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Open Letter to Discovery Health

Dear Discovery Health

IFAASA is a Non-Profit Company focusing on advocacy, empowerment, and information for the population group diagnosed with infertility. Advocating with medical schemes to afford patients the treatment they deserve for their diagnosis is a key focus of our organisation. 

Infertility affects 1 in 6 couples of reproductive age (15 to 44 years) and is one of the most common diseases that couples in this age group are diagnosed with. Despite this, Discovery Health continues to refuse a treatment plan to allow members access to In Vitro Fertilisation and Intra Uterine Insemination for a recognised disease entity 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. We acknowledge Discovery Health pays for the minimum required diagnostic assessments as per the Medical Schemes Act for infertility, yet does not offer any cover for the actual treatment of infertility outside of members accessing what they can through their savings account.

Whilst we have insight into the need to properly manage the funds of a Medical Aid Scheme, we place on record that this cannot be done at the expense of patients suffering from a recognised PMB disease entity. We understand that there cannot be open-ended funding for the treatment of infertility but there are many examples around the world where medical schemes give their members access to a well-structured, holistic infertility program which often includes access to three IVF cycles per couple. And it has been proven that well-structured infertility programs can save the medical scheme money by agreeing on guidelines that manage the number of embryos transferred. IFAASA has been in discussion with Discovery for a few years through presentations at the AGM’s, face to face meetings and written correspondence. In addition, the Fertility Specialists have been in discussion with Discovery about the cover for fertility treatment even longer. Yet the status quo has stayed the same with regard to the non-funding of infertility treatment. Due to the financial strain that a system like this places on infertile couples the very same couples are often diagnosed with other medical illnesses, which your scheme pays for.

It is noted on the Discovery Health website that one of your values relating to members is to ‘Dazzle Clients’. Well, we want you to know that your members in their reproductive age (15 to 44) that are diagnosed with one of the most common diseases, infertility, are not feeling dazzled. They are feeling ignored, discriminated against, and isolated.

We urge you to listen to the needs of your members that are asking Discovery Health to offer reasonable cover relating to the treatment of infertility. Namely 3 In Vitro Fertilisation per couple with conditions such as single embryo transfer. You can and should be doing better for a recognised disease entity.

To the members of medical schemes diagnosed with infertility as well as the many family members and loved ones who witness the devastation of this type of diagnosis, lend your voice to the campaign. Please leave your comments stating which medical aid scheme you are a member of and speak out on why you think medical schemes such as Discovery Health should cover treatment for infertility.

DATE: 21 April 2016

Please comment with your thoughts below,  including the name of your Medical Aid Scheme. Your email address will not be published and you can remain anonymous if you wish.

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Timeline of IFAASA’s campaign with Discovery Health

February 2011: A submission was made to the Council of Medical Schemes about the exclusion of infertility treatment by medical schemes, in particular Discovery Health.

June 2013: A submission and presentation were made at the Discovery Health AGM with regard to the exclusion of infertility treatment for its members.

June 2014: IFAASA made another submission and presentation on behalf of its members at the Discovery Health AGM with regard to the exclusion of infertility treatment.

July/August 2014: IFAASA met with Discovery Health to discuss the cover of infertility treatment for its members. IFAASA clarified the use of the members’ savings accounts for infertility treatment, to assist many Discovery Health members, to access their savings to cover a small part of infertility treatment.

2015: IFAASA continued discussions with Discovery Health with regard to reasonable cover for the treatment of infertility.

2016 – 2020: IFAASA continued public lobbying through various platforms, video campaigns, and an online petition, as well as physically signed petition at the Fertility Show Africa, signed by Dr. Bandile Masuku (Gauteng MEC for Health).