Discovery Health Medical Scheme will from next year cover the costs of infertility treatment for members on their elite schemes. This means they will now pay for interventions such as in-vitro fertilisation.
While this has been welcomed by some stakeholders in the industry, they believe it is not enough for the millions of people battling with infertility.
It is estimated that globally, one in six couples struggle with infertility. This means they are unable to conceive within the first year or more of trying for a baby. Infertility has been ranked as the 5th highest serious global disability in the world.
However, in South Africa, medical aid schemes do not cover treatment for infertility. Discovery Health Medical Scheme will soon include it in their cover, but only for selected members.
“What we are introducing in 2021 is a benefit for assisted reproductive therapies which is in-vitro fertilisation, the inter-uterine insemination. These are more expensive interventions that are over and above the basic benefit that is offered from the prescribed minimum benefit point of view. Currently, medical schemes cover basic costs for investigations relating to infertility, treatment to the tubes, ovaries and uterus, partly because that’s what they are expected to by the law. The cost of infertility treatment is also another major factor with each cycle costing anything between R60 000 and R100 000,” says Head of Clinical Policy at Discovery Health Doctor Noluthando Nematswerani.
Nematswerani says the new offering is reserved for members on their top plans, the comprehensive and executive plans.
She says it will only apply to those who have been on these plans for a minimum of two years and are between the ages of 25 and 42.
“It’s always a challenge because we are looking at various benefits. It’s not just infertility that we are looking at. It’s always competing for requirements from the same pot of money. The oncology patients will come wanting their high-cost drugs to be funded for. The diabetes patients will come asking us to pay for specific technologies that are high cost. So, it’s really about ensuring that as we do all that we ensure the sustainability of the scheme as well.”
Concerns over those who do not afford treatment
Doctor Jack Biko, Vice President of the South African Fertility Society, says this is a positive move, but will do little for people who cannot afford the expensive treatment.
“The issue we have here is that this only applies to the high plans. Now, the high plans are generally the people who can afford to pay for themselves in any case. So, we would have preferred that everybody on all the medical aids should be covered for infertility treatment because infertility is a disease and it is unfair to discriminate people simply because they’ve got infertility because already people with infertility are discriminated by society, by family and by everybody else. So, we are adding more burden to this burdensome disease.”
The Infertility Awareness Association of South Africa (IFAASA) has been negotiating with medical aid schemes for over a decade to compel them to cover infertility treatment.
“We were pushing the fact that they are discriminating against one disease on a list of 270 diseases. Now, we hope that the other medical aids follow suit because if they don’t they stand to lose members of child-bearing age and a lot of people who are going through infertility are your top professionals. A lot of the public have started fighting with us about the fact that the cover doesn’t help them because they are not on the top two covers at discovery,” says founder and CEO Saskia Williams.
Members will be expected to use accredited health centres with proven track records. In addition to quality service and outcomes, the health centres must have prior agreement with the schemes on the rates they will pay.
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