Medically reviewed by Dr. Shwetha Y Baratikka, Fertility Specialist & IVF Consultant, Janisthaa IVF Bangalore
IVF treatment in India costs between ₹1.5 lakh and ₹3 lakh per cycle. For many couples, that number is the single biggest barrier between them and starting a family. What most patients do not realise is that some health insurance policies — if chosen carefully or already in force — can cover part or all of that cost.
The challenge is knowing which policies apply, what documentation your insurer will ask for, and how to file a claim correctly so it is not rejected on a technicality.
This guide answers all three questions. It explains which major health insurance policies in India currently cover IVF treatment, what ICD-10 codes your hospital will use when filing your claim (and what they mean in plain English), and exactly how to file an IVF insurance claim step by step — including the documents Janisthaa IVF provides to support your application.
If you have a policy and are unsure whether it covers IVF, or if you are choosing a policy before beginning treatment, read this guide before speaking to your insurer or your fertility clinic.
Couples in India who are planning IVF treatment and want to understand their insurance options, or who already have a policy and want to know how to claim. Also useful for patients whose employer provides group health coverage — many corporate policies now include IVF, often without employees knowing.
Finding out your IVF embryo transfer was successful is one of the most emotionally profound moments of the fertility journey. After all the injections, the waiting, the uncertainty — a positive beta hCG result changes everything. But it also raises a new set of questions: What happens next? What symptoms are normal? When will I see a heartbeat? When is it really safe?
This guide answers every question an IVF patient at Janisthaa IVF Center Bangalore typically has after a positive pregnancy test — week by week, milestone by milestone.
What is an ICD-10 code?
ICD-10 stands for the International Classification of Diseases, 10th Revision. It is a global medical coding system used by hospitals, clinics, and insurance companies to classify diseases, diagnoses, and procedures.
When Janisthaa IVF files your insurance claim, every diagnosis and procedure is assigned an ICD-10 code. Your insurer uses these codes to determine whether your treatment falls within your policy’s covered conditions. Using the correct codes — and ensuring they match your policy’s coverage list — is one of the most common reasons IVF claims succeed or fail.
You do not need to memorise these codes. But understanding what they mean helps you verify that your hospital has coded your claim correctly before it is submitted.
IVF and Infertility — Key ICD-10 Codes
| ICD-10 Code | Medical Term | What It Means for You |
|---|---|---|
| N97.0 | Female infertility associated with anovulation | Your ovaries are not releasing eggs regularly — common in PCOS |
| N97.1 | Female infertility of tubal origin | One or both fallopian tubes are blocked or damaged |
| N97.2 | Female infertility of uterine origin | A uterine condition (fibroids, septum, Asherman’s) is preventing pregnancy |
| N97.4 | Female infertility associated with male factors | IVF is needed partly or fully because of a sperm issue |
| N97.9 | Female infertility, unspecified | Unexplained infertility — no single identified cause |
| N46 | Male infertility | Used when the primary diagnosis is a sperm-related problem |
| N80.0–N80.9 | Endometriosis (various sites) | Endometriosis affecting the ovaries, tubes, or pelvic cavity |
| D25.0–D25.9 | Uterine fibroids (leiomyoma) | Fibroids requiring treatment before or during IVF |
| E28.2 | Polycystic ovarian syndrome (PCOS) | PCOS as primary diagnosis driving infertility |
| N91.0–N91.2 | Absent or scanty menstruation | Anovulatory cycles linked to infertility |
Procedure Codes (what Janisthaa IVF does during your treatment)
| ICD-10 / Procedure Code | Procedure | What Happens |
|---|---|---|
| Z31.2 | In vitro fertilisation (IVF) | Full IVF cycle — stimulation, egg collection, fertilisation, transfer |
| Z31.1 | Artificial insemination (IUI) | Sperm placed directly into uterus during ovulation |
| Z31.81 | Encounter for male factor infertility | Investigation and treatment for male infertility within IVF cycle |
| Z34 | Supervision of normal pregnancy post-IVF | Used after confirmed IVF pregnancy for antenatal care coding |
