Assisted Reproductive Services

What is covered under Assisted Reproductive Services?

Hospital Cover for Assisted Reproductive Services includes hospital treatment for fertility treatments or procedures. 

Examples are:

• retrieval of eggs or sperm
• in-vitro fertilisation (IVF)
• gamete intra-fallopian transfer (GIFT).

This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).

Some treatments you might expect to be in the Assisted Reproductive Services clinical category are in other clinical categories. For example, treatments for:

• the female reproductive system are under Gynaecology 
• pregnancy and birth-related services are under Pregnancy and Birth.

Which Hospital Cover tiers include Assisted Reproductive Services?

What does it mean if cover is ‘optional’?

‘Optional’ means the Australian government allows insurers to choose whether or not to cover a clinical category under that Hospital Cover tier.

What does ‘restricted cover’ mean? 

Restricted cover means the insurer pays only limited benefits. 

If insurers offer cover for Assisted Reproductive Services under Basic Hospital Cover, they can do so on a ‘restricted’ basis. If you are admitted as a private patient in a private hospital for treatments under this clinical category, you will face considerable out-of-pocket costs.

Always check with your insurer before agreeing to be treated as a private patient in a private hospital if you have restricted cover for Assisted Reproductive Services. 

Does Medicare cover Assisted Reproductive Services?

Yes. Medicare covers all treatments under the Assisted Reproductive Services clinical category.

If there is an MBS item number for the treatment, Medicare covers it. 

Medicare does not place any limit on the number of treatment rounds you can have.

Even so, most people who undergo fertility treatment still have to pay some of the cost themselves. This depends on:

• the type of service
• how much your doctor charges
• whether you have private health insurance.

To avoid any unexpected costs, talk to your doctor, the clinic and your insurer about:

• all costs involved
• what Medicare covers
• how much your private health insurer pays if you have Hospital Cover
• what you have to pay.

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