condition must be due to organic causes which can only be overcome with the aid of reproductive help. Finally, as previously mentioned, both the man and the woman benefiting from the infertility treatment must hold the same plan with DKV; namely both must be insured by the Top or Plus policies.

However, the actual coverage provided by DKV Globality under their infertility benefit is rather robust, with the benefit including protection against the costs of:

  • Invitro fertilization (IVF)

  • Intracytoplasmatic sperm injection (ICSI)

    • IVF and ICSI may only be applied alternatively

  • Gamete intrafallopian transfer (GIFT)

  • Zygote intrafallopian transfer (ZIFT)

  • Artificial insemination (AI)

  • Prescribed drug treatment and laboratory work

As can be seen, even with the tight wording of the coverage and the many caveats which exist towards obtaining protection under the plan with regards to infertility treatments, DKV Globality can actually offer fairly robust coverage options for Infertility.



Allianz Worldwide Care Gold and Silver Plans


A second option for infertility coverage can be found with Allianz Worldwide Care, another internationally renowned health insurance company.


Allianz operates slightly differently than DKV in that the infertility benefit on its plans are offered through the purchase of an optional Outpatient coverage module; but in order to purchase the optional out-patient coverage an individual must first purchase the core Inpatient coverage modules. It is a fairly complicated situation, but will get into the details on how to access the infertility benefit in a minute.


First we’ll look at the coverage offered in respect to Infertility Treatment under the Allianz Gold and Silver outpatient plans.
 

Plan

Cover

Overall Outpatient Limit

Silver

GBP 9,960, EUR 12,000, USD 17,000 per person per policy Lifetime

GBP 7,450, EUR 9,000, US$ 12,700 per person per year.

Gold

GBP 9,960, EUR 12,000, USD 17,000 per person per policy Lifetime

No Limit Per Person Per Year


As can be seen from the table, both the Gold and Silver Outpatient modules from Allianz Worldwide Care offer exactly the same coverage for Infertility Treatment. However, the overall outpatient limits of these plans mean that you can receive all your infertility treatment under the Gold option in the course of a single year while you would have to space the treatment out over the course of 2 years if you elected to purchase the Silver plan. It is important to note though that both the Silver and Gold modules include a waiting period of 18 months before the coverage can take effect.


Purchasing either the Gold or Silver outpatient modules from Allianz will mean that you are able to receive coverage against the costs of investigating the cause of infertility, such as a hysterosalpingogram, laparoscopy or hysteroscopy. Additionally, because these modules specifically name an infertility benefit they will also provide coverage for medically assisted reproduction (such as IVF) and the adverse consequences (if any) associated with such treatment.


The down side to the Allianz Infertility coverage is that in-patient treatment for multiple birth babies (a significant risk when dealing with assisted reproduction) born as a result of medically assisted reproduction will only be covered up to GBP 24,900/EUR 30,000/USD 42,500/ per child for the first three months following birth.


Now, back to actually obtaining one of these plans from Allianz.


The Infertility Coverage benefit available under the Gold or Silver Outpatient Modules is available for purchase on an individual basis, meaning that a single individual can purchase the policy and obtain the relevant coverage. However, in order to receive coverage against the costs of actually delivering the child (in addition to pre and post-natal treatments) the spouse/partner of the mother to be must also be insured by the exact same policy. To complicate matters further, the Allianz Maternity Benefit is only available in addition to the purchase of an outpatient module, which itself is only available with the purchase of an Allianz core plan in the form of the company’s Club Individual Core Policy.


So even with the higher levels of coverage available from Allianz in relation to infertility protection, at the end of the day, because of the conditions of the policy, such coverage could actually end up being more expensive than that offered by the DKV plan; although the waiting period under the Allianz policy is 6 months shorter.

 


The Bottom Line on Infertility Insurance Coverage


Infertility Insurance is available from at least two well-known international health insurance companies offering plans in Hong Kong. The coverage can be limited but will normally be sufficient to get to the root cause of the infertility in addition to at least one round of reproduction assistance treatment. However, if Infertility Insurance coverage is offered under a health insurance policy the benefit will normally be tied to a waiting period; necessitating the purchase of a plan well in advance of your intended delivery date, often by a factor of years.


Furthermore, purchasing infertility insurance coverage after you have experienced issues conceiving may mean that the insurance company will deny your infertility related claims due to this being deemed a pre-existing condition. As such, individuals considering starting a family should purchase a policy with this type of coverage before any symptoms or infertility related conditions are realized.
 

Finally, infertility health insurance coverage can be a complex topic with no two insurance companies offering plans in exactly the same manner. If you are looking for this kind of health insurance protection it is important that you shop around, ask questions, and get a full understanding of all the available options in order to ensure that the plan you are purchasing is the right one for your needs.

 

 

 

About the Author

Michael Lamb

Michael Lamb

Michael Lamb is the Marketing Director for  Cooper,  Claridge-Ware Limited, an expert international insurance brokerage headquartered in Hong Kong. With more than 7 years’ experience within the Hong Kong insurance market, Michael is especially focused on the needs and challenges facing modern expatriates.

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