Is artificial insemination covered by Health Insurance?

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Medically assisted procreation (MAP), which includes artificial insemination or in vitro fertilization (IVF), is fully supported by Social Security. However, each technique has these limits and conditions of compensation.

Artificial insemination occurs in the context of medically assisted procreation (PMA). It helps couples with fertility disorders to give birth. The sperm of the spouse (IAC) or a donor (IAD) is injected directly into the uterus of the woman to facilitate the meeting between the sperm and the egg.

Artificial insemination can be proposed by a practitioner as soon as one of the two spouses encounters problems in the act of conception. The causes can be multiple: abnormalities in the cervix or cervical mucus in women, insufficient amount of sperm or ejaculation problems in humans.

Who can use artificial insemination?

Only couples meeting specific criteria, set by the Public Health Code, may have access to artificial insemination:

– The woman must be under 43 years old
– Obligation to be married or cohabiting for at least two years
– To be of childbearing age
– Complete a certificate of consent to artificial insemination

Is artificial insemination covered by Health Insurance?

Artificial insemination is entirely covered by Health Insurance, but in a limited way. Only 6 attempts (10 to 15% success) are supported by Social Security. It should be noted, however, that each successful pregnancy puts the "attempt counter" back to zero.

The assumption covers the expenses for:

-Stimulation drugs
– Luteal phase maintenance drugs
– The blood tests
– Ultrasound
– The technical act of insemination (preparation and insertion of sperm …)

What to do to be supported?

Before embarking on the process, it is imperative that the treating physician, or other licensed physician, complete what is called a care protocol. A document in several parts indicating the various specialists potentially available for insemination and treatment. The protocol must then be sent to the primary health insurance fund (CPAM).

Once the application has been administratively processed, the Health Insurance sends the couple a 100% charge certificate valid for 2 years. Be careful not to misplace it, no copy is provided, and many institutions may require proof (hospitals, pharmacies …) Furthermore, all prescriptions filled by the doctor to provide products and treatments must include the mention the reference "Relative prescription with exonerating affection" in order to benefit from the total care.

Any attempt at insemination must then be declared to the Health Insurance and a validation in return. Is generally considered as validation the absence of response of the CPAM.

It should be noted that some non-reimbursed drugs will still not be reimbursed with care. Also pay attention to fees and overruns in some clinics. Not reimbursed too. It will be advisable to turn to the case or to the complementary mutual to check the proposed coverage in parallel with that of Social Security.