Assisted Reproductive Therapy Benefit

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What is the Assisted Reproductive Therapy Benefit?

Assisted reproductive therapy includes medical treatment and procedures to assist with infertility. Depending on your chosen treatment, and if you meet the benefit and clinical criteria, you will have access to a comprehensive basket of care, which may include cover for the following:

  • In vitro fertilisation (IVF)
  • Frozen embryo transfer (FET)
  • Intrauterine insemination (IUI)
  • Embryo and sperm storage

What we cover

Please refer to the Assisted Reproductive Therapy benefit guide for more details.

Once you have activated the benefit, the Assisted Reproductive Therapy Benefit offers comprehensive cover for a defined basket of care of up to two cycles of assisted reproductive therapy. For each cycle, this basket of care includes:

Assisted reproductive therapy (ART) consultations and medicine

A defined list of pathology

Oocyte (egg) retrieval

Embryo transfer and freezing

Ultrasound scans

Admission costs, including the laboratory fees

Embryo and sperm storage relating to the approved assisted reproductive therapy procedures.

Members registered on the Oncology Programme who meet the Scheme's benefit entry criteria, have access to cryopreservation and egg and sperm storage of up to five years. Egg cryopreservation is covered for female members up until the age of 42.

Cover is up to 75% of the agreed Discovery Health Rate up to a limit of R115 000 per year. You will have to pay a co-payment of 25% of the costs for assisted reproductive therapy and any other costs not covered by the benefit.

We pay up to two cycles of assisted reproductive therapy (ART), including egg donated cycles, if you are 25 to 39 years old and one cycle from the age of 40 up to and including 42 years of age, per year. If you are 43 years of age up to and including 50 years of age, we will cover one egg donated IVF cycle per year, including the egg donor matching fee.

Although Assisted Reproductive Therapy is not part of the Prescribed Minimum Benefits (PMB), infertility is classified as a PMB condition by the Council for Medical Schemes (CMS). This means that all schemes must provide funding for the diagnosis, treatment and care of infertility, subject to a defined basket of care, regardless of a member's chosen plan type. You can read more about PMB cover in the Assisted Reproductive Therapy benefit guide.

This cover is automatically activated when the Assisted Reproductive Therapy Benefit is activated successfully. Semen analysis for male partners also qualifies for cover under the Prescribed Minimum Benefits. You can contact us to activate this portion of the benefit. Please send an email with the membership details for the female who will be undergoing treatment, as well as the male partner (if they are on a different policy), to PMB_APP_FORMS@discovery.co.za. We will communicate the outcome of this application by email, within 2 to 3 working days thereafter.

How to get the benefit

If you meet the benefit and clinical entry criteria, you can activate the Assisted Reproductive Therapy (ART) Benefit below. If you still meet the benefit and clinical entry criteria the following years, you do not need to activate the benefit again.

ACTIVATE ASSISTED REPRODUCTIVE THERAPY BENEFIT
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