Covering the Costs of Fertility Treatment

For many couples struggling with fertility problems, there is a further challenge to contend with: covering the costs of the fertility treatment they require to build their family. This is because some fertility treatments are advanced medical procedures that can be expensive and, in addition, many fertility treatments are not covered by most medical aids.

However, there are some options available to help the parents-to-be cover to the costs of fertility treatments, which our team at Cape Fertility is glad to share in this article.

It is often a great relief to couples facing fertility challenges to find out that many of these fertility challenges can be treated very successfully through a range of safe, trusted and effective medical treatments, ranging from medication to surgery and including highly advanced procedures such as in vitro fertilisation, commonly referred to as IVF, and Intracytoplasmic Sperm Injection, better known as ICSI.

Some fertility problems can be addressed with affordable medication, while others can be treated with simple, cost-effective and non-invasive procedures such as in uterine insemination, or IUI for short. However, other fertility treatments can be quite expensive, such as a cycle of IVF, which extends over several weeks and requires a number of different procedures to be completed. Many couples also need to repeat a treatment cycle or may need to try a different treatment.

As a result, some couples face an additional challenge when it comes to building their families: covering the costs of the fertility treatments required, especially when many fertility treatments are not covered by medical aids in South Africa.

However, there are some fertility treatments that fall under the Prescribed Minimum Benefits (PMB) that must be covered by all medical aids in South Africa, as well as certain medical aid plans that offer further cover for selected fertility treatments. In addition, medical loans are also available for those who do not have medical aid, or whose medical cover for fertility treatments do not extend beyond the Prescribed Minimum Benefits.

Fertility treatments covered by all medical aids

By law in South Africa, all medical aids have to offer cover for Prescribed Minimum Benefits or PMBs to every member.

This is often the starting point for couples requiring fertility treatment and who do have medical aid cover.

In terms of fertility treatments, a number of tests, procedures and treatments are covered by all medical aids in South Africa under the Prescribed Minimum Benefits.

These include a range of blood tests, namely Chlamydia, D21 progesterone, Day 3 FSH/LH, HIV, Oestradiol, prolactin, rubella, Thyroid function and VDRL, as well as semen analysis. It also includes procedures such as hysterosalpingogram (an X-ray procedure used to view the inside of the uterus and fallopian tubes), hysteroscopy and laparoscopy, and uterus and tubal surgery.

The treatment of local infections, ovulation defects and deficiencies as well as counselling and advice on sexual behaviour, temperature charts etc, also falls within the scope of the Prescribed Minimum Benefits.

Where the fertility treatments required by a couple are not included in the PMB list, couples will need to investigate other alternatives, such as specific benefit packages offered by certain medical aids, or private medical finance.

Extended cover offered by select medical schemes

Cover for fertility treatments beyond those under the Prescribed Minimum Benefits is not widely offered by medical aids.

Fortunately, South Africa’s largest medical scheme, Discovery Health offers an Assisted Reproductive Therapy (ART) Benefit on its top tier cover options. This was the result of discussions with the Southern African Society for Reproductive Medicine and Gynaecological Endoscopy (SASREG) and the Infertility Awareness Association of South Africa (IFAASA) in 2020.

The benefit is available to female members of Discovery’s Executive and Comprehensive plan, who are between the ages of 25 and 42, and up to age 50 for patients undergoing egg donated cycles.

It covers a comprehensive basket of care which includes:

* consultations with the clinicians,
* ultrasounds,
* a defined list of pathology,
* egg retrieval,
* embryo transfer and freezing,
* admission costs and lab fees,
* medicine
* embryo and sperm storage relating to approved assisted reproductive therapy procedures.

The Discovery Benefit specifically covers up to two IVF cycles of for members aged 25 to 42, and one IVF cycle for those members who are between the ages of 43 and 50. Other ART procedures such as intra uterine insemination (IUI) are also covered, as well as certain medications.

The cover extends to 75% of the agreed Discovery Health rate, which means members have a 25% co-payment. The cover limit for 2023 is R122,000, and that means that any other benefits or treatments required that are not included in the package, or exceeds R122,000 limit, must be paid by the members out of their own pockets.

To ensure that all Discovery members receive the same level of care, professionalism, costs and outcomes, this benefit is only available in the network of Southern African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG) accredited facilities, which is subject to world class clinical criteria, protocols and treatment guidelines that meet global standards.

For those couples facing fertility challenges without a medical aid that covers all the fertility treatments they may require, another funding option is medical finance or medical loans.

Medical loans

Fin Medical Loans, previously known as Medifin, was among the sponsors of the Fertility Show Africa 2023. It is South Africa’s preferred medical financial services provider that enables South Africans to obtain medical procedures that are not covered by their medical aid provider.

Fin Medical Loans can provide fertility finance of up to R80,000 which includes any fertility or pregnancy related procedure or treatment such as IVF, ICSI, egg freezing, caesarean sections and more.

Their hassle-free service means you can apply online and get instant preapproval, and they pay out in 24 hours. Fin Medical Loans also offer flexible repayment options, and require no deposit.

Let Cape Fertility assist!

Covering the costs of fertility treatments is an important consideration, and it is essential to balance this with your dream of starting or expanding your family. By being proactive, seeking support, and understanding your options, you can make informed decisions that increase your chances of success and also align with your financial goals.

By consulting with a reputable fertility clinic like Cape Fertility, you can gain a clearer understanding of what treatments you need and the specific costs associated with these treatment, enabling you to make informed decisions regarding your fertility care.

Understanding the costs associated with different fertility treatments can help you plan and budget for your fertility journey more effectively. Open communication with your fertility specialist is key to understanding the specific costs involved and exploring any available options to manage the costs better.

Our team at Cape Fertility can provide you with detailed information about potential additional expenses and help you navigate the financial aspect of your treatment effectively, ensuring transparency and informed decision-making throughout the process.

Embarking on a fertility journey is a significant decision, and Cape Fertility is dedicated to providing comprehensive care, including transparent cost information. By partnering with a reputable fertility clinic and being proactive in managing the financial aspect, you can move forward with confidence, knowing that you are taking important steps towards fulfilling your dream of parenthood.

You can simply contact us by clicking here

At Cape Fertility, we value each individual patient and we look forward to providing you with individualised and personalised care, affordable quality fertility treatment, and higher success rates at our purpose-built premises in the beautiful city of Cape Town, in South Africa.