Fertility care needs financial planning: What to do for insurance, funding

Couples contemplating surrogacy must know about their legal obligations

Lekhni Ishman, 45, an Instagram influencer who lives in Mumbai, and her husband have been trying for a child for 12 years. After several failed vitro fertilisation (IVF) cycles, the couple still wants to try a couple of more times. "A failed IVF does not only hurt emotionally but also financially too. We wish we knew what we were getting into financially before taking the plunge. If we don't succeed, surrogacy is our other option," says Ishman, whose name was changed in this story for privacy.

Couples considering IVF or surrogacy must consider these aspects.

Cost

"In India, the average cost of IVF treatment is around Rs 1.5 lakh to Rs 2.5 lakh for a package," says Madhumathi Ramakrishnan, executive vice-president at Star Health and Allied Insurance Co. Ltd. IVF success depends on factors such as a woman's age, her health, and the quality of treatment. Conceiving a child may take more than one attempt.

Most banks do not lend specifically for reproductive treatment but couples can take personal loans. "Some NBFCs may offer personalised fertility treatment loans, including IVF loans that cater to very specific needs of the treatment. Some of these may be offered as unsecured personal loans while others might require collateral," says Adhil Shetty, chief executive officer (CEO) of Bankbazaar. The loan amount, interest rates and repayment tenure will vary. 

The Surrogacy Regulation Act of 2021 laid down dos and don’ts for couples. "First and foremost, surrogacy has to be altruistic and not commercial, which means the surrogate cannot charge for carrying the child of the intended parents. The medical expenses and insurance coverages of the surrogate and the child are both responsibilities of the intended parents," says Ekta Rai, an advocate at the Delhi High Court.

Responsibility for a child and that for the surrogate mother for the period she takes care of the child is with the prospective parents, Rai says.

"To incorporate surrogacy into one's financial plan, it's essential to first calculate the total expenses involved, with a comprehensive breakdown," says Jay Thacker, a member of Association of Registered Investment Advisors (ARIA).

The lead time for prospective parents to arrange surrogacy ranges between six months to three years. The surrogacy process can take between 1.5 to 2.5 years. "Thus, the corpus should be primarily built using low-risk fixed-income instruments with no mandatory lock-in periods. Options like bank term/recurring deposits, low-duration and short-duration debt mutual funds, and high-interest savings accounts can be tailored to the lead time available and the expected financial outflows during surrogacy," Thacker says.

"Funds can be diverted from lower-priority goals such as vacations or second homes. Contributions to long-term objectives like retirement may be temporarily reduced, and discretionary expenses can be optimised to redirect income towards surrogacy planning."

"Use liquid funds, to park emergency funds or for very short-term goals, liquid funds are a suitable choice. They provide liquidity and competitive returns," says retired Col. Sanjeev Govila, CEO of Hum Fauji Initiatives, a financial planning firm.  A financial advisor will help you create a diversified portfolio for your specific short and medium-term goals.

Insurance

Expenses, which will include medical care for the surrogate mother, should be insured to reduce financial burden and for a safety net. According to the law, a couple opting for surrogacy has to purchase a health insurance policy with a tenure of 36 months. "The coverage of the policy must be adequate to cover the complications that may arise due to pregnancy and should cover postpartum delivery complications as well. The couple should also buy insurance for the oocyte donor for at least 12 months," says Naval Goel, CEO and founder of PolicyX.com.

"It's advisable to conduct a thorough comparison of health insurance plans to understand the availability and scope of these insurance offerings that provide the most comprehensive coverage for infertility treatments and related aspects," says Siddharth Singhal, business head for health insurance at PolicyBazaar.com.

Star Health Insurance recently introduced surrogacy coverage and oocyte donor coverage. "The surrogacy cover begins from the date when the treatment or procedure is initiated. In the event of a miscarriage due to an accident," says Ramakrishnan.

Buy a policy that has coverage for the oocyte donor and caters to inpatient hospitalisation expenses linked to complications arising from assisted reproductive treatment for 12-month duration. Manipal Cigna Health Insurance and Care Health Insurance have similar policies; the average premium ranges Rs 18,000-Rs 30,000. Most insurance companies do not cover the cost of IVF.

Earlier this year, Aegon Life started a policy that provides three years of life cover for surrogate mothers and one year for egg donors. 

Prospective parents must consider legal obligations of surrogacy. "The laws are intended to protect children, and hence, a child of surrogacy cannot be treated any differently than the children born by any other means," says Rai. 

Agarwal says, "This law allows Indian heterosexual couples who have been married for at least five years and Indian single women (who are not married but are medically and socially fit) to avail surrogacy services."

Know the law

Traditional surrogacy, where the surrogate gives her eggs, is not permitted in India

Indian law only permits gestational surrogacy when the intended parents' eggs and sperm are used

The surrogate cannot charge the intended parents for carrying their child, so surrogacy has to be altruistic and not commercial

Intended parents are responsible for the medical expenses and insurance coverage of the surrogate and child

It is necessary for the couple to produce a certificate indicating their infertility issued by a medical board, along with proof that they do not already have a child

Should the child be born with any defects, the intended couple cannot disown it

Parents are entirely responsible for the health of the child as well as the surrogate mother during the period when she is obligated to care for the child and is healing from childbirth