South Africans desperate to conceive are demanding that the country's largest medical aid scheme cover infertility treatment.
In an open letter to Discovery Health Medical Scheme, the Infertility Awareness Association of South Africa (Ifaasa) accused it of discriminating against an entire disease.
"One in six couples are forced to suffer in silence because their private medical scheme which they pay dearly for on a monthly basis does not offer any treatment cover for one of the most common diseases in this age group [15 to 44 years old]," Ifaasa wrote.
It said Discovery did not cover in vitro fertilisation (IVF) and intra uterine insemination (IUI) for a recognised disease which is also a prescribed minimum benefit (PMB) disease.
"Infertility is a life-shattering diagnosis for many couples and these couples currently only receive assistance from Discovery Health in the form of diagnosis (PMB-related claims). In addition, it is an insult to many couples across our population including members of the Discovery Health Medical Scheme to be the only PMB disease category listed as a blanket exclusion on the exclusion list for Discovery Health."
Ifaasa said Discovery covered the diagnostic assessments as per the Medical Schemes Act for infertility, but did not offer any cover for the actual treatment outside of a member's savings account.
Southern African Society for Reproductive Medicine (Sasreg) president Dr Paul le Roux said about 6000 IVF treatments, costing an average of R40000, were done in SA each year.
"It is unfair to exclude fertility treatment from a patient's medical cover. There is no ethical justification for this, and the funder's claim that there is only a "limited pool of money" does not really explain why this disease should be excluded compared with other medical conditions," Le Roux said.
He said the global trend was for medical insurers to pay a portion towards a patient's fertility treatment or pay for a limited number of IVF treatments per year.
Discovery Health principal officer Milton Streak said the medical scheme was aware of the challenges facing families confronting infertility, and had engaged repeatedly with Sasreg and Ifaasa.
"The scheme has a responsibility to balance the various healthcare needs of its members with ensuring that premiums remain affordable in the long term, and unfortunately, like all other medical schemes, it simply cannot afford to meet all demands at all times."
He said its cover was in line with the Medical Schemes Act and the Council for Medical Schemes' requirements, however, Discovery would support a review of these benefits by the council.
'Infertility is a disease' - Calls for medical aid to pay costs
South Africans desperate to conceive are demanding that the country's largest medical aid scheme cover infertility treatment.
In an open letter to Discovery Health Medical Scheme, the Infertility Awareness Association of South Africa (Ifaasa) accused it of discriminating against an entire disease.
"One in six couples are forced to suffer in silence because their private medical scheme which they pay dearly for on a monthly basis does not offer any treatment cover for one of the most common diseases in this age group [15 to 44 years old]," Ifaasa wrote.
It said Discovery did not cover in vitro fertilisation (IVF) and intra uterine insemination (IUI) for a recognised disease which is also a prescribed minimum benefit (PMB) disease.
"Infertility is a life-shattering diagnosis for many couples and these couples currently only receive assistance from Discovery Health in the form of diagnosis (PMB-related claims). In addition, it is an insult to many couples across our population including members of the Discovery Health Medical Scheme to be the only PMB disease category listed as a blanket exclusion on the exclusion list for Discovery Health."
Ifaasa said Discovery covered the diagnostic assessments as per the Medical Schemes Act for infertility, but did not offer any cover for the actual treatment outside of a member's savings account.
Southern African Society for Reproductive Medicine (Sasreg) president Dr Paul le Roux said about 6000 IVF treatments, costing an average of R40000, were done in SA each year.
"It is unfair to exclude fertility treatment from a patient's medical cover. There is no ethical justification for this, and the funder's claim that there is only a "limited pool of money" does not really explain why this disease should be excluded compared with other medical conditions," Le Roux said.
He said the global trend was for medical insurers to pay a portion towards a patient's fertility treatment or pay for a limited number of IVF treatments per year.
Discovery Health principal officer Milton Streak said the medical scheme was aware of the challenges facing families confronting infertility, and had engaged repeatedly with Sasreg and Ifaasa.
"The scheme has a responsibility to balance the various healthcare needs of its members with ensuring that premiums remain affordable in the long term, and unfortunately, like all other medical schemes, it simply cannot afford to meet all demands at all times."
He said its cover was in line with the Medical Schemes Act and the Council for Medical Schemes' requirements, however, Discovery would support a review of these benefits by the council.
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