THE ESSENTIALS
Before you start
- In the contractual example read, the infertility exclusion includes consultations and tests; it is not limited to IVF.
- The clause must be assessed against the procedure’s actual purpose, without concluding that all gynaecology is excluded.
- An express agreement to the contrary, network access and an insurer’s contribution require separate checks.
The exclusion may extend to the initial assessment
In Multicare General Terms 28, D0028 of September 2026, clause 4(18) excludes procedures within the scope of infertility and medically assisted reproduction. Its list includes consultations, diagnostic and therapeutic procedures, tests and treatments, as well as artificial fertilisation, IVF, embryo transfer and their consequences. The opening wording allows an express agreement to the contrary in the policy.
In that document, therefore, not yet having started a technique does not settle whether preparatory expenses are eligible. Clara asks Marta to identify the purpose of the procedures she wants clarified. She does not conclude that every policy excludes infertility or that this clause describes the terms accepted in an individual policy.
Sources: Multicare — General Terms 28 D0028, September 2026: clause 4 opening/paragraph 18, clause 3 and SC005/006, pp. 6–9 and 19–20; read 2 November 2026 ↗ · Multicare — current 1|2|3 page and contractual documents; link to General Terms followed and read 2 November 2026 ↗
The specialty’s name does not establish the procedure’s purpose
The Outpatient condition in the same document lists consultations and diagnostic procedures while retaining the general exclusions. Reading only “consultations and tests” in a commercial table would leave the specific rule unchecked. A diagnostic procedure is not confirmed simply because it precedes treatment or appears under a general benefit heading.
Nor does this justify rejecting every gynaecology consultation or every similarly named test as a group. The question is which need and context the proposed procedure relates to. Marta gathers the provider’s description and asks the insurer for an answer linked to that expense without making a clinical classification herself.
An authorised centre and insurance cover are separate questions
CNPMA describes medically assisted reproduction centres as structures authorised for that activity and distinguishes public and private centres. That authorisation concerns carrying out the activity. The editorial inference is straightforward: attending an authorised centre does not replace checking the insurance policy, just as a clinic appearing in a network does not, by itself, decide payment for the procedure.
Under the Multicare wording consulted, the Network Access arrangement provides agreed prices with the cost borne by the insured person. If that is the answer given for the intended service, it should not be described as an insurer’s contribution. The actual provider, procedure and arrangement must be checked; this guide confirms neither access nor a price at any centre.
Sources: Multicare — General Terms 28 D0028, September 2026: clause 4 opening/paragraph 18, clause 3 and SC005/006, pp. 6–9 and 19–20; read 2 November 2026 ↗ · CNPMA — Medically assisted reproduction centres: definition and authorisation of public/private centres; read 2 November 2026 ↗
Marta compares scope and personal costs before relying on reimbursement
Clara helps Marta separate three answers: what the general document excludes; whether the proposal or policy contains a relevant express agreement; and the expected cost to her for each procedure. The possibility of an agreement to the contrary does not mean an extension is available, has been purchased or will be accepted. The answer should identify the documents considered.
To compare future protection, choose Health under “Request a quote” on the RMACHADO website and explain that you want to clarify the infertility scope without including diagnoses in the initial request. For an existing policy, use Support and claims. Clinical documents should follow only the channel indicated for the case; this article gives no treatment guidance or individual expense confirmation.
KEEP THESE QUESTIONS
Your checklist for the next conversation
- Look for consultations and diagnostic tests in the infertility exclusion, not only the technique’s name.
- Identify the procedures’ purpose using the provider’s documents without classifying them yourself.
- Check any express provision to the contrary and distinguish network access from an insurer’s contribution.
- Request an answer about the actual expenses and use the reserved channel for clinical information.
FROM THE ARTICLE TO YOUR SITUATION
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Sources and transparency
Content updated on .
Consultation dates are stated in individual references when available.
Numerical examples are fictional and explain concepts. Editorial interpretations are identified in the text.
- Multicare — General Terms 28 D0028, September 2026: clause 4 opening/paragraph 18, clause 3 and SC005/006, pp. 6–9 and 19–20; read 2 November 2026 ↗
- Multicare — current 1|2|3 page and contractual documents; link to General Terms followed and read 2 November 2026 ↗
- CNPMA — Medically assisted reproduction centres: definition and authorisation of public/private centres; read 2 November 2026 ↗
Information from RMACHADO GROUP. This is not an insurance offer or individual advice. Covers, acceptance, exclusions, sums insured and costs depend on the policy. The intermediary does not underwrite the risks.