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Assisted reproduction techniques

For MUFACE members, assisted reproduction is regulated in Chapter 2, point C of the 2018 and 2019 Healthcare Agreement

The Resolution of 28 December, 2017, of the General Mutual Society for Civil Servants, through which is published the agreement signed with insurance companies for ensuring access to national healthcare for its beneficiaries during 2018 and 2019, and which regulates the change of healthcare provider, regulates assisted reproduction techniques in Chapter 2.C

With respect to this regulation, we will see:

Infertility diagnosis and treatment

Assisted reproduction techniques are aimed at helping achieve pregnancy for those people who cannot do so in a natural way, who are not susceptible to exclusively pharmacological processing, or after their failure. These procedures may also be employed to avoid serious genetic illnesses or disorders in the offspring and when an embryo is required with the identical immunological characteristics to those of a sibling who is affected by a serious pathology, who is not susceptible to another therapeutic resource, according to the current regulations at all times

General considerations

The considerations that must be taken into account relating to assisted reproduction are:

  1. The organisation is obliged to assume the expenses necessary to obtain a diagnosis of infertility, which will be extended, when applicable, to the partner.
  2. At the start of the infertility study, the beneficiary must be over 18 years old and less than 40 years old, and not be suffering any type of pathology due to which the pregnancy could involve a serious and uncontrollable risk, either for the health of the woman or that of their possible offspring. In the case of couples, the man must be over 18 years old and under 55 years old.
  3. Assisted reproduction techniques will be the responsibility of the organisation when the woman who is to receive the treatment is a policy holder or beneficiary of MUFACE and who has no other prior, healthy children. For couples, with no common, prior, healthy child.
  4. All the techniques listed in the National Health System common services list are included, according to Act 14/2006, of 26 May, on Assisted Human Reproduction techniques, and Order SSI/2065/2014, of 31 October, modifying Annexes I, II and III of Royal Decree 1030/2006, of 15 September, through which is established the National Health System's common services list and the procedure for updating it, with the conditions and requirements established therein.
  5. Not included among the funded services are those assisted reproduction techniques performed when the sterility of a member of the couple was produced voluntarily or has occurred as a consequence of the natural physiological process at the end of the person's reproductive cycle, or there is a documented medical contraindication.
  6. In assisted reproduction treatments, the tests that must be performed in the scope of said treatment to the other member of the couple will be facilitated by the organisation the woman on whom the Assisted Human Reproduction technique will be performed is a member of. Funding of drug therapies associated with the Assisted Human Reproduction technique to which the other member of the couple is to be subjected is excluded.
  7. In the case of assisted human reproduction techniques involving gamete and pre-embryo donation, the costs deriving from the activities and, where applicable, medications required by the donors, will be borne by the organisation as part of the cost of the technique used. In no case can these be passed on to the beneficiary who receives the donation.
  8. The organisation will be responsible for covering the cryopreservation and maintenance of gametes and ovarian tissue for the individual use by beneficiaries who are to undergo medical and/or surgical treatments that may significantly affect their fertility. In the case of the woman, the period of cover will extend until the day prior to her 50th birthday, and in the case of the man until the day prior to his 55th birthday.
  9. The organisation will be responsible for the cryopreservation and maintenance of surplus pre-embryos of authorised IVF cycles until the day before the woman's 50th birthday.
  10. The organisation will address the cover for assisted human reproduction techniques in women where there is a diagnosis of infertility due to gynaecological pathology that prevents a pregnancy, regardless of the existence or not of a partner.

Limits when it comes to the number of cycles and the age of the woman

In any case assisted human reproduction techniques will be subject to limits with regard to the number of cycles and age of the patient, based on principles of efficiency and safety to ensure the greatest possible effectiveness with the lowest possible risk.

The limits for the maximum number of treatment cycles and the age of the beneficiary for each technique are the following:

 

Artificial insemination

In vitro fertilisation

Limits

Partner's semen

Donor semen

Own gametes

Donated gametes

Maximum no. of cycles

4

6

3

3

Maximum age of the woman

<38

<40

<40

<40

 

In cases where cryopreserved ovarian tissue and oocytes are used, the age limit will be that established for the IVF technique with gamete/pre-embryo donation. The ages are calculated up to the day prior to the woman's 38th or 40th birthday, as appropriate. To correctly interpret and apply the limits the following criteria will be taken into account:

  1. The prescribing of the Assisted Human Reproduction treatment must have occurred prior to the day on which the woman reaches the age that has been established as the limit for funding eligibility for each of the techniques.
  2. For computational purposes, the number of cycles is independent for each technique, although the total number of cycles carried out will be taken into account, regardless of the funding body. For this reason, in the event that a couple avails themselves of the cover in this agreement, after having previously undergone an assisted human reproduction treatment, the number of cycles that had been carried out up to that moment will be taken into account and the corresponding cover will be assigned up until the maximum number of cycles established has been completed.
  3. To consider that a patient has carried out an IVF cycle, she must have reached, at least, the oocyte recovery phase.
  4. When there are surplus frozen pre-embryos, from authorised IVF cycles, their transfer forms part of the same IVF cycle in which they were obtained, the transfer of pre-embryos being financed until the day prior to the woman's 50th birthday, regardless of the existence of prior, healthy children.
  5. A new cycle of IVF will not be authorised when there are surplus cryopreserved pre-embryos from previous cycles.
  6. In any case, it is guaranteed that the initiated cycle that was covered by applying the criteria and limits in force when it was initiated will be finalised.
  7. If after carrying out an assisted human reproduction technique a pregnancy is achieved and the patient aborts the pregnancy, a new cycle can be repeated with the technique which resulted in the pregnancy, once the maximum number of established cycles has been completed and as long as the age limit for funding eligibility for each of the techniques has not been exceeded.

Members must understand the following general contents relating to the insurance for civil servants:

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