Two-tier system: Private health insurer fills gap in B.C.'s infertility treatment care

Company offers fertility coverage Some infertility treatments, such as IVF, aren't covered by B.C.'s public health-care plan. One private company is stepping in to fill the gap – at a premium.

Infertility is a medical condition that impacts one in six couples, but British Columbia remains one of the only provinces in Canada that does not pay for treatment.

Now, a private company is moving in to try and fill that gap, offering new coverage at a premium.

Pacific Blue Cross has expanded its Personal Health Insurance Health and Dental plan.

It will now include family planning benefits, incorporating fertility drugs, fertility treatments and adoption.

It’s the first personal health insurance plan in Canada to do so.

“We've heard really clearly from our members and from our partners at the BC Women's Health Foundation, what the needs of women are when it comes to their health needs, but also their fertility needs. That journey is something that's really important to a lot of women and families here in B.C.,” said Sarah Hoffman, President and CEO of Pacific Blue Cross.

Experts say it’s a welcome option, but many who need the help will still not be able to afford it.

“It is kind of sliding to a little bit more into an American-style, two-tier health-care system,” said Laura Spencer, a Vancouver based fertility coach.

Spencer spent years struggling to navigate the private system when she was trying to get pregnant.

She decided to make a career out of helping others find resources.

“I do think we've just been left behind and there is this opportunity here for us to make up for that,” said Spencer.

She’s encouraged there will now be more private options for financial aid, but says extended health is still financially out of reach for many of her clients.

“If you were to apply as an individual it would start at about $50 a month, or a couple about $80 a month and for a family about $100 a month for the base-level coverage. And anyone can apply,” said Hoffman.

Milder treatments like intrauterine insemination typically cost $1,000 a cycle, but in vitro fertilization can cost up to $20,000 a cycle.

“The coverage limits are $5,000 for drugs per family per year, and $5,000 per fertility treatment and adoption per family per year. And there's a 12-month waiting period for both of those benefits to kick in,” said Hoffman.

The NDP has been fiercely against the privatization of health care in B.C., but has been slow to address the issue when it comes to infertility.

“We're just one of three provinces who don't provide any provincial funding towards infertility treatment like IVF. And it's really not that costly when we look at the entire health budget,” said Spencer.

Manitoba offers an annual tax credit up to $8,000, and it costs that province $2.5 million a year to fund.

Ontario funds one IVF cycle per lifetime. That program’s price tag is $50 million.

It’s the same in Quebec, which also pays for medications.

“It’s something that’s obviously concerning to lots of people. So we're looking at it as we continue to improve health-care services in B.C.,” said Adrian Dix, B.C’s Minister of Health.

But with every day the province spends considering a change in policy, a couple could be losing out on their dream to start a family.

“There are people who are suffering, who are not getting the treatment that they deserve,” said Spencer.

The news that a private option will be filling the gap does not appear to have added any urgency on the government’s part, to find a solution.

“With respect to what an insurer might do outside of the public health-care system, (it) doesn't really affect your decision in and of itself one way or another,” Dix told CTV News.

The Ministry of Health added in a statement that B.C.'s Medical Services Plan "covers many costs related to infertility assessments and investigations," as well as artificial insemination.

In 2020-21, MSP covered 3,600 procedures, which the ministry says helped hundreds of families conceive children.

"We will continue to cover many costs related to infertility assessments, investigations, and artificial insemination, while monitoring developments in IVF," the ministry's statement reads.

"Our focus continues to be ensuring that British Columbians have access to effective, medically necessary procedures while keeping health-care costs sustainable."

Spencer says if the issue is important to the NDP government, it needs to act now.

“Time is of the essence when it comes to fertility. Every day that you're not getting this treatment is one day that your fertility is diminishing,” said Spencer.

The Public Health Agency of Canada says the number of couples battling infertility issues has doubled since the 1980s.