IVF Costs Covered by Discovery
Fertility patients and fertility specialists around the country welcomed the news when Discovery Health Medical Scheme – the largest in South Africa – made cover available for specialised fertility treatments such as IVF.
In this article, we look at what the Discovery cover for IVF entails and what enhancements have been made to the cover since it was launched in 2021, find out why choosing the right IVF clinic is so important and discover how Medfem continues to work with other industry players to ensure more South Africans can enjoy cover for this proven treatment that has helped thousands of couples to have the families they dream of.
With incredible medical advances in the field of infertility management, the majority of infertility cases are now treatable with assisted reproductive technologies (ART) – a range of medical procedures and infertility treatments to assist with conception.
Perhaps one of the best-known ART treatments available today is IVF or in vitro fertilisation. Others include, for example, frozen embryo transfer (FET), intracytoplasmic sperm injection (ICSI) and intrauterine insemination (IUI).
Sadly, IVF, along with the other ART treatments, are not funded by most local medical schemes. Fortunately, things changed when Discovery Health Medical Scheme announced the launch of their ART benefit in 2021.
Discovery Health’s move to offer limited cover for fertility treatments such as IVF 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 actively supported by Medfem Fertility Clinic.
For more than 30 years, in vitro fertilisation or IVF treatment has helped millions of couples around the world to become parents.
IVF treatment was originally developed for women with damaged or missing Fallopian tubes and has been the standard treatment for infertility since 1983. Since then, millions of babies have been born worldwide as a result of IVF treatment. In fact, IVF treatment success rates are now comparable – and even superior – to those of nature.
However, IVF treatment is not a single event, but rather a series of procedures that are completed over five stages to complete a treatment cycle.
IVF treatments commence with a course of hormone therapy to stimulate the development of several follicles in the ovary. Under ultrasound guidance, these are then punctured with a specialised needle to retrieve eggs, which are then fertilised in a petri dish (‘in vitro’ which literally means ‘in glass’) to create several embryos. After three to five days in an incubator, one or two of these embryos are transferred through the vagina to the uterus, where implantation occurs and pregnancy begins. The whole process from commencement of ovarian stimulation up to the embryo transfer stage usually takes just under three weeks.
As a result, this advanced treatment is expensive, and it may also be necessary to have more than one IVF cycle.
How is IVF covered by Discovery?
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 the accompanying consultations with clinicians; ultrasounds; egg retrieval; embryo freezing and transfers; admission costs; lab fees; and medication.
The latest enhancements to Discovery’s IVF cover
Recently speaking at the Fertility Show Africa (FSA) 2022, Dr Noluthando Nematswerani, Head of the Centre for Clinical Excellence within the Strategic Risk Management Division at Discovery Health shared a number of enhancements made to the cover in 2022.
These include egg-donated cycles, embryo storage, and cryopreservation.
The inclusion of egg-donated cycles now also provides cover for one cycle for women up to the age of 50 when undergoing IVF with egg donation.
IVF treatments often result in more embryos than are required. Spare good quality embryos that are suitable can be cryopreserved. Following IVF treatment, many couples choose to freeze and store their spare embryos for use at a later stage.
Eligible Discovery members who are also registered on oncology benefit, will now 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.
Discovery’s Rules for IVF cover
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 are covered only at approved medical facilities.
Where to get Discovery-covered IVF treatment
One of the strict terms and conditions of Discovery’s IVF cover is that the treatment must be received at a Discovery designated service provider (DSP) and SASREG Centre of Excellence, such as Medfem Fertility Clinic.
Discovery Designated Service Provider (DSP) – A healthcare provider (for example doctor, specialist, allied healthcare professional, pharmacist or hospital) who has an agreement with Discovery to provide treatment or services at a contracted rate. Visit www.discovery.co.za or click on Find a healthcare provider on the Discovery app to view the full list of designated service providers (DSPs).
As Dr Nematswerani explained during her talk at FSA 2022, the value of choosing a SASREG Centre of Excellence includes assurance that strict medical and safety guidelines are adhered to, and working with a Discovery designated service provider will ensure the fertility treatment costs are in accordance with the Discovery Health Rate.
This facilitates both fair fees and a seamless claims process.
Not only is Medfem an approved healthcare facility for receiving IVF treatment covered by Discovery’s ART Benefit, we are also proud to be a leading force for chance in the industry.
We are committed supporters of the Infertility Awareness Association of South Africa (IFAASA), and its efforts in lobbying the medical industry to provide cover for ARTs, which dates as far back as 2011. IFAASA is a non-profit organisation established to represent the infertility community as advocates and through education and research, and to educate the general public about reproductive challenges. It is also lobbying for fair support and change and equal access to public and private sector medical treatment for the one in six couples that statistics show suffer from some form of infertility.
We are proud that one of Medfem Fertility Clinic’s Directors and Reproductive Medicine Specialists, Dr Antonio Rodrigues (MBBCh, FCOG, MBA), is a Non-Executive Board Member of IFAASA.
“We believe everyone has the right to IVF treatment,” says Dr Rodrigues. “If your medical aid does not cover IVF yet, don’t despair: Medfem, IFAASA and SASREG will continue to pressure medical schemes to provide fair cover for fertility treatment.”
In the meantime, we have many years of experience working with Discovery Health Medical Scheme and we help our patients to claim all the costs possible from their medical schemes.
Our team at Medfem Fertility Clinic also believes in making world-class fertility treatments available for everyone. It is our joy and commitment to give you a positive outcome to your fertility journey, so you will have a fond memory of feeling empathy, caring and being part of the Medfem Fertility Clinic family.
If you would like to meet one of our fertility specialists at Medfem Fertility Clinic, simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.
Our Fertility Specialists can also meet with You During a Virtual Consultation Via Zoom or Skype. Click here to book a virtual consultation now.
We look forward to meeting you!