Procedure to conceive a Child now reimbursable under CGHS
The Department of Health and Family Welfare coming under the ministry of Health and family welfare has clarified that In-Vitro Fertilisation (IVF) treatment is reimbursable under CGHS (Central Government Health Scheme).
In Vitro Fertilization to conceive a child is commonly referred to as IVF. IVF is the process of fertilization by manually combining an egg and sperm in a laboratory dish. When the IVF procedure is successful, the process is combined with a procedure known as embryo transfer, which is used to physically place the embryo in the uterus.
While allowing the reimbursement for this treatment to the CGHS beneficiaries and beneficiaries under Central Services (Medical Attendance) Rules, 1944, Government has formulated certain guidelines.
The following Office Memorandum provides full details in this regard.
Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi 110 108
No: Z. 15025/5/2011-CGHS III/CGHS (P)
Dated, the 22nd November, 2011
Subject: Guidelines / Criteria for reimbursement of expenses for In-Vitro Fertilisation (IVF) treatment to CGHS beneficiaries and beneficiaries under Central Services (Medical Attendance) Rules. 1944.
The undersigned is directed to say that the Ministry of Health & Family Welfare has been receiving requests for providing clarifications as to whether the expenditure incurred on In-Vitro Fertilisation ((IVF) treatment is admissible under CGHS, and if so. whether any guidelines have been laid down for reimbursement of the expenses incurred on IVF treatment.
(2) The matter has been examined by a Technical Committee of the Heads of Department of Gynaecology & Obstetrics of Government Medical institutions, and based on the recommendations of the Committee, the following guidelines are laid down for considering cases for reimbursement of expenses incurred on IVF treatment by CGHS beneficiaries and beneficiaries under Central Services (Medical Attendance) Rules, 1944:-
(I) Requests for IVF treatment will be considered only on the basis of advice tendered by the Head of Department of Gynaecology & Obstetrics of a Government Medical institution;
(ii) Permission for IVF treatment to be undertaken may be given by the Head of Department in the Ministries / Departments on the recommendations of the Head of Department of Gynaecology & Obstetrics of a Government Medical institution;
(iii) IVF procedure will be allowed in a Government Medical institution on the recommendations of the Head of Department of Gynaecology & Obstetrics of a Government Medical institution;
(iv) IVF procedure may be allowed, on a case to case basis, in a private medical institution if the Institution is registered with the State / Central Government and has the necessary facilities including equipment and trained man power for carrying out the procedure. It is, however, mandatory to obtain the recommendations of the Head of Department of Gynaecology & Obstetrics of a Government Medical institution for permitting the procedure to be undertaken in a private institution;
(V) There should be clear evidence of failure of conventional treatment before permitting IVF treatment procedure;
(vi) The age of women undergoing IVF treatment procedure should be between 21 and 39 years
(vii) The woman has to be married and living with her husband;
(viii) The IVF treatment procedure will be allowed only in cases of infertility where the couple has no living issue
(ix) Reimbursement of expenditure incurred on IVF procedure will be allowed upto a maximum of 3 (three) fresh cycles;
(X) An amount not exceeding Rs.65,000/- (Rupees sixty five thousand only) per cycle or the actual cost, whichever is lower, will be allowed for reimbursement. This amount will be inclusive of the cost of drugs and disposables and monitoring cost during IVF procedures;
(xi) As IVF treatment is a planned procedure, reimbursement cases can be considered by the Ministries / Departments only if prior approval was obtained by the beneficiary for undergoing the IVF treatment.
(xii) There will be a onetime permission for availing IVF treatment consisting of three cycles in total, which would be admissible to the beneficiary. The concerned Ministry / Department shall obtain an undertaking from the applicant that he / she has not claimed the reimbursement earlier from the Government of India in the past and will not claim it in the future.
These guidelines come into force from the date of issue of the Office Memorandum and reimbursement cases of IVF treatment undertaken after the issue of the Office Memorandum only can be considered by the Ministries / Departments.
4. This issues with the concurrence of Integrated Finance Division in the Ministry of Health & Family Welfare, vide Dy. No.C.1747/IFD (Health)/2011 dated the 21st November,October, 2011
Deputy Secretary to the Government of India