| Z31.3 | Encounter for assisted reproductive services | Consultations, monitoring, and support procedures around IVF |
Commonly paired codes on IVF insurance claims
Most IVF claims use a combination of codes typically one or two diagnosis codes plus one procedure code. A typical claim from Janisthaa IVF might look like:
N97.0 + E28.2 + Z31.2 – IVF for a patient with PCOS causing anovulatory infertility
N97.4 + N46 + Z31.2 – IVF for a couple with combined male and female factor infertility
N97.1 + N80.2 + Z31.2 – IVF for tubal infertility caused by endometriosis
N97.9 + Z31.2 – IVF for unexplained infertility
What to check on your claim before submission
Once Janisthaa IVF prepares your claim documentation, verify the following before your insurer receives it:
1. Diagnosis code matches your actual diagnosis – if you have PCOS, N97.0 and E28.2 should both appear
2. Procedure code Z31.2 is included – this is the primary IVF procedure code. Its absence is a common claim rejection reason
3. Treating doctor’s name and registration number – Dr. Shwetha Y Baratikka’s MCI/NMC registration must appear on all claim documents
4. Janisthaa IVF’s ROHINI/hospital registration number – required on all claim forms. Our admin team provides this automatically
5. Dates of service match your treatment dates – any discrepancy between the claim date and your discharge summary triggers a rejection
Which Health Insurance Policies Cover IVF in India?
As of 2025, IVF treatment is not universally covered under health insurance in India. However, following the Insurance Regulatory and Development Authority of India (IRDAI) directive in 2019 and subsequent updates, a growing number of insurers are required to offer coverage for infertility-related treatments — including IVF — under specific policy tiers.
Whether your policy covers IVF depends on four factors:
1. Your insurer – not all providers offer IVF coverage even if IRDAI regulations permit it
2. Your policy tier – most insurers restrict IVF coverage to higher-value plans (₹5 lakh sum insured and above)
3. Waiting period – the majority of policies impose a 2–4 year waiting period before IVF claims are eligible
4. Pre-existing conditions – PCOS, endometriosis, and prior surgeries may affect eligibility depending on disclosure at policy inception
Major Insurers — IVF Coverage Comparison Table (2025)
| Insurer | Policy Name | IVF Covered? | Coverage Amount | Waiting Period | Sub-limit | Notes |
|---|---|---|---|---|---|---|
| Star Health Insurance | Star Women Care Policy | ✅ Yes | Up to ₹1 lakh per cycle | 2 years | ₹1L per cycle, max 2 cycles | Specifically designed for women; includes fertility treatments |
| Star Health Insurance | Comprehensive Policy | ⚠️ Partial | Subject to sum insured | 2 years | Depends on SI | IVF under maternity extension — check policy wording |
| HDFC Ergo | my:health Suraksha | ✅ Yes | Up to ₹50,000 | 3 years | ₹50,000 per cycle | Available under Gold and Platinum tiers only |
| HDFC Ergo | Optima Restore | ❌ No | Not covered | — | — | Maternity covered; IVF excluded |
| New India Assurance | New India Mediclaim | ⚠️ Partial | Limited coverage | 4 years | Varies by SI | Check latest endorsement — coverage added post-2022 |
| Bajaj Allianz | Health Guard | ✅ Yes | Up to ₹50,000 | 2 years | Per policy year | Covers IVF, IUI, and ICSI under infertility treatment |
| Niva Bupa (Max Bupa) | ReAssure 2.0 | ✅ Yes | Up to ₹1 lakh | 2 years | 2 cycles per lifetime | One of the most comprehensive IVF cover plans available |
| Niva Bupa | Health Premia | ✅ Yes | Up to ₹2 lakh | 2 years | Per policy year | Platinum tier only; includes fertility consultations |
| Care Health (Religare) | Care Advantage | ✅ Yes | Up to ₹50,000 | 2 years | Per policy year | Requires pre-authorisation before treatment begins |
| Aditya Birla Health | Activ Health Enhanced | ✅ Yes | Up to ₹1 lakh | 3 years | ₹1L per cycle | Chronic management programme must be active |
| ICICI Lombard | Complete Health | ❌ No | Not covered | — | — | IVF excluded under standard policy; check add-ons |
| Group / Corporate Policies | Employer-provided | ✅ Often yes | Varies by employer | Often waived | Employer-set | Many TCS, Infosys, Wipro, and Accenture policies now include IVF — check your HR portal |
Important: Policy terms change annually. Always verify current IVF coverage directly with your insurer before beginning treatment. The table above reflects publicly available policy information as of mid-2025 and is for guidance only — not a guarantee of coverage.
