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Is Infertility Treatment Covered By Medical Aids?

Is Infertility Treatment Covered By Medical Aids?

So recently was watching The Bold Type and one of the main characters has the BRCA gene. She is advised to freeze her eggs and to consider an oophorectomy to mitigate her risk of cancer. So she goes to start the process only to discover her insurance (medical aid) does not cover most of what is recommended, which got me thinking what along these lines do South African medical aids cover?

The answer is not much.

While it may be women’s month, apparently we are still not covered for this. Choosing to have a vasectomy covered. Choosing to have an oophorectomy, only in certain situations… Fertility treatments, like IVF not covered. Medical aids, for the most part only cover the treatment of diseases that could be contributing to infertility, such as polycystic ovarian syndrome, hypothyroidism and endometriosis among others.

SA Medical Aids states: “The reality is that no open medical aids in South Africa cover fertility treatments and related procedures. However, a handful of restricted medical aids do pay for fertility treatments up to a certain amount and depending on the plan.”

Some medical aids will cover certain medical conditions associated with infertility, but only “those medical and surgical services, as prescribed by the Medical Schemes Act of 1998, as amended, as part of Prescribed Minimum Benefit (PMB) entitlements for diagnosis and treatment of infertility”.

So why draw the line here?

It seems medical aids “draw the line” so to speak between essential and non-essential procedures and fertility treatments are not covered because of the cost and also because medical aids feel the treatment of infertility is “not necessary” because it will not affect a person’s lifespan or health status.

IFAASA ( Infertility Awareness Association of South Africa) states on their site: “Infertility is not a well-covered disease by medical aids in South Africa. IFAASA intends to help more people expand their family by increasing access to fertility treatments. To achieve this IFAASA is in the process of advocating for acceptable cover from Medical Aids but until this is realised it is important to know your rights and what you can claim for”.

So what are the costs for infertility treatment?

According to a recent Huffington Post article, one consultation can cost around R2,000. Yeah ok.  Wait for it. That’s not the big number. This is. An artificial insemination treatment costs between R4000 and R8000 per cycle, and IVF costs about R40000 to R50000 per cycle, but this is only if you bring your own eggs to bake with so to speak. Add an extra R20000 to R40000 if you use some else’s eggs! And this is only if all goes to plan and there are no unexpected issues or additional procedures required.

Waiting until later to have kids?

Then it’s recommended to freeze the necessary items. Again it’s not cheap and it’s mostly not covered or only partly covered…  Freezing those precious eggs costs around R30000, tack on medication and blood tests, another R20000 and then you have the annual “don’t thaw it yet” cost of say R5000.

But hey don’t worry if you’re a guy it’s cheaper! Semen freezing is about R2000 a pop, with tests tacking on another R6000 and keeping it on ice costs about R2000 per year.

Whats the prognosis?

Many South Africans, in fact, many people are worldwide, are choosing to delay having kids until later in life. Why? For many reasons, from focussing on their career, to wanting to travel and even needing a solid relationship commitment before kids. The point raised by many of my friends currently is “do I even want to have kids”?

Either way, have them early and do it naturally, but be warned having kids is costly. Or go the preservation route and then tack on the cost of kids, double whammy. Or even wait until later, hope it happens naturally and just have the cost of kids later in life.

Whatever your choice. Educate yourself and decide, before you hit your 30s, what you want to do.

As ever I look forward to your feedback.

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