All you need to know: New Assisted Reproductive Therapy (ART) benefit

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 that 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. This is done in collaboration and close consultation with the Southern African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG)," explains Dr Ryan Noach, CEO of Discovery Health.

• Find out more.

What causes infertility?

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

• 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," adds Dr Noach. "Some of these treatments include lifestyle changes, medicine, surgery or assisted reproductive therapy. With medical advances in the field of infertility management, the majority of fertility cases can now be treatable with assisted reproductive technologies."

What are Assisted Reproductive Therapies?

Assisted Reproductive Technologies include medical treatment and procedures carried out in the process of infertility management:

1. In vitro fertilisation (IVF): The process of combining an egg and sperm outside of a woman's body. Once the egg is fertilised, the embryo is put into the woman's uterus with the aim that this process will result in a pregnancy.
2. Intra-uterine insemination (IUI): The process of injecting sperm directly into a woman's cervix or uterus.
3. 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.
4. 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 new Discovery Health Medical Scheme 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:

1. Assisted reproductive therapy consultations and medicine
2. Oocyte (egg) retrieval
3. Embryo transfer
4. Ultrasound scans
5. Admission costs, including the laboratory fees
6. Embryo and sperm storage

Who is eligible for this benefit?

Female DHMS members aged 25 to 42 who are on the Executive and Comprehensive Plans will have access to the benefit. They will 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?

We pay up to 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 the cost 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 Prescribed Minimum Benefits (PMBs), where applicable. You can use the Benefit and limit tracker to track your benefit usage to-date. Go to 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 our network of SASREG accredited facilities and is subject to clinical criteria, protocols and treatment guidelines.

• Access our network provider list.

How many cycles of ART do I have cover for?

If you are aged from 25 to 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 you are on an Executive or Comprehensive plan.