In Vitro Fertilisation (IVF)

The TAC Medical Excess may apply to these services 

 

 

Policy

The TAC will consider funding the reasonable cost of IVF treatment for a TAC client and their partner, where the client has sustained an injury in a transport accident that has resulted in their compromised fertility.

Transport Accident Act 1986 reference: s.3 'medical service' and s.60

Background

It is recognised by the TAC, that as a consequence of an injury sustained by a female or male client in a transport accident, that their fertility may be compromised. As such, the TAC will consider funding the reasonable cost of IVF treatment where there is supporting medical documentation which reconciles the need for treatment to the clients transport accident injuries.

The TAC further recognise that while IVF treatment may be approved in order to address the client's compromised fertility status, that it is a service in totality, for the client and their partner.

The TAC is liable to fund the total combined cost of treatment where there is an identifiable accident related need.

Definitions

In Vitro Fertilisation (IVF) - Eggs are collected and inseminated (put together with sperm outside the body). These embryos will either be transferred 'fresh', two days later, or 'frozen' for later use. (Royal Women's Hospital, Explanation Notes to Patients 1996).

Intra-Cytoplasmic Sperm Injection (ICSI) – This is a more focussed technique used for male factor infertility. A single sperm is injected into each egg using microscopic techniques. (Royal Women's Hospital, Explanation Notes to Patients 1996).

Guidelines

What will the TAC consider funding?

The TAC will consider funding the reasonable cost of IVF treatment for a male or female client, who has sustained an injury in a transport accident that has resulted in their compromised fertility.

IVF treatment may be funded with or without the use of the ICSI technique, as deemed appropriate by the provider as a mechanism for enhancing the client's fertility status.

What documentation does the TAC require in order to consider funding IVF treatment?

In order to consider funding IVF related treatment, the TAC requires supporting documentation from a specialist in fertility medicine. The documentation should specify:

  • the relationship between the client's compromised fertility and their accident injuries
  • the likely permanence of the client's compromised fertility status
  • the anticipated outcome of IVF intervention
  • any relevant information relating to the client's or their partners fertility status.

Will the TAC fund the reasonable cost of Intra-Cytoplasmic Sperm Injection?

The TAC will consider funding the reasonable cost of Intra-Cytoplasmic Sperm Inject when used as a technique within an IVF intervention.

Will the TAC fund the reasonable cost of counselling as part of the IVF intervention?

The TAC will consider funding fertility counselling only as an inclusive component of the IVF intervention for a client and/ or their partner.

All other requests for counselling for a TAC client will be considered in line with the relevant TAC policies.

Are there limits placed on the number of IVF interventions funded by the TAC?

The TAC will fund the reasonable number of IVF treatments for a TAC client and their partners in line with community standards. In determining the reasonable number of IVF treatments, it is expected that a client and their partner will be governed by the recommendations of the practitioners involved in facilitating their IVF intervention.

Will the TAC fund the reasonable cost of obtaining donor eggs or sperm for a client who is undergoing IVF intervention?

The TAC will consider funding the reasonable costs associated with obtaining donor eggs or sperm, in circumstances where a client, because of their accident injury, is unable to produce viable eggs or sperm.

Will the TAC fund the reasonable cost of semen storage?

The TAC will fund the reasonable cost of semen storage services required for a client who has sustained a complete spinal chord injury, which has resulted in compromised fertility as a result of their transport accident injuries.

Does the TAC have a liability to fund any associated costs for the birth of a baby conceived with the use of IVF techniques?

The TAC has a liability to fund only those costs that are associated with a client's accident injuries. Therefore, costs that are associated with the pregnancy and/ or the birth of a baby conceived with the use of IVF techniques, not directly related to a client's accident injuries, are not deemed to be a liability of the TAC.

Can the TAC fund IVF services administered by a member of a client's immediate family?

Refer to the Funding Treatment by a Member of a Client's Immediate Family policy.

What IVF Services will the TAC not fund?

The TAC will not fund:

  • services for a person other than the injured client
  • treatment or services where there is no objective evidence that a treatment or service is safe and effective
  • treatment that is experimental or not consistent with intervention offered to the general community
  • counselling for a client's partner which is not inclusive of the IVF program
  • membership of support/ self help groups for clients or their partners
  • IVF intervention for a condition that existed before a transport accident or that is not a direct result of a transport accident
  • IVF intervention to address the fertility needs of the client's partner not the result of accident injury
  • treatment/practices that are not consistent with the guidelines of the IVF facility that the client and their partner are attending
  • treatment or services that are inconsistent with relevant State or Commonwealth Legislation
  • treatment or services received by the injured person outside the Commonwealth of Australia
  • treatment or services provided more than 2 years prior to the request for funding except where the request for payment is made within 3 years of the transport accident. Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.