Assisted Reproductive Technology (ART) is the application of laboratory or clinical technology to gametes (human egg or sperm) and/or embryos for the purposes of reproduction. In vitro fertilisation (IVF) is one type of ART procedure. Generally, the main surgical procedure in an IVF cycle is the egg collection; this is also referred to as egg pick-up, oocyte pick-up, OPU, and sometimes egg harvesting.
Can I claim a benefit on ART/IVF with HIF?
As IVF procedures are carried out in an operating theatre, you can claim benefits towards the treatment from HIF, provided that all of the following criteria have been met:
a) you hold an eligible private hospital insurance policy which includes Assisted Reproductive Technology;
b) the associated waiting period has been served;
c) you are admitted to hospital as an inpatient; and
d) the medical items/procedures have valid Medicare item numbers.
However, it’s important to note that IVF treatment involves both inpatient and outpatient services. Medicare contributes to the cost of inpatient and outpatient medical services and HIF will pay a benefit towards the cost of medical and hospital treatment for inpatient services (provided that IVF is included on your policy and waiting periods have been served which are 2 months for new conditions and 12 months for pre-existing conditions).
Essentially, the benefit that HIF is allowed to pay towards IVF and any other type of surgery/treatment is based on the Government’s Medicare Benefit Schedule (MBS). Medicare will pay 75% of the doctors’ fee up to their pre-defined limit, then HIF will cover the remaining 25%. So, any out-of-pocket expenses will really depend on how much the specialist charges for their services.
Which HIF policies include ART/IVF?
HIF's Gold Tier Hospital cover includes Assisted Reproductive Technology, including ward fees, theatre fees and accommodation, plus you can claim benefits towards your anaesthetist and treating doctors’ fees.
The benefit that HIF is allowed to pay towards IVF and any other type of surgery/treatment is based on the Government’s Medicare Benefit Schedule (MBS). Medicare will pay 75% of the doctors’ fee up to their pre-defined limit, then HIF will cover the remaining 25%. So, any out-of-pocket expenses will really depend on how much the specialist will charge for their services.
You can also claim for IVF drugs under one of our top two Extras Cover products.
What are the waiting periods for ART/IVF?
A 2 months for new conditions and 12 month pre-existing Hospital waiting period will apply for new HIF members who haven't previously held cover for Assisted Reproductive Technology and pregnancy and birth, and a 12 month Extras cover waiting periods applies for IVF drugs. If you would like to check your eligibility for ART procedures or to find out more about IVF and discuss some options, please don't hesitate to get in touch.
Can I use AccessGap for ART/IVF?
We include ‘AccessGap Cover’ on all our Hospital insurance policies. AccessGap is HIF’s medical gap cover arrangement and it was designed to minimise (and sometimes eliminate) large out-of-pocket expenses for inpatient medical services.
It’s important to note though that providers can nominate to opt-in or out of AccessGap on a per-patient basis though, which is why we always recommend that our members request an itemised medical estimate prior to undergoing treatment. We can then review the estimate for you in advance and provide you with an accurate benefit estimate detailing any potential gap expenses to ensure you’re fully informed.