All you need to know: The 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, MCMAS 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.

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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

The Assisted Reproductive Therapy Benefit provides cover for a defined list of female infertility procedures and treatments up to a Rand limit of R129 150 for each person, each year, subject to specific rules. Cover is up to 75% of the Scheme Rate when you use an accredited facility in our network.

To access this benefit, you must meet the following benefit entry requirements which were developed in consultation with the South African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG):

• You are female, aged 25 to 42 years
• You will be undergoing treatment at one of the Southern African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG) accredited facilities

If you no longer meet the age requirement, you will be able to finish any active cycle. The criteria must be met at all times for you to enjoy cover under this benefit.

What we cover

Once activated, the benefit covers a comprehensive basket of care which includes consultations, ultrasounds, egg retrieval, embryo transfers, admission costs and lab fees, medicine and embryo and sperm storage relating to the approved assisted reproductive therapy procedures. Any costs incurred for procedures not currently listed under this benefit will not be covered by the Scheme.

Cover is up to 75% of the agreed Scheme Rate up to a limit of R129 150 per person 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) 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.

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

If you are 25 - 39 years old, you have access to 2 cycles of assisted reproductive therapy. If you are 40 - 42 years old, you have access to one cycle of assisted reproductive therapy.