Navigating the cost of conception

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Navigating the cost of conception
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Before assessing any insurance policies or working out a strategic savings plan for your clients, it is important to have an understanding of what IVF can cost.

There are more than 90 registered IVF clinics in the UK. The cost of a IVF cycle usually includes your scans, egg collection, embryology and embryo transfer.

Research from Opinium in July 2021 put the average cost of a cycle between £2,000 and £4,500 in the UK, but this is more like the advertised cost – it is far from the actual cost. 

Medication, tests, embryo freezing, egg or sperm donor fees and other additional procedures are not normally included in the cost of a cycle and are charged separately, along with consultation fees and additional follow-ups.

This can add up to £14,000 for a treatment cycle; no wonder many people go overseas to Europe for cheaper fertility treatment.

Our own IVF journey has cost me and my partner more than £40,000 of our joint savings over the past six years, as the NHS hospital in my postcode area would only provide one round free of charge.

We reduced our costs by getting our GP to book our blood tests, and asking the clinic to send a letter to our GP requesting the drugs on prescription, so we paid cost price (still more than £700 of our money) but far less than it would have cost otherwise.

This great expense is accrued due to many health insurers refusing to pay out for fertility treatments due to them deeming it a ‘lifestyle choice’...Gentry

We also relied on diligent Isa saving and switching on occasion between 0 per cent credit cards – but not everyone is able to fund world-class treatment out of their own savings, and many people have fallen into debt as a result.

One couple I know remortgaged their home to pay for 11 rounds of IVF after the NHS in their region stopped providing IVF services after two rounds. 

Another woman borrowed almost £10,000 from her retired parents to help her overcome her fertility issues. 

But while these costs are eye-watering, the question must be asked: why isn't infertility covered by protection policies? After all, workplace and personal medical insurance covers everything else – so why is fertility treatment classed as an elective procedure and, therefore, not covered by the vast majority of providers?

In fact, only one provider responding to this feature actually does make provision for fertility treatment within its workplace protection plan (Aviva PMI) but – and here's the rub – it depends on the employer whether or not they want to include it for their staff, because it all adds up to a higher premium.

So what can financial services professionals do to help their individual or corporate clients?

Firstly, help create a proper financial plan that includes access to cash savings, as while not everything requires treatment upfront, there will be sizeable bills coming through pretty much every couple of weeks.

This could be up to £3,000 or so for the embryo transfer or around £7,500 for a donor egg cycle (covering the donor's egg collection bills as well as buying the eggs). 

Boxes of drugs can cost £800 a time. There will always be someone from the fertility clinic phoning the day before a consultation or scan asking for payment upfront, even if the in-person clinic visit has to be cancelled as a result of extraneous factors – Covid-19 being a prime example.

Most families do not have this kind of cash lying around and few will be prepared to liquidate stocks-and-shares Isa savings to do so. So it will help to create a budget.

But what about insurance providers themselves? Surely those monthly premiums your clients pay must come into play at some point, right? Wrong.

A medical issue

The World Health Organization and the NHS have stated that infertility is a medical issue. However, it does not appear among the lists of conditions covered by the majority of protection policies.

Emma Walker, chief marketing officer at LifeSearch, notes: “There is little reference to infertility or IVF in any protection policy that we are aware of."

Given that infertility is stated to be a medical problem, why is it not covered by insurance on most insurance policies?

Charlotte Gentry, founder of The IVF Network, comments: "On top of the cost of my egg-retrieval and IVF treatments, I spent approximately £1,500 trying to get advice from a diverse set of opinions.

"This great expense is accrued due to many health insurers refusing to pay out for fertility treatments due to them deeming it a ‘lifestyle choice’.

"Unfortunately, this view is not uncommon and the majority of workplace employee protection policies share ‘elective’ medical processes, putting fertility treatment on a par with cosmetic surgery."

Kathryn Knowles, co-founder of Cura Financial Services, says it is mostly because of the nature of the condition – although there may be a historical element to the way in which policies were created and underwritten in the past. 

She says: "It could be because men didn’t want to talk about hoo-hahs and what goes on 'down there', or face the reality that some men aren’t virile. I think ultimately it comes down to people thinking that infertility is not as bad as other conditions.

"I would guess that some people would think that infertility is a sad situation, but not one that is life threatening, that people get over it and adopt [a child instead].

"I think that could be the harsh reality of it. Critical illness contracts do not tend to take into account claims for emotional and mental health, and I imagine that infertility has previously been linked to these areas."

I am sure that sooner or later some form of cover will be available.Lakey

Dr John Burke, deputy chief medical officer at Axa Health, says it is, simply, too expensive and would lead to unaffordable premiums.

He explains: "Infertility can be one of the most difficult issues for an individual to face. It is a medical condition that can have wide reaching consequences and as a company we continually examine our coverage and strive to support our members as much as possible.

"In an ideal world, we’d cover all proven treatment for all health conditions, all of the time, no matter how they’ve come to affect our customers. But to do so would make our health insurance policies unaffordable and unsustainable.

"The costs associated with infertility coverage and the risks of adverse selection that are associated with it mean that, at the current time, coverage is excluded in the interests of providing affordable premiums."

But Alan Lakey, founder of CI Expert, says it goes beyond cost or a fear of "hoo-ha" discussions and back to underwriting known risk: "Insurance plans are designed around a known risk that can be quantified and therefore turned into a profitable contract.

"I am sure that sooner or later some form of cover will be available, but don’t forget, the precept of insurance is to cover a potential event not a known one. So cover will likely only be available to women who are unaware of fertility problems."

And then there is the entirely logical response, as LifeSearch's Walker says, that infertility, in isolation, is generally not life-threatening nor is it a condition that is classified as a critical illness.

This is not to say that no policies will cover fertility treatment, or part of it, as the next article in the guide shows.

However, it is worth making sure prospective protection clients are aware of such limitations, given the prevalence of infertility, and that you are able to provide a financial plan to support them if they need to draw on savings for future fertility treatment.

simoney.kyriakou@ft.com