Does your employer’s group policy cover IVF?
Corporate group health policies are increasingly including IVF coverage — particularly among large IT, pharma, and BFSI employers. Unlike individual policies, group policies often have shorter or no waiting periods for maternity and fertility treatments.
How to check:
1. Log into your company’s HR portal (Workday, SAP, Darwinbox, or similar)
2. Search for “health insurance policy document” or “group mediclaim schedule of benefits”
3. Look for sections titled “maternity benefits,” “fertility treatment,” or “assisted reproduction”
4. If unclear, email your HR or the insurance helpdesk with the question: *”Does our group policy cover IVF treatment including ICSI? What is the sub-limit and waiting period?”*
Janisthaa IVF works directly with corporate insurance desks and can provide a pre-treatment cost estimate in the format most corporate insurers require for pre-authorisation.
What if your current policy does not cover IVF?
If you are planning IVF and your existing policy excludes it, you have three options:
Port to a policy with IVF coverage – IRDAI portability rules allow you to port to another insurer without losing your waiting period credit. A Star Women Care or Niva Bupa ReAssure policy purchased now may cover IVF after the waiting period expires
Purchase a top-up plan – some insurers offer fertility-specific top-up plans that can be layered over your existing policy
EMI and financing – Janisthaa IVF offers treatment financing options for patients without applicable coverage
Important: An IVF pregnancy is NOT a high-risk pregnancy by default. The “high-risk” label applies only when specific factors are present — such as advanced maternal age, twins, or pre-existing health conditions. Most IVF pregnancies proceed normally.
Step-by-Step IVF Insurance Claim Guide
Before you begin: two types of claims
Cashless claim – your insurer pays the hospital directly. You do not pay upfront. Available only at network hospitals. Check whether Janisthaa IVF is on your insurer’s network list before starting treatment.
Reimbursement claim – you pay the hospital first, then submit bills to your insurer for reimbursement. Available at all hospitals. More common for IVF because many fertility clinics are not on insurer networks.
Step 1 – Verify your policy covers IVF (before booking your first appointment)
Do this before spending any money on treatment.
– Call your insurer’s customer care line and ask specifically: “Does my policy cover IVF treatment under ICD-10 code Z31.2? What is the sub-limit and waiting period?”
– Request confirmation in writing (email or WhatsApp message from their official number) — verbal confirmations are not binding
– Check your waiting period status log into your insurer’s app or portal and look for “waiting period tracker” or contact customer care
– Confirm Janisthaa IVF’s network status — ask your insurer or check their hospital network search tool
Documents to gather at this stage:
– Your policy schedule (shows sum insured, sub-limits, and exclusions)
– Your policy wording document (the detailed terms — not the brochure)
Step 2 – Get a pre-authorisation letter (for cashless claims)
If you are pursuing a cashless claim, your insurer must approve treatment in advance. This is called pre-authorisation or pre-auth.
– Submit the pre-auth request 7–10 days before your treatment start date
– Janisthaa IVF’s billing and insurance team will prepare the pre-auth documents you do not need to do this yourself
– Documents your insurer typically requires for IVF pre-auth:
– Treating doctor’s letter confirming diagnosis and proposed treatment (Dr. Shwetha’s letterhead)
– Infertility diagnosis report investigation reports confirming the diagnosis (semen analysis, AMH, HSG, follicular study reports)
– ICD-10 codes for diagnosis and procedure (Janisthaa IVF provides these)
– Janisthaa IVF’s hospital registration / ROHINI number
– Your insurance card and photo ID
– Your insurer will respond within 3–5 working days with approval, partial approval, or a query
– If queries are raised, forward them to Janisthaa IVF’s billing team we respond to insurer queries directly
Step 3 – Collect and organise your documents during treatment
Whether cashless or reimbursement, you will need a complete set of treatment documents. Ask Janisthaa IVF to prepare a full documentation package at the end of your treatment cycle. This should include:
| Document | Why Your Insurer Needs It |
|---|---|
| Discharge summary | Confirms dates of admission, treatment performed, and diagnosis codes |
| Itemised hospital bill | Breaks down costs by procedure — insurers reject lump-sum bills |
| Doctor’s prescription and treatment plan | Shows medical necessity of IVF |
| All investigation reports | AMH, semen analysis, HSG, follicular study, embryology reports |
| Pharmacy receipts | For medications purchased outside the hospital (injectables, supplements) |
| Original receipts / paid bills | Required for reimbursement claims |
| Pre-auth approval letter | If cashless — shows insurer’s prior commitment to pay |
Step 4 – File your reimbursement claim
For reimbursement claims, submit all documents within the time limit stated in your policy this is typically 30–90 days after treatment ends. Late submissions are rejected.
