At HCi, we understand that starting or growing a family can be a deeply personal and sometimes complex journey. If you’re considering fertility treatment, including in-vitro fertilisation (IVF), it’s important to know what your HCi hospital cover includes, what Medicare may contribute, and what costs you may need to plan for.

Waiting Periods

If you’re new to HCi or recently upgraded your hospital cover, a waiting period will apply before you can claim for assisted reproductive services such as IVF.

As infertility generally means the inability to conceive after one year, assisted reproductive services are usually subject to a 12-month pre-existing condition waiting period. Thus for eligibility, you need to be an HCi member with appropriate hospital cover (Gold or Silver Plus Advantage) for 12 months prior to starting IVF treatment. This in accordance with the standard waiting period for pre-existing conditions.

If you’re unsure whether waiting periods apply to you, please contact us before beginning treatment.

What IVF Services Are Covered?

HCi hospital cover (Gold or Silver Plus Advantage) may help with IVF procedures as an inpatient. This can include:

• theatre and accommodation costs
• anaesthetic and specialist fees (depending on your provider and agreement status)

Important notes:

• Standard waiting periods and pre-existing condition rules apply.
• Excess payments may apply, depending on your cover level.
• Out-of-pocket costs may still arise (e.g. if your provider or hospital doesn’t have an agreement with HCi).

The Commonwealth Ombudsman factsheet has detailed information on Infertility and Assisted Reproductive Services.

Inpatient vs Outpatient – what’s the difference?

Like other treatments and procedures, IVF cover depends on whether you are an inpatient or outpatient. So it’s important to know the difference.

• Inpatient: services when you are formally admitted to hospital, such as during egg collection under general anaesthetic.
• Outpatient: treatments or services done outside of a hospital admission, such as consultations or diagnostic tests at a clinic.

Our outpatient costs factsheet explains the difference in greater detail.

What’s not covered for IVF?

The following services are outpatient services, so they are not covered by private hospital insurance:

What about Medicare for IVF?

Medicare rebates often do not cover the full cost, so members should expect to pay some gap fees.

You may get a Medicare rebate for:

• specialist consultations (if the provider is Medicare-registered)
• certain diagnostic tests and scans
• some medications prescribed during fertility treatment
• selected components of treatment provided through an approved fertility clinic

IVF Preparation Checklist

Before beginning fertility treatment, we suggest that you:

✔   Confirm your level of hospital cover (only Gold & Silver Plus Advantage include IVF).
✔   Ask your obstetrician/clinic for a detailed, itemised quote with MBS item numbers – these codes let us check exactly what’s claimable.
✔   Contact HCi to confirm waiting periods and pre-existing condition rules.
✔   Budget for out-of-pocket costs (even with Medicare and HCi cover).
✔   Check if your hospital and providers have agreements with HCi to minimise costs.

Helpful Tips

✔  Contact HCi early – we can help you understand your cover and avoid surprises.

✔  Talk to your doctor/clinic – request a clear cost estimate before treatment begins.  Ask your treating doctor if they will provide services under HCi’s Access Gap Cover (AGC). AGC arrangements can help minimise your out of pocket expenses.