Fertility Treatment Fees

It is important to be aware that certain employers and provinces may provide coverage for fertility treatments, ranging from tax deductions to complete coverage. Having a clear understanding of your insurance coverage and what it includes can help you prepare for your treatment.

Fertility Procedures and Private Insurance Coverage

• Private insurance may cover most fertility procedures that are not covered by OHIP.
• If you have a private plan, it’s important to review your policy to determine the extent of coverage, whether it’s full or partial reimbursement for procedures such as Non-Funded IVF and IUI cycles, Intracytoplasmic Sperm Injection (ICSI), DFI, AMH, and others.
• Before beginning fertility treatment, request written proof or an explanation of your specific coverage from your insurance company. This will help you know what’s covered before your treatment.
• If full coverage is not available, you may be eligible for partial coverage or coverage during specific stages of a procedure or treatment, such as ultrasounds, blood work, and specific tests.
• Speak with your HR provider about the possibility of ‘flex’ benefits that can be used for non-OHIP expenses.
• Check with your employer if you are eligible to upgrade your insurance for a set monthly fee. However, before paying the extra fee, make sure the additional coverage covers some of the treatment costs and is worth it.
• Verify if you have a Health Spending Account with your insurance.

Most fertility treatments often involves specialized medications that are tailored to each individual. The cost of these medications can vary depending on the extent of coverage provided by your health insurance plan, which could be full, partial, or not at all. It’s important to note that having prescription coverage does not necessarily mean fertility medications are included. Therefore, it’s crucial to check with your insurance provider to verify coverage.

Here are some tips to help you prepare:

• Before starting treatment, request a written explanation from your insurance provider regarding what is and isn’t covered by your fertility treatment coverage.
• If your insurance claim is denied, you can appeal the decision by requesting the reason for the denial and the exact policy provision that supports it.
• Your insurance company may require preauthorization for your medications. Your treatment team can provide a letter that outlines the medications included in your treatment and their Drug Identification Numbers (DINs) to give to your insurance provider.
• Always confirm with your insurance plan if there are any limits on the total amount, total treatment cycles, yearly limits, or lifetime limits before submitting a claim, particularly for medication expenses.
• If your insurance coverage is limited by yearly or treatment cycle limits, you may consider delaying your claims until the end of the year or opting for more affordable treatment options to save your benefits for more expensive treatments.
• If both partners have different insurance benefits, you may be able to combine them by separating the costs and submitting them to different plans. Your treatment team can assist you with this process.

• It is advisable to research your individual insurance benefits to understand how they apply to such treatment and related medications.
• Before embarking on treatment, if possible, confirm that your insurance provides full coverage for the treatments you need.
• Contact your insurance provider to obtain a clear explanation of your coverage, and if possible, ask for a written description outlining precisely what is covered.
• Prior to submitting any claims, make sure to determine whether your benefits include any limits, such as yearly or lifetime limits, treatment cycle limits, or total dollar limits.
• Review your insurance plan to see whether it covers naturopathic treatments that involve preconception care, as well as treatment such as acupuncture. Naturopathic doctors use natural remedies to improve the health of the egg and sperm before conception.

Fertility treatments may qualify as deductible medical expenses on your income tax return. This tax credit can help individuals reduce the impact of medical costs for themselves or their dependents. In all cases, please check with your personal accountant for further details and to confirm eligibility.

Allowable fertility medical expenses on your income tax may include:

• In Vitro Fertilization (IVF)
• Select fertility medications
• Intrauterine insemination (IUI)
• Intracytoplasmic Sperm Injection (ICSI)
• Embryo Freezing
• Embryology Lab Fee
• Sperm Processing & Extraction
• Satellite Monitoring
• Transfer of Frozen Embryo
• Note: Sperm bank donations are excluded