August 31, 2014
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Fertility


Cost of fertility treatments

Paying for your treatment

As you begin to consider fertility treatment, you will want to determine the payment options and insurance benefits that may be available to you. Every clinic is different in terms of what the payment options are, so if you have questions, you should contact the clinic directly to find out more.

Reimbursement sources

Start by differentiating between your medical treatment/procedure costs (anything that the doctor, nurse, or lab does) and your medication costs (the medications you will take).

Both the government and private health insurance may pay for some of your medical treatment costs. The federal government and some provincial governments (Quebec and Manitoba, for example) offer financial assistance around fertility treatment. Speak to your health care provider or insurance carrier for further details.

Some drug plans will cover part or all of your medication costs, although there is usually a "cap" or maximum amount of coverage.

Remember that expenses that aren't covered can be submitted as a medical deduction claim on your income tax.

Benefit from your company benefits

If you and/or your partner are part of an employer's health plan, talk to the insurer or a human resources representative to find out what treatments or medications are covered. Not all insurers will cover fertility prescriptions and some have a cap on what you can put through. This cap may be a one-time limit or an annual maximum. In Quebec, all employers have to match the RAMQ (Régie de l'assurance maladie du Quebec, the Quebec public formulary) list of publicly-funded medications.

Depending on the drug plan, you may be responsible to pay a co-insurance amount. Check if the plan has any flexible coverage that can be used to pay for medical procedures not covered by provincial health plans. Ask for confirmation in writing. If you don't have coverage, speak up, and ask that an exception be made. Often your human resources department has the ability to approve special medication requests. Your clinic may be able to help you write the letter requesting special medications or provide you with a sample letter or template.

Benefit from your private insurance

As with company insurance, you need to check what procedures and medications are covered. Read your policy closely and speak with your insurance representative. Private insurers may cover some fertility procedures or certain parts of them, such as investigative tests. Ask specifically about intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI). Ask if there is a limit in dollars, amount of time, or number of treatment cycles. If you have coverage for medication, you will be eligible for reimbursement whether you bought the medications at the clinic or at a retail pharmacy. If your fertility clinic dispenses medications on-site, you are still eligible for reimbursement if you get your medications there. Just ensure that they provide you with an official receipt.

Benefit from your provincial healthcare benefits

Provincial health care generally covers visits to your doctor and most diagnostic tests. It may cover certain treatments; for example, Ontario supplements 3 cycles of in vitro fertilization if you suffer from bilateral tubal occlusion.

In Manitoba, there is a Fertility Treatment Tax Credit on fertility treatment fees paid to an accredited clinic in Manitoba, and for related prescription medications. For details, please refer to: http://gov.mb.ca/finance/pcredits.html#fertility.

In Quebec, assisted reproduction treatments are covered by the provincial health plan and are available to people of child-bearing age as of August 2010. The costs covered include all medical activities and medications related to artificial insemination and IVF.

The new services covered by the public program are:

  • Services required for ovarian stimulation and ovulation induction.
  • Services required for artificial insemination, including the medical procedure for sperm extraction.
  • Services required for freezing and storing sperm, purchasing sperm straws, sperm washing, and preparation for IVF.
  • 3 stimulated cycles of IVF, including follow-up, follicular monitoring, ultrasound, egg retrieval, ICSI, assisted hatching, preimplantation diagnosis, transfer of fresh and frozen embryos, and the cost of freezing embryos.
  • Should the first 3 cycles fail, a 50% tax credit already in place will continue to apply for subsequent attempts.
  • Up to 6 cycles for natural or modified natural cycles, which generally produce a single embryo.

For more details on Quebec's public medication plan and the assisted procreation program, please visit: http://www.ramq.gouv.qc.ca/en/citoyens/assurancemedicaments/tarifs.shtml, and; http://www.msss.gouv.qc.ca/en/sujets/santepub/assisted-procreation.php.

If you're on a private medical insurance plan and are unclear about your coverage, do not hesitate to speak with your health insurer or human resources department to get more information on your insurance plan.

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