The treatment for infertility is largely dependent on the underlying cause. When it is associated with specific diseases, then the proper treatment and management of these diseases may resolve the infertility problem. Medical aids cover the treatment of these diseases that could be contributing to infertility. For example, hypothyroidism which is an underactive thyroid gland may lead to infertility yet pregnancy is possible when this condition is properly treated and managed.
However, there are some instances where fertility treatments are needed. It is important to understand what is meant by fertility treatments. These are procedures that are specifically performed to assist with pregnancy itself. One of the commonly known fertility treatments is in vitro fertilisation (IVF) where the fertilised egg is implanted into the uterus. These types of fertility treatments are very costly and often unaffordable to most women without adequate financial resources.
Do medical aids pay for fertility treatments?
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. A restricted medical scheme is one that only allows certain workers and professionals from specific industries or professions to join their scheme. These schemes are not open to the general public and even so not all restricted medical aids offer infertility cover.
One restricted medical aid that does pay for fertility treatments on its higher plans in 2012 is CAMAF, the Chartered Accountants Medical Aid Fund. There are very specific criteria to apply for CAMAF membership and only a small portion of the South African population would actually qualify. However, there are other restricted medical aids that may also offer such benefits but with medical aids constantly changing their benefit schedule, it is best to speak to a medical aid directly and verify whether it covers fertility treatments.
Reasons why medical aids do not cover infertility
It has to be stressed that medical aids do pay for the treatment of diseases that can affect fertility. This includes conditions such as polycystic ovarian syndrome, endometriosis and hypothyroidism to name but a few. The goal of treatment is often to ease the symptoms that a person is experiencing, prevent complications and manage the condition in the long term. Ultimately infertility may also resolve although the medical aid does not view the treatment of these diseases as being specific for infertility. It is important however, to clarify the scheme’s stance on these treatments directly with the medical aid.
Fertility treatments itself are often not covered because it is expensive and is not intended to correct a disease that can drastically affect the health status and lifespan of a person. Although there is a major psychological impact associated with infertility, medical aids have to sometimes draw the line between essential and non-essential procedures. It is often confusing to some medical aid members as psychotherapy for depression sometimes due to infertility is pay for by a medical aid, yet not the fertility treatment. It is important to bear in mind that apart from fertility treatments not posing a danger to one’s life and being very expensive, many of these procedures do not have a very promising success rate.
Medical aid members are often mistaken that since they pay their monthly contributions then the scheme is required to pay for any medical service that they opt for. This is untrue. A medical aid is a collective pool of member’s contributions. The scheme has to prioritise by paying for services that pose an immediate or future threat to a person.
With a rising infertility rate globally, medical aids can be significantly affected if they opt to pay for fertility treatments across the board. Furthermore fertility medical specialists charge a premium rate and fertility treatments itself are hugely expensive and it is unreasonable for a medical aid to bear these costs. Ultimately the drain of resources affects all its members and the focus has to be on essential medical services. Each medical aid may have its reasons for refusing to cover fertility treatments but since it is not mandatory to cover these procedures, many opt not to.