Young women who choose to delay having children until they have established their careers may need assistance to fall pregnant once they’re ready. Knowing what help is available and what costs can be covered is important.
Effective contraceptive methods have given modern women greater choice about planning to start their families later, once they’ve reached certain financial or career goals. But fertility experts warn that age does play a role in women over the age of 35 possibly struggling to fall pregnant. Infertility is defined as being unable to fall pregnant after one year of stopping birth control measures. Fertility treatment can be very expensive, so what are the ways to get costs covered?
Related article: 6 contraceptive pros and cons
WHAT ARE THE OPTIONS?
In South Africa, some state hospitals in major centres do offer fertility treatment, but generally couples consult private fertility clinics, which can be very costly, depending on what procedures are needed. Treatment can be home-based hormonal stimulation, which is not so expensive, but artificial insemination (inserting the sperm directly into the uterus) or in vitro fertilisation (IVF – where the egg and sperm are mixed in a laboratory and if an embryo grows it is inserted into the uterus) are costly.
INFERTILITY DIAGNOSIS IS A PMB
If you belong to a medical aid scheme, for a start, the diagnosis should be covered. In South Africa, infertility diagnosis is classified as a PMB (Prescribed Minimum Benefit) condition. This means that all medical aid schemes have to cover the costs of certain tests from the scheme funds – and not your medical savings. This applies to both men and women, but some schemes will state that they don’t cover sperm analysis, for example, so it’s important to check what is covered and insist that your scheme covers it. Even if you have a hospital plan only, the scheme has to cover PMB conditions, even out-of-hospital tests and counselling. The Infertility Awareness Association of South Africa (IFAASA) has a full list of tests and procedures that must be covered, on their website.
Related article: 6 contraceptive pros and cons
WHAT ARE THE OPTIONS?
In South Africa, some state hospitals in major centres do offer fertility treatment, but generally couples consult private fertility clinics, which can be very costly, depending on what procedures are needed. Treatment can be home-based hormonal stimulation, which is not so expensive, but artificial insemination (inserting the sperm directly into the uterus) or in vitro fertilisation (IVF – where the egg and sperm are mixed in a laboratory and if an embryo grows it is inserted into the uterus) are costly.
INFERTILITY DIAGNOSIS IS A PMB
If you belong to a medical aid scheme, for a start, the diagnosis should be covered. In South Africa, infertility diagnosis is classified as a PMB (Prescribed Minimum Benefit) condition. This means that all medical aid schemes have to cover the costs of certain tests from the scheme funds – and not your medical savings. This applies to both men and women, but some schemes will state that they don’t cover sperm analysis, for example, so it’s important to check what is covered and insist that your scheme covers it. Even if you have a hospital plan only, the scheme has to cover PMB conditions, even out-of-hospital tests and counselling. The Infertility Awareness Association of South Africa (IFAASA) has a full list of tests and procedures that must be covered, on their website.
ASSISTED REPRODUCTIVE THERAPY BENEFITS
Unfortunately, once the diagnosis has been confirmed, the treatment of infertility is excluded by most medical aid schemes. IFAASA has been campaigning for medical aids to cover infertility treatment. In 2021, Discovery Health introduced the Assisted Reproductive Therapy Benefit, but only for members of their Executive and Comprehensive plans. There are various criteria that have to be met, and treatment varies according to age, so after a certain age only one cycle of treatment may be covered, for example. These plans cover some of the costs of:
• IVF
• Frozen embryo transfer (FET)
• Intrauterine insemination (IUI)
• Embryo and sperm storage.
Related article: Trying to grow your family? Everything you should know
FERTILITY INSURANCE
Fertility insurance is not something we often hear about in South Africa. While other countries have a range of fertility insurance options to choose from, and some employers even offer it as part of their employment package, to our knowledge there’s only one SA insurer who mentions it. Old Mutual offers Severe Illness Cover, a policy that pays out a lump sum to assist with related costs if you have cancer, a heart attack or stroke. Fertility insurance can be added to this health insurance policy as an extra called ‘For Women Benefit’, which pays out 50% of cover for fertility-related conditions. It also covers complications during pregnancy.
HELPFUL FERTILITY ADVICE
For a wealth of helpful information and advice, on everything from infertility statistics (one in every six couples of reproductive age has a fertility problem) to delicious recipes for eating healthily to boost fertility, visit the IFAASA website: https://ifaasa.co.za.
Related article: Methods and benefits of family planning
Sources
https://capefertility.co.za/medical-schemes-that-cover-fertility-treatment/
https://ifaasa.co.za/2013/10/30/med-aids-infertility-pmb/
https://www.oldmutual.co.za/v3/assets/blt0554f48052bb4620/blt4d8c21f0a4f8cb2e/5f0c08bff157173843d8768b/KPF_Severe_Illness_Cover_RSA.pdf
https://www.discovery.co.za/wcm/discoverycoza/assets/medical-aid/benefit-information/2022/assisted-reproductive-therapy-benefit.pdf
Unfortunately, once the diagnosis has been confirmed, the treatment of infertility is excluded by most medical aid schemes. IFAASA has been campaigning for medical aids to cover infertility treatment. In 2021, Discovery Health introduced the Assisted Reproductive Therapy Benefit, but only for members of their Executive and Comprehensive plans. There are various criteria that have to be met, and treatment varies according to age, so after a certain age only one cycle of treatment may be covered, for example. These plans cover some of the costs of:
• IVF
• Frozen embryo transfer (FET)
• Intrauterine insemination (IUI)
• Embryo and sperm storage.
Related article: Trying to grow your family? Everything you should know
FERTILITY INSURANCE
Fertility insurance is not something we often hear about in South Africa. While other countries have a range of fertility insurance options to choose from, and some employers even offer it as part of their employment package, to our knowledge there’s only one SA insurer who mentions it. Old Mutual offers Severe Illness Cover, a policy that pays out a lump sum to assist with related costs if you have cancer, a heart attack or stroke. Fertility insurance can be added to this health insurance policy as an extra called ‘For Women Benefit’, which pays out 50% of cover for fertility-related conditions. It also covers complications during pregnancy.
HELPFUL FERTILITY ADVICE
For a wealth of helpful information and advice, on everything from infertility statistics (one in every six couples of reproductive age has a fertility problem) to delicious recipes for eating healthily to boost fertility, visit the IFAASA website: https://ifaasa.co.za.
Related article: Methods and benefits of family planning
Sources
https://capefertility.co.za/medical-schemes-that-cover-fertility-treatment/
https://ifaasa.co.za/2013/10/30/med-aids-infertility-pmb/
https://www.oldmutual.co.za/v3/assets/blt0554f48052bb4620/blt4d8c21f0a4f8cb2e/5f0c08bff157173843d8768b/KPF_Severe_Illness_Cover_RSA.pdf
https://www.discovery.co.za/wcm/discoverycoza/assets/medical-aid/benefit-information/2022/assisted-reproductive-therapy-benefit.pdf
FERTILITY INSURANCE – WHAT IS IT, AND WHY CONSIDER IT?
Reviewed by Edgars Mag
on
May 06, 2022
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Reviewed by Edgars Mag
on
May 06, 2022
Rating:
