Funding The Costs of Fertility Treatment

Fertility treatment can be a very challenging journey to parenthood for many couples who are struggling to conceive, facing traumatic emotional challenges, the physical aspects of fertility testing and treatment, and the mental strain that affects every aspect of life – work, family and friends. These couples often also face the challenge of privately funding their fertility treatments, particularly since most fertility treatments are generally excluded by medical aids.

Fortunately, there are ways to overcome the financial challenges of fertility treatments, such as the PMBs covered under all medical schemes, the fertility benefits launched and upgraded by Discovery Medical Scheme, and medical finance specifically designed for fertility treatment.

Funding under PMBs

According to the Council for Medical Schemes Prescribed Minimum Benefits (PMBs) are a set of defined benefits that ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected.

Infertility is indeed one of the 270 Prescribed Minimum Benefit Diseases (PMBs) listed in the Medical Schemes Act, No. 131 of 1998.

This means that all medical schemes regulated by the Council for Medical Schemes must pay for prescribed minimum benefits.

Recently speaking at the Fertility Show Africa 2022, Dr Noluthando Nematswerani, Head of the Centre for Clinical Excellence within the Strategic Risk Management Division at Discovery Health shared how to claim the costs of certain fertility procedures from medical schemes under the PMBs.

Dr Nematswerani explained that there is a specific code for infertility PMBs: 902M. This benefit is titled “Infertility” and the treatments covered includes certain medical and surgical procedures, briefly listed below.

What is included under PMBs?

* Hysterosalpingography (HSG) – imaging of uterus and Fallopian tubes
* Specific blood tests for hormone levels
* Thyroid function testing
* Tests for HIV as well as other infections
* Treatment of a local infections
* Laparoscopy and hysteroscopy
* Surgery of the uterus and Fallopian tubes
* Ovulation defects and deficiencies
* Tests for male infertility
* Counselling and advice on sexual behaviour, including temperature charts and more

All of the investigations, procedures and treatments listed above are available to all members of all local medical schemes, regardless of the plan type they fall under.

Unfortunately, these are only the most basic benefits and most medical aids exclude any other fertility treatments from their cover. This is not the case in other countries, where fertility treatments are commonly covered by medical schemes – making South Africa a notable exception.

“The reality is that the treatment of infertility is often excluded as the only prescribed minimum benefit disease on the exclusion list of most medical aids. Although open medical aids will pay for diagnosis, once you have been diagnosed with infertility, the treatment of the disease will not be covered,” explains Saskia Williams, founding member and CEO of IFAASA.

Medical scheme cover

Discovery Medical Scheme – South Africa’s biggest medical scheme – took the lead in the beginning of 2021 by offering cover for fertility treatments beyond PMBs for some of its clients, and still subject to rigorous terms and conditions.

Discovery Health’s move to offer limited cover for fertility treatments to certain clients is a significant step in the right direction, the result of many years of extensive consultations with industry stakeholders such as the Southern African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG) and the Infertility Awareness Association of South Africa (IFAASA), both of which are strongly supported by Cape Fertility.

“Cape Fertility is proud to be a SASREG-accredited fertility clinic. Making quality fertility treatment affordable is one of our team’s most cherished values and we have diligently participated in creating awareness and pressure on the medical aid industry to provide cover for fertility treatments, as a member of SASREG and working closely with other organisations, such as IFAASA,” explains Dr Sulaiman Heylen, one of Cape Fertility’s specialists and President of SASREG, which serves to protect the interests of patients undergoing fertility treatment and represents specialists in the field of Gynaecological Endoscopy and reproductive medicine.

Speaking at the Fertility Show Africa 2022, Dr Nematswerani shared details of the benefit that Discovery launched in 2021, as well as enhancements added in 2022.

The original fertility treatment benefit has been available to members since January 2021 on the scheme’s two top medical plans, the Discovery Comprehensive and Discovery Executive plans. It is available to women between the ages of 25 and 42 years, providing cover for two cycles of Assisted Reproductive Therapy (ART) including In-Vitro Fertilisation (IVF), Intra-Uterine Insemination (IUI), Embryo Transfer (FET) and Intra-Cytoplasmic Sperm Injection (ICSI).

The benefit is quite comprehensive, covering consultations with clinicians; ultrasounds; egg retrieval; embryo freezing and transfers; admission costs; lab fees; and medication.

There have been a number of enhancements in 2022, including embryo storage, egg-donated cycles and cryopreservation. The inclusion of egg-donated cycles now also provides cover for women up to the age of 50 when undergoing IVF with egg donation.

Eligible members who are also registered on oncology benefit, will qualify for cryopreservation of fertility, which involves retrieving and safely storing eggs or sperm before chemotherapy or radiation therapy is received, to preserve the patients fertility, providing the possibility of starting a family later, using the preserved eggs or sperm and the relevant ARTs.

A general limit of R115,000 per year applies on Discovery’s benefit, and medical scheme members are responsible for a 25% co-payment on the approved costs. All treatments must be done at a SASREG Centre of Excellence, such as Cape Fertility.

As Dr Nematswerani explains, the value of choosing a SASREG Centre of Excellence includes assurance that strict medical and safety guidelines are adhered to, and fertility treatment costs are in accordance with the Discovery Health rate. This both ensures fair fees and a seamless claims process.

Medical finance

Another option for fertility patients who do not have any or sufficient medical cover for the treatments they require is medical finance designed specifically for fertility patients. At Fertility Show Africa 2022, visitors could find out more about one local medical finance provider, Medifin, which offers loans of up to R100,000 for IVF, sperm and egg donations, normal delivery and Caesarean sections, and more.

How to fund your fertility treatments

If you require fertility treatment or if you want to know more about the costs, cover and finance available for fertility treatment, we would like to invite you to contact us by clicking here…

At Cape Fertility, we value each individual patient, and we look forward to providing you with affordable quality fertility treatment, our signature individualised and personalised care, and higher success rates at our purpose-built premises in the beautiful city of Cape Town, along with advice and guidance for the best funding options for your particular fertility treatment requirements.