IVF and Private Health Insurance

If you're here, chances are you've got enough going on without trying to decode what's covered and what's not. So, let's break it down - ahm Gold tier hospital covers do pay benefits towards IVF, but only for specific inpatient procedures. We'll walk you through what's included, what's not, and where Medicare and the PBS (Pharmaceutical Benefits Scheme) fits in.

A few things to know up front, if you have a pre-existing condition (such as infertility), a 12-month waiting period may apply. Otherwise, you may still have a 2-month waiting period. And while this does pay benefits towards inpatient IVF services, most costs happen outside of hospital, so potentially significant out of pocket expenses are likely.

Does ahm hospital cover include IVF?

IVF (in vitro fertilisation) falls under the clinical category called Assisted Reproductive Services (ARS), which also includes gamete intrafallopian transfer (GIFT), intracytoplasmic sperm injection (ICSI) and the retrieval of eggs or sperm.

ahm Gold tier hospital covers pay benefits towards IVF, but only for services you receive when you're admitted to hospital as an inpatient where a Medicare benefit is payable.

So basically:

  • Benefits are only paid for the procedures you receive when you're admitted to hospital as an inpatient
  • Many IVF related costs are for services you receive outside the hospital so ahm can’t pay benefits towards these costs

What does ahm Gold tier hospital cover pay towards for IVF?

ahm Gold tier hospital cover only pays benefits towards IVF-related services when you're formally admitted to hospital as an inpatient. Here's what that looks like in practice.

What it does include

If your ahm hospital cover includes Assisted Reproductive Services and you're admitted to hospital for IVF treatment after your waiting periods have been served, typically benefits will be payable towards the accommodation and theatre fees for services you receive in hospital like:

  • Egg collection (oocyte retrieval)
  • Embryo transfer
  • Preparation and transfer of frozen embryos
  • Surgical semen collection

Benefits will also be payable towards your in-patient specialist fees charged by the doctors treating you in hospital. However, you may still have to pay an out of pocket cost if the doctors treating you charge above the Medicare Benefits Schedule fee. If you have an Excess or Daily Charge on your hospital cover, you may also need to pay these.

Not all ahm hospital covers include IVF and other Assisted Reproductive Services. To see what’s included on different hospital products, you can compare hospital cover options

What it doesn’t include

Most of the IVF journey happens outside of a formal hospital admission. ahm hospital cover is specifically for inpatient treatment, so these costs sit outside of what it covers.Even if a service happens on the same day as your hospital admission, it might still be considered an outpatient service - which means it wouldn't be included.

This includes things like:

  • Consultations and appointments with your doctor at the clinic or the hospital
  • Tests, scans, ultrasounds and other diagnostic procedures
  • Medications
  • Laboratory fees
  • Storage and transport costs for embryos, eggs and semen
  • Any other treatment you receive that's not part of a hospital admission

Some of these services may be eligible for Medicare benefits and some will be completely at your own expense.

How do I check my policy?

Assisted Reproductive Services are only available on ahm Gold tier hospital covers - so it's worth checking exactly what's on your specific cover before you start planning.

You can:

Already a member? Check your policy details.

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How Medicare and the PBS can support your IVF

The good news - Private health insurance isn't the only help available.

Medicare may cover some of your IVF related costs, and the PBS (Pharmaceutical Benefits Scheme) may subsidise some of your medications - which adds up when you're going through treatment.

Your ahm hospital cover works alongside Medicare and the PBS for inpatient services. If you have an eligible ahm extras cover with pharmacy included, it may also help with the cost of some IVF-related medications that aren't subsidised by the PBS. Waiting periods and annual limits apply. Check out FAQs below for the full details. 

Learn more about Medicare Support(opens in a new tab)

Thinking ahead IVF

Every IVF story is different. Before beginning your journey, please get in touch so we can confirm your hospital cover inclusions and whether you will need to serve any waiting periods, and walk you through what going to hospital might look like. If pregnancy becomes part of your journey, you can learn more about pregnancy and pre and post natal care for ahm members

Learn more

Common questions

Things you should know

*While we hope you find this information helpful, please note that it is general in nature. It is not health advice, and is not tailored to meet your individual health needs. You should always consult a trusted health professional before making decisions about your health care. While we have prepared the information carefully, we can’t guarantee that it is accurate, complete or up-to-date. And while we may mention goods or services provided by others, we aren’t specifically endorsing them and can’t accept responsibility for them. For these reasons we are unable to accept responsibility for any loss that may be sustained from acting on this information (subject to applicable consumer guarantees).