• Confirm the patient is receiving an eligible Assisted Reproductive Technology (ART) treatment, which for the purpose of this program is defined as:
  • clinical treatments; counselling services; and laboratory procedures for the assessment and preparation of human oocytes, sperm or embryos and includes in vitro fertilisation; gamete intrafallopian transfer; intracytoplasmic sperm injection; embryo or gamete cryopreservation; surgical sperm recovery; oocyte, semen or embryo donation; embryo biopsy or non-invasive sampling for preimplantation genetic testing; gestational and traditional surrogacy and intrauterine insemination and also includes the storage of gametes and embryos for use in ART, the obtaining of a gamete from a gamete provider for use in ART or for research in connection with ART and treatments determined by an ART Provider to be performed for the purposes of an ART treatment.
• Confirm that the patient has incurred an eligible out-of-pocket expense associated with ART treatment as defined above
• Confirm that the patient is receiving treatment from an eligible ART Provider, that is:
• registered as an ART provider under the Assisted Reproductive Technology Act 2007 (NSW), and
• accredited to provide the ART treatment by the Reproductive Technology Accreditation Committee (“RTAC”) of the Fertility Society of Australia, in accordance with the RTAC Code of Practice.
• Confirm that the patient has undergone an ART treatment with an ART Provider on or after 1 October 2022
• Confirm that the patient is not claiming the Fertility Treatment Rebate for any of the following ineligible costs:
  • any component of cost for treatment that has already been reimbursed by another government program or rebate, such as Medicare
  • costs for treatments that are for the sole purpose of fertility preservation
  • costs for treatments incurred from the publicly supported lower cost IVF programs at the following clinics:
    • Fertility Unit at Royal Prince Alfred Hospital
    • Westmead Fertility Centre linked with Westmead Hospital
    • Fertility and Research Centre at the Royal Hospital for Women
• Acknowledge that Service NSW and NSW Ministry of Health will store the information provided on this form to assess and manage the rebate. Service NSW will handle this information in line with their privacy statement linked on the Fertility Treatment Rebate Declaration Form.

Female applicant

The rebate form can only be submitted for the rebate by the female applicant. The form must be accompanied by one receipt for out-of-pocket expenses incurred during fertility treatment.

NSW Health acknowledges people in the transgender community, or who are non-binary, may receive fertility treatment but may not identify as women.

• Confirm the applicant is a resident of NSW
• Confirm the applicant has not previously claimed the rebate and/or has not had the rebate claimed on their behalf
• Inform the applicant that Service NSW and NSW Ministry of Health will store the information provided on this form to assess and manage the rebate. Service NSW will handle this information in line with their privacy statement linked on the Fertility Treatment Rebate Declaration Form.

For further information on eligibility and identification enquiries, please contact Service NSW at 13 77 88.