Discovery Medical Aid – Covers the cost of IVF in South Africa
For couples struggling with infertility, it is always great news to find out that there are many advanced medical treatments, such as IVF, available right here in South Africa, that can help almost all couples to conceive. These treatments are sadly not funded by most local medical schemes.
For this reason, fertility patients and fertility specialists around the country welcomed the news when Discovery Medical Aid – the largest in South Africa – made cover available for fertility treatments on some of their medical aid packages – bringing the hope of having a baby closer for some couples and setting the bar for other medical aid companies to aim for.
In this article, we find out how advanced treatments such as IVF can restore a couple’s hope of having a baby, how Discovery’s medical cover for fertility treatment can help you if you are a member of this scheme, and what other options there are.
There are many safe and effective treatment options that can improve a couple’s chances of getting pregnant. Some of these treatments include lifestyle changes, medicine, surgery or assisted reproductive therapy. With medical advances in the field of infertility management, the majority of fertility cases can now be treatable with assisted reproductive technologies.
What is a great challenge to many couples, is the cost associated with these advanced treatments.
Medical aid cover brings hope
Recently, Discovery published an article sharing the story of baby Jaxon and his parents, Randi and Adele Kunz-Steyn.
The couple were married in 2017 and started their journey to parenthood in 2018 with three rounds of intrauterine insemination (IUI) using donated sperm. IUI is a type of artificial insemination where sperm are placed directly into the uterus around the time the ovary releases eggs.
Carried out for three months in a row, the three rounds of IUI were unsuccessful. “Going through any form of assisted reproductive therapy is both financially and emotionally taxing, especially when you’re undergoing the same treatment month after month, hoping and praying for a baby each time,” Randi says in the article. “We’d used up all our savings.”
The couple waited a year before undergoing an in vitro fertilisation (IVF) treatment cycle. During this treatment, eggs are collected from the ovaries and combined with sperm to be fertilised in the lab. One or more fertilised eggs, called embryos, are then transferred to the uterus. Here, they may implant in the uterine lining and develop into a successful pregnancy.
“Owing to our financial situation, we went for a lower-cost option where fewer medicines are used to stimulate egg production. This means fewer eggs are extracted in the process,” explains Randi.
Even after saving for a year and selecting a lower-cost option, they could afford only one cycle of IVF, at around R26,000. The couple did not fall pregnant. “So, we called it a day,” says Randi. “It had all cost us so much, on so many levels. We started to look at adoption.”
A year later, at end of 2020, things changed when Discovery Health Medical Scheme announced the launch of their Assisted Reproductive Therapy (ART) Benefit, available from January 2021. The couple waited to upgrade their plan type at the end of 2021, so they could access this benefit.
Overjoyed to discover that their fertility doctor was on the medical scheme’s network of doctors for the benefit, the couple decided to do one more cycle of IVF. This time, ten eggs were extracted and fertilised, and two of the five resulting embryos were transferred into Randi’s uterus.”
It was successful! “We couldn’t believe it! Especially after so many failed attempts at falling pregnant!” says the couple. “We struggled for three years to have a baby and, honestly, we’d given up. We also couldn’t afford to go on. Accessing IVF with Discovery Health Medical Scheme’s help meant we paid 25% of the costs and the medical scheme funded the rest. Discovery Health Medical Scheme’s Assisted Reproductive Therapy Benefit changed our lives. Jaxon was born healthy and well. He is so lovely; a very easy-going baby.”
What Assisted Reproductive Therapies are covered?
The benefit is only available to female DHMS members aged 25 to 42 on Discovery’s Comprehensive and Executive plans. It provides cover for a defined basket of care for up to two cycles of assisted reproductive therapy. For each cycle, this basket of care includes: assisted reproductive therapy consultations and medicine; egg retrieval; embryo transfer; ultrasound scans; admission costs, including the laboratory fees; and embryo and sperm storage. This benefit is available through Discovery’s network of SASREG accredited facilities and is subject to clinical criteria, protocols and treatment guidelines.
Discovery pays up to up to 75% of the Discovery Health Rate for treatment up to a limit of R110 000 per person per year. Any additional treatment will be funded from available day-to-day benefits or Prescribed Minimum Benefits (PMBs), where applicable.
What are the other options for covering the cost of IVF?
The cost of fertility treatments, such as in vitro fertilisation (IVF), are unfortunately not covered by most open medical aids in South Africa. They also do not cover the cost of the initial appointment.
However, some medical aids may cover part of the costs and others may pay for treatment of certain issues related to infertility.
Dr Ryan Noach, CEO of Discovery Health, explains that the diagnosis of infertility and a defined list of linked investigations, and medical and surgical treatments, are classified under the Prescribed Minimum Benefit (PMB) conditions, which means that all medical schemes are obliged to fund infertility in line with the stipulated regulations. PMB cover, however, does not make provision for Assisted Reproductive Technologies (ART) such as in vitro fertilisation (IVF) and embryo transfer (ET).
The only way to be certain what your medical aid scheme will cover is to ask the company to confirm in writing which costs related to the treatments required will be covered.
For many couples, the only other alternative is to fund their fertility treatments within the private sector by obtaining a loan. This may be, for example, a personal loan, or finance available for fertility treatment through companies such as MediFin, which works with registered doctors, dentists, plastic surgeons and fertility specialists registered with the Health Professions Council of South Africa and also offers finance specifically for pregnancy and fertility.
Your next step
The next step on your fertility journey is a consultation with a fertility specialist who will be able to determine what type of fertility treatment you require. This will allow you to make decisions regarding how to cover this cost. Your fertility specialist will also be able to provide guidance in this regard.
At Medfem Fertility Clinic, we have assisted couples struggling with infertility to experience the joy of parenthood for decades, helping to bring more than 18,000 babies into the world!
Our team of committed, understanding medical professionals have the experience, knowledge and desire to provide you with the best chance of a successful outcome at the end of your treatment.
Simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.
We look forward to meeting you!