IVF covered by the insurance company – how much it costs and what you are entitled to

Infertility is becoming a more frequently discussed topic in today's society. Thanks to advances in reproductive medicine and the amendment to the law on IVF, thousands of people have a chance to become happy parents. However, this treatment is very costly. How much does IVF cost and what are the options for its payment by the insurance company?

Who is entitled to have their IVF paid for by their insurance company in 2020?

The good news is that most adult women are entitled to have their fertility treatment covered by health insurance. In the event of diagnosis of bilateral ovarian obstruction, women between the ages of 18 and 39 may undergo the procedure. Women who do not suffer from this condition are covered by health insurance from the age of 22, while the upper age limit remains the same as above.

However, it should be taken into account that insurance companies do not meet the full cost of treatment, but only part of it. Clients must pay for the remainder of treatment themselves. This usually encompasses drugs for hormonal stimulation, additional procedures, procedures that increase the chance of fertilisation and conception, or laboratory tests. Surcharges range in the thousands of crowns and can be as much as about 20,000 crowns. If a candidate for assisted reproduction pays for procedures themselves, the price of one complete cycle is around 50,000 crowns.

In some cases, the insurance company pays part of the amount, and sometimes the entire financial burden is borne by the client. The specific amount reimbursed depends on the price lists of individual health insurance companies. All reputable clinics have a price list of individual procedures on their websites, and you find out the price of individual procedures during the consultation.

How many IVF cycles does the insurance company pay for?

According to the amendment to the IVF Act, women are entitled to three cycles of IVF and, under certain conditions, to four cycles. Four cycles can only be performed if only one embryo has been placed in a woman's uterus during previous procedures. Of course, it is possible to undergo further cycles, but clients must meet the entire cost themselves.

Single embryo transfer is therefore an appropriate choice for several reasons. The health insurance company pays for one more procedure, which increases the chance of successful IVF. The placement of a single embryo also eliminates the possibility of multiple pregnancies.

An exception to this is the intrauterine insemination (IUI) method, which is one of the most basic IVF methods. This is the least invasive procedure, in which laboratory-selected sperm are applied directly to the uterus during ovulation. This procedure is paid for in full by the health insurance company. In addition, it is possible to undergo this procedure up to six times each year.

Commercial insurance options

Some insurance companies offer the possibility of commercial additional insurance for assisted reproduction, which serves as a supplement to the usual health insurance. However, it must be taken into account that stricter rules for the payment of insurance premiums apply here. These usually include:

• a lower age limit up to which clients can undergo IVF

• requirement to hold insurance for a certain period prior the procedure

• clearly defined intervals between individual cycles

The offer of commercial insurance of assisted reproduction can also include other items. These include obstetric or postpartum complications, multiple births, and others. On the other hand, the disadvantage of commercial insurance is the fact that it is not possible to agree separately, but it is usually part of life insurance or supplementary insurance for serious women's conditions.

*This article is translated from Czech original to English language by translation agency Marvel, s. r. o.