All you need to know: New Assisted Reproductive Therapy benefit

Discovery Health Medical Scheme has launched the new Assisted Reproductive Therapy benefit, which is available on the Comprehensive and Executive plans, to support couples struggling to conceive.

The diagnosis of infertility and a defined list of linked investigations and medical and surgical treatments are classified under prescribed minimum benefit (PMB) conditions. This means all medical schemes are obliged to fund infertility in line with the stipulated regulations.

PMB cover, however, does not make provision for assisted reproductive technologies (ART) such as in vitro fertilisation (IVF) and embryo transfer (ET). “Now, Discovery Health Medical Scheme offers richer benefits and cover for assisted reproductive therapies, in collaboration and consultation with the SA Society of Reproductive Medicine and Gynaecological Endoscopy (Sasreg),” says Dr Ryan Noach, Discovery Health CEO.

What causes infertility?

Infertility may result from a medical problem in either partner or from a combination of factors.

• Female infertility factors may involve problems with ovulation, the reproductive organs, or hormones.
• Male infertility factors may involve abnormal sperm production or function, problems with sexual function or environmental factors such as alcohol, cigarette smoking or medication.

What are some of the treatment options for infertility?

“Fortunately, there are many safe and effective treatment options that can improve your chances of getting pregnant,” says Noach. “Some of these treatments include lifestyle changes, medicine, surgery or assisted reproductive therapy. With medical advances in infertility management, most fertility cases are treatable with assisted reproductive technologies.”

What are assisted reproductive therapies?

Assisted reproductive technologies include medical treatment and procedures carried out in infertility management:

• In vitro fertilisation (IVF): The process of combining an egg and sperm outside a woman’s body. Once the egg is fertilised, the embryo is put into the woman’s uterus to result in a pregnancy.
• Intra-uterine insemination (IUI): The process of injecting sperm directly into a woman’s cervix or uterus.
• Frozen embryo transfer (FET): A process where a frozen embryo from a previous IVF cycle is thawed and transferred back into a woman’s uterus. This means you won’t have to undergo another cycle of hormone stimulation and egg collection.
• Intra-cytoplasmic sperm injection (ICSI): A process where an individual sperm cell is introduced into an egg cell

More detail: the new DHMS Assisted Reproductive Therapy benefit

The Discovery Health Medical Scheme (DHMS) Assisted Reproductive Therapy benefit provides cover for a defined basket of care for up to two cycles of assisted reproductive therapy. For each cycle, this basket of care includes:

• assisted reproductive therapy consultations and medicine;
• oocyte (egg) retrieval;
• embryo transfer;
• ultrasound scans;
• admission costs, including the laboratory fees;
• embryo freezing; and
• embryo and sperm storage.

Who is eligible for this benefit?

Female DHMS members aged between 25 and 42 who are on the Executive and Comprehensive plans have access to the benefit. They receive cover for up to two cycles of ART if they meet scheme benefit and clinical entry criteria.

* The Assisted Reproductive Therapy benefit is available on the Executive and Comprehensive plans only.

How much funding do I have access to? Are there any co-payments?

Discovery pays up to 75% of the Discovery Health rate for your treatment, up to a limit of R110,000 per person per year. You will need to pay 25% of your treatment and any other costs not covered by the benefit.

• Any additional treatment needed before, during or after the therapy, or once the benefit limit has been reached, will be funded from your available day-to-day benefits or PMB, where applicable. You can use the benefit and limit tracker to track your benefit usage to date.
  Visit www.discovery.co.za under Medical Aid > Benefits and cover > Benefit and limit tracker to view the usage of your limits to date.

Do I have to see a specific healthcare provider to access the benefit?

This benefit is available in Discovery’s network of Sasreg-accredited facilities and is subject to clinical criteria, protocols and treatment guidelines.

Access Discovery’s network provider list >>>

How many cycles of ART do I have cover for?

If you are aged between 25 and 39, you have access to two cycles of assisted reproductive therapy. If you are aged 40 to 42, you have access to one cycle of assisted reproductive therapy.

How do I activate this benefit?

You can activate the Assisted Reproductive Therapy benefit if you are a female member, aged 25 to 42, and on an Executive or Comprehensive plan.

Activate the Assisted Reproductive Therapy benefit >>> 

The Discovery Health Medical Scheme is an independent nonprofit entity governed by the Medical Schemes Act and regulated by the Council for Medical Schemes. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.

This article was paid for by Discovery Health.