Yes, we do pay benefits on IVF (provided the treatment is deemed ‘medically necessary’ by Medicare).
IVF is is included on our top two levels of hospital cover - Gold Hospital and GoldStar Hospital.
We cover a range of in-hospital treatment for reproductive technology/IVF. Some examples include:
- Item number 13212 (egg retrieval)
- Item number 13215 (transfer of embryos)
- Item number 13218 (preparation of frozen or donated embryos).
However it’s important to note though, IVF treatment involves both inpatient and outpatient services. Medicare contributes to the cost of inpatient and outpatient medical services and HIF will pay benefits towards the cost the cost of medical and hospital treatment for inpatient services (provided that IVF is included on your policy and a 12 month waiting period has been served).
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 would cover the remaining 25%. So the out-of-pocket expenses would really depend on how much the specialist would charge for their services.
We include ‘AccessGap Cover’ on all of 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. 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. That way, we can review the estimate in advance and provide you with an accurate benefit estimate in return, detailing any potential gap expenses to ensure you’re fully informed.