What aspects of fertility treatment might policies cover?

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What aspects of fertility treatment might policies cover?
Photo: Karolina Grabowska via Pexels

While it is important to explain to clients why certain conditions are not covered, there may be areas where clients could potentially claim, or products that might include elements of treatment.

Kathryn Knowles, co-founder of Cura Financial Services, says when it comes to protection policies such as critical illness cover, the policies tend to cover physical conditions that are not already active.

Once someone knows that they have a health condition, this can potentially affect the choices that they have.

She says: "It’s all about what a person knows about their health at the time they take the policy out. You could have someone with high blood pressure, or atrial fibrillation or cancer, and they might not know about it. They could potentially apply for CI cover without any difficulty at all.

"If someone does know these things, it will have an influence upon their options for CI cover. So maybe there is an argument that infertility could be classed as a claimable condition, if someone has no knowledge of any fertility-related health diagnoses."

Knowles adds that CI cover, like most insurance policies, is all about the financial impact someone might face by their new health condition.

So, while fertility treatment can come at a phenomenal cost, she says: "I imagine claims would be restricted to partial payments, such as 25 per cent of the sum assured to a maximum of £25,000.

"This might seem incredibly unfair, but I think an argument would be presented that fertility difficulties do not have the same impact as a diagnosis of stage 3 cancer.

"This is of course a highly emotive topic and I do not want to negate the significant hardship that infertility can cause, I just want to explain the barrier that I think would be there."

Implications of IVF that can be covered

However, Emma Walker, chief marketing officer at LifeSearch, says there are instances where the implications of IVF can be covered.

She explains: “IVF is often a long and sometimes emotional journey for many couples, and this can have implications on their mental health, which could be covered by an income protection policy.

"The family carer benefit that comes included in some IP [policies] could be useful if there was a need to take time off to take care of a pregnant spouse or for a child.

"With CI cover it feels like a relatively level playing field. There are female-specific payouts (cervical, breast and ovarian cancer) and those for males (testicular and prostate cancer). Enhanced children CI cover policies really do a good job protecting mother and child too."

One area where treatment for infertility might be covered is in the world of private medical insurance, but it would depend on the definition of an 'acute medical condition'.

In fact, Alan Lakey, founder of CI Expert, describes PMI as "a minefield where insurance is sometimes offered but it may only cover investigations".

Dr Doug Wright, medical director at Aviva UK Health, explains: "PMI is designed to treat ‘acute conditions’ that start after a customer has a policy in place.

"An acute condition is a disease, illness or injury that is likely to respond quickly to treatment aiming to return the customer to the state of health they were in immediately before suffering the disease, illness or injury, or which leads to a full recovery."

He says Aviva covers the treatment of acute medical conditions for individual PMI, which could be contributing to or causing infertility (endometriosis for example).

However, individual PMI from Aviva does not cover investigations into infertility because this is not an acute condition, although this could be an option for corporate PMI policies.

Who makes provision for fertility issues?

Zurich said its products (life insurance, CI cover and IP) are designed to indemnify a financial loss due to an illness, disease or death. Therefore, it does not cover infertility or the treatment of IVF on any of its current products.

While Aviva does not cover investigations into infertility for individual PMI, corporate policies might be a different ballgame – so it is worth advisers delving into the details of a client's workplace healthcare provision.

Wright comments: "For corporate-funded PMI policies, benefits can be added. In the case of fertility problems this can include investigations and treatment, and this is factored into the premiums.

"For example, where a large company does wish to provide extra cover for IVF, we can produce bespoke cover."

So it is not beyond the realms of possibility for a company to provide PMI benefits to staff that include investigations and treatment for fertility issues, which would benefit staff members for whom the NHS route is blocked. This includes any woman over 40, as I was told after three years of ongoing consultations in my late 30s, only to get to 39 and be told they could not fund me for a second round after 40, as they did not realise I was "so old" (I apparently looked young). 

But whether it would be beyond the realms of price is another matter – and something that advisers can discuss with their corporate clients, specifically if the employer is keen to promote a diverse workforce and encourage more women into senior positions.

simoney.kyriakou@ft.com