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Does any insurance cover infertility?

By Jessica Anne Wood

Infertility is a challenge that many couples face, with approximately one in every six struggling with infertility issues. But do any medical aids cover infertility treatments?

According to the Infertility Awareness Association of South Africa (IFAASA) website, “infertility is not a well-covered disease by medical aids in South Africa. IFAASA intends to help more people expand their family by increasing access to fertility treatments. To achieve this IFAASA is in the process of advocating for acceptable cover from medical aids but until this is realised it is important to know your rights and what you can claim for.”

Dr Nozipho Sangweni, the principal officer of Discovery Health Medical Scheme (DHMS), notes that the scheme does cover some infertility services. She explained that DHMS will cover “those medical and surgical services, as prescribed by the Medical Schemes Act of 1998, as amended, as part of Prescribed Minimum Benefit (PMB) entitlements for diagnosis and treatment of infertility.”

In other words, if there is a medical reason as to the infertility issue, this will be treated as a medical condition/procedure by the medical scheme. Furthermore, Sangweni highlighted that DHMS members are able to access infertility investigations and treatment from their available medical savings account, as well as from the above threshold benefit (ATB) where applicable.

However, not all aspects of infertility treatment are covered by medical aids. “In Vitro Fertilisation (IVF) is not covered by the scheme from the ATB, but is covered from the Medical Savings Account (MSA) for members with a positive MSA balance,” pointed out Sangweni.

She added: “DHMS continues to work with representatives of the South African Society of Reproductive Surgery and Science (SASREG), the IFAASA as well as various healthcare professionals to define a sustainable funding solution to IVF treatment.”

Sangweni stressed that a medical aid scheme has a responsibility to balance the various healthcare needs of its members with ensuring that premiums remain affordable in the long term. “Unfortunately, like all other medical schemes, it cannot afford to meet all demands at all times.”

For more information on infertility treatments see:

Other medical aids were contacted for comment, but could not respond in time for publication.

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