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Infertility and PMBs

The Medical Schemes Act, No. 131 of 1998, recognizes infertility as a PMB disease under the category Female Reproductive System and treatment guidelines are classified as:

  1. Code : 902M
  2. Diagnosis : Infertility
  3. Treatment : Medical and surgical management

Furthermore the Regulations in terms of the Medical Schemes Act make specific reference to Infertility in Annexure A.

It states that the following is the minimum that MUST be covered by your Medical Aid Scheme:

In respect of Code 902M (Diagnosis: Infertility), ‘medical and surgical management’ shall be limited to the following procedures or interventions:-

  1. Hysterosalpingogram
  2. The following blood tests:
    • Day 3 FSH/LH
    • Oestradiol
    • Thyroid function (TSH)
    • Prolactin
    • Rubella
    • HIV
    • VDRL
    • Chlamydia
    • Day 21 Progesterone
  3. Laparoscopy
  4. Hysteroscopy
  5. Surgery (uterus and tubal)
  6. Manipulation of ovulation defects and deficiencies
  7. Semen Analysis (volume; count; mobility; morphology; MAR-test)
  8. Basic Counselling and advice on sexual behaviour, temperature charts etc.
  9. Treatment of local infections.

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