How to file:
1. Download your insurer’s reimbursement claim form from their website or app
2. Fill in your personal details, policy number, and total claim amount
3. Attach all documents from Step 3 in the order the form specifies
4. Submit via your insurer’s preferred channel:
Online portal – most insurers now accept digital submissions
Email – send to your insurer’s claims email with a clear subject line: “IVF Reimbursement Claim — [Your Name] — Policy No. [XXXXXXXX]”
Physical submission – courier to your insurer’s nearest branch with acknowledgement receipt
5. Note the claim reference number you receive track your claim status using this number
Step 5 – Follow up and respond to queries
Most IVF claims receive at least one query from the insurer requesting additional documents or clarification. This is normal — it does not mean your claim is rejected.
– Respond to queries within the insurer’s stated deadline (usually 15 days)
– Forward all queries to Janisthaa IVF’s billing team we will prepare the response documents
– If your claim is partially approved, request a written explanation of which items were excluded and why
– If your claim is fully rejected, request the rejection reason in writing. Common rejection reasons and how to appeal:
| Rejection Reason | What to Do |
|---|---|
| “Treatment not medically necessary” | Request Dr. Shwetha to write a detailed medical necessity letter citing the diagnosis codes and failed prior treatments |
| “Waiting period not completed” | Check your policy inception date — if the waiting period is complete, submit proof. If genuinely not complete, the rejection is valid |
| “IVF not covered under this policy” | Request the exact policy clause being cited. If the policy wording is ambiguous, escalate to IRDAI Grievance Cell |
| “Incomplete documentation” | Submit the missing documents within the deadline. Call Janisthaa IVF billing team immediately |
| “Procedure code mismatch” | Ask Janisthaa IVF to resubmit with corrected coding. This is a hospital-side fix |
Janisthaa IVF supports your insurance claim end to end
Navigating insurance claims while going through IVF treatment is stressful. Janisthaa IVF’s billing and insurance team handles the documentation, coding, pre-authorisation requests, and insurer query responses on your behalf so you can focus on your treatment.
What Janisthaa IVF provides for your claim:
– ✅ Full itemised billing in insurer-accepted format
– ✅ ICD-10 coded discharge summary and treatment plan
– ✅ Doctor’s medical necessity letter on clinic letterhead
– ✅ All investigation reports in certified copy format
– ✅ Pre-authorisation request preparation and submission
– ✅ Direct communication with your insurer’s TPA (Third Party Administrator)
– ✅ Query response documents prepared within 48 hours
IVF Pregnancy Care at Janisthaa IVF Center Bangalore
Dr. Shwetha Y Baratikkae — IVF Specialist, Janisthaa IVF Bangalore
“After a positive beta hCG, I personally review every patient’s results and plan the follow-up schedule. The early weeks of an IVF pregnancy require the same level of attention as the treatment cycle itself. We do not simply discharge patients after a positive test — we walk with you through every milestone until you are safely in the hands of your OB.”
20+ years experience | 10,000+ successful pregnancies | Basaveshwar Nagar, RR Nagar & Malleshwaram
Heavy periods affecting your fertility plans?
Dr. Shwetha at Janisthaa IVF Bangalore will identify the cause and create a treatment plan that protects your fertility. Same-day ultrasound and hormonal testing available.
Book Consultation WhatsApp Us +91 95911 11407
