Discovery Health to Cover Fertility Treatments in 2021

Great leap forward for medical aid cover for fertility treatments

As long ago as 2011, the Infertility Awareness Association of South Africa (IFAASA) began lobbying the medical industry with a submission to the Council for Medical Schemes (CMS), placing on record that the majority of medical aids in South Africa are not affording infertility the cover that it is due.

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. For resources and more information about the Infertility Awareness Association of South Africa, visit www.ifaasa.co.za.

Two years later, IFAASA representatives attended the Discovery Health AGM, with over 240 signed proxies, to present the case of infertility as a Prescribed Minimum Benefit (PMB) and submit a motion.

“Fertility is mistakenly viewed as a non-essential medical condition and as a result, treatments have not been funded by medical schemes in the past,” explains Dr Nicholas Clark, a reproductive medicine specialist at Medfem Fertility Clinic in Bryanston, Sandton, Gauteng. “This attitude is misguided and ultimately is backed by false economics. Support of therapy would come with regulation and influence over the treatments, and funding would encourage the main flow of patients with medical insurance to reputable fertility centres, biasing the medical outcomes in favour of less risky single pregnancies which would benefit not only the maternal outcome but also the health funders.”

It is therefore a great leap forward, after so many years of pressure, that Discovery Health Medical Scheme will be providing cover for fertility treatments during 2021 and onward.

Another reason why it is great news that Discovery has come on board, is that Discovery is the country’s largest medical scheme and its decision to provide cover for fertility treatments will certainly create a precedent in the market for other medical schemes in South Africa to follow suit.

According to their website, Discovery Health Medical Scheme (DHMS) is the largest open medical scheme in South Africa, with an open market share of 56.7% (according to the Council for Medical Schemes Quarterly Report for the period ended 30 June 2019) and covering 2,808,106 beneficiaries at 31 December 2019.

Discovery Health Medical Scheme Discovery’s T&Cs in a nutshell

There are, of course, a number of terms and conditions applicable to the cover provided for fertility treatments by Discovery Health Medical Scheme and these are listed below.

* The cover from Discovery Health Medical Services is only available to members of the Executive or Comprehensive Plans
* The cover only applies to those who have been members of these plans for more than two years
* The cover only applies to members who meet the scheme’s benefit and clinic entry criteria
* The cover is for two cycles of Assisted Reproductive Therapy (ART)
* The cover includes a basket of care covering consultations, ultrasounds, oocyte retrieval, embryo transfers, admission costs including laboratory fees, medication, and embryo and sperm storage
* Discovery pays up to a limit of R110,000.00 per person per year at the Discovery Health Rate (DHR)
* A co-payment of 25% will apply – you will need to pay in 25% of the amount covered by Discovery
* Cover is only provided for ART treatments received at a SASREG registered clinic

These terms and conditions make it critical that you choose the right fertility clinic to receive fertility treatment.

Contact your medical aid for confirmation

Whether you are already a member of Discovery Health Medical Scheme, or if you are a member of another medical scheme, the only way to be certain whether you qualify for cover for fertility treatments is to ask your medical aid to confirm in writing which costs related to the treatments required will be covered.

The cost of fertility treatments, such as in vitro fertilisation (IVF), are usually 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 some may pay for treatment of issues related to infertility, such as surgical procedures for blocked fallopian tubes, cyst removal in the womb and treatments for endometriosis. There are also certain medical aids that do cover fertility treatments on selected plans, subject to cover limits.

“If your medical aid does not yet cover ART yet, don’t despair!” says Dr Rodrigues. “Medfem, IFAASA and SASREG will continue to pressure medical schemes to provide fair cover for fertility treatment – we believe everyone has the right to IVF treatment.”

Make sure you choose a SASREG accredited clinic

The cover provided by Discovery is only available for treatment received at a fertility clinic that is accredited by the Southern African Society for Reproductive Medicine and Gynaecological Endoscopy (SASREG).

SASREG is the South African society of fertility specialists that serves to protect the interests of the patients undergoing fertility treatment.

SASREG also represents gynaecologists with a special interest in Gynaecological Endoscopy, sub-specialists, embryologists and scientists working in the field of reproductive medicine. The Society also supports fertility and theatre nursing sisters, allied practitioners as well as psychologists and social workers working in the field of Gynaecological Endoscopy and reproductive medicine.

SASREG not only sets minimum standard for ART such as In Vitro Fertilization, Gamete Intra Fallopian Tube Transfer and related Procedures, it also conducts inspection at the accredited clinics to ensure that the laboratories are up to standard and quality controls and processes are in place to ensure your fertility journey is both scientific and rewarding for you as a patient.

You can visit their website sasreg.co.za to check if a fertility clinic is registered.

Make sure you choose the right fertility clinic

Given that even Discovery’s cover is only for two cycles of Assisted Reproductive Therapy (ART) and limited to R110,000.00 per person per year, with a co-payment of 25% – you want to make sure you are not only choosing an accredited clinic, but also the right fertility clinic.

The right clinic is staffed by qualified and experienced specialists; and offers advanced facilities; technologies on par with the latest medical advancements and a range of fertility treatments to achieve great success rates. Choosing the right clinic will give you the best chance of becoming pregnant.

Your next step is simply to contact us at Medfem and book an initial consultation. Simply click here or contact us telephonically on +27 (11) 463 224 now.

Booking your initial consultation today means that you will be able to undergo a comprehensive assessment of your fertility status during the last few weeks in 2020 and start your IVF treatment program in the new year.

We look forward to meeting you at Medfem Fertility Clinic!