5 Best Medical Aids in South Africa Cover IVF
Do Medical Aids Cover IVF in South Africa revealed.
We verified the best medical aids that cover IVF treatment in their medical aid plans.
This is a complete guide to the best medical aid that cover IVF treatment in South Africa.
In this in-depth guide you’ll learn:
- What is IVF treatment?
- Where can you get free IVF in South Africa?
- Where is IVF the cheapest in South Africa?
- Are there IVF grants in South Africa?
- Which medical aid pays for IVF treatment in South Africa?
So if you’re ready to go “all in” with the best medical aid that covers IVF treatment in South Africa, this guide is for you.
Let’s dive right in…
Best Medical Aids in South Africa Cover IVF (2024)
- Discovery Medical Aid – Overall, Best Medical Aid for IVF Treatment in South Africa
- KeyHealth Medical Aid – Top Extensive Medical Protection in South Africa
- Momentum Health – Broadest Range of Low-Cost Medical Aid Plans
- Bonitas Medical Aid – Best Pay-As-You-Go Private Healthcare
- Medihelp Medical Aid – Best Customer Service Medical Aid
Introduction to Medical Aid Support & IVF Coverage
👉 According to the findings of the Infertility Awareness Association of South Africa (IFAASA), one in every six couples of reproductive age experiences difficulties in conceiving a child.
👉 The most common reasons for infertility are obstructions in the fallopian tubes, fibrous growths in the uterus, and a decrease in the generation of sperm or eggs. Endometriosis and hormonal imbalances are two conditions that have been linked to infertility.
👉 In around 20 per cent of cases, despite the progress that has been made in medical knowledge, there is no identifiable medical cause.
👉 The good news is that several specialised procedures and techniques can increase the likelihood of becoming pregnant. The type of treatment recommended to a couple is determined by the underlying cause of the issue and the ages of both partners.
👉 Common fertility treatments vary according to the root of the problem and include:
- ➡️ laparoscopic surgery
- ➡️ medication (Clomiphene / Metformin)
- ➡️ hormone injections
- ➡️ insemination
👉 In South Africa, the costs of drugs and specialised medical treatments related to infertility are not covered by open medical aid plans.
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👉 The majority of programmes, on the other hand, do provide financial assistance for diagnostic tests and procedures that are carried out to determine the reason for infertility.
👉 Because infertility is listed as one of 270 prescribed medical benefits (PMB) diagnostic treatment pairs recognised by the Medical Schemes Act under the female reproductive system category, they are also legally obligated to cover the costs of certain surgeries and techniques aimed at creating the optimal conditions for a natural pregnancy.
👉 It is necessary that a diagnosis of infertility is supported by a qualified medical specialist to be eligible for PMB benefits.
👉 After that, operations and treatments should be paid for.
👉 Specialised ART methods such as in vitro fertilisation (IVF) are exceedingly pricey, and there is no assurance that they will be successful.
👉 The procedure of fertilisation known as in vitro fertilisation involves combining an egg and sperm in a lab dish rather than in a human body. The method entails monitoring and promoting the ovulatory process of an individual, taking an ovum or ova from the individual’s ovaries, and then allowing sperm to fertilise the ovum or ova in a culture medium in a laboratory.
👉 In vitro fertilisation involves several different steps that are carried out to improve a couple’s fertility, avoid certain genetic disorders, and improve their chances of conceiving a child.
👉 Mature eggs are removed from the ovaries and then fertilised in a laboratory by sperm. The fertilised egg (also called an embryo) or eggs (also called embryos) are then placed in a woman’s uterus.
👉 IVF treatments typically last for roughly three weeks from start to finish. As a result of these steps being broken up into separate portions, the procedure may take significantly more time.
👉 It is possible for a couple to carry out the surgery using their own eggs and sperm. Or, in vitro fertilisation (IVF) may involve using eggs, sperm, or embryos donated by a known or unknown donor.
👉 IVF increases your odds of producing a healthy baby, but those chances are contingent on several circumstances, including your age and the root of your infertility. In vitro fertilization is also known to be time-consuming, expensive, and uncomfortable at times.
👉 IVF has the potential to result in more than one pregnancy if more than one embryo is implanted into the woman’s uterus during the process (multiple pregnancies).
👉 The cost of IVF treatment can range anywhere from R70,000 to R80,000 per cycle. The total price will be determined by the quantity of medication that is taken as well as whether or if any extra procedures, such as embryo biopsy or embryo freezing, are required.
✅ Read more about the best medical aids for moms that are pregnant
5 of the Best Known Medical Aids in South Africa & IVF Coverage
👉 Medical Aid companies say that fertility treatments do not put the patient’s life in danger. Unlike conditions like heart disease, which are very dangerous to your life, this is a treatment option that you can choose to go through.
👉 Some medical assistance programmes might pay for procedures like surgery to unblock the fallopian tubes or blood tests if they find that the infertility was caused by a treatable medical condition.
👉 Even though infertility is a specified recommended minimum benefit illness in South Africa, fertility treatments are not generally covered by medical aids – a debatable situation.
👉 Members of medical aids feel that, since infertility is considered a disease that needs a defined minimum benefit, you should be able to get treatment for it no matter what medical aid plan you are currently enrolled in.
👉 Since 2021, the Discovery Medical Scheme, which is the largest medical scheme in South Africa, began providing coverage for fertility treatments. This coverage, however, is subject to stringent terms and conditions and will only be available to a select few of the scheme’s customers.
1. Discovery Medical Aid
Overview
👉 Discovery Health Medical Scheme (DHMS) is most likely the largest open medical scheme in South Africa. It is a registered open medical scheme, which means that anyone can join as long as they adhere to the Scheme’s rules and regulations.
👉 The Discovery Health Medical Scheme provides more than 20 different choices for health plans, each of which includes limitless coverage for private hospital care as well as a range of other benefits that can be tailored to your preferences and your financial situation.
👉 You will have access to a wide variety of benefits, care programmes, and services that will ensure that you can receive the highest quality medical care whenever it is required.
👉 Discovery asserts that its monthly premiums are, on average, 14.9% lower than the contributions that other South African medical schemes demand for the same level of coverage.
👉 Vitality, the company’s wellness initiative, invites you to participate and provides incentives for doing so if you lead a healthy lifestyle.
👉 The Scheme is owned by its members and is managed through an independent Board of Trustees. A separate company, Discovery Health (Pty) Ltd, an authorised financial services provider administers the fund.
👉 The Discovery Health Medical Scheme is an independent non-profit entity regulated by the Council for Medical Schemes and governed by the Medical Schemes Act.
Discovery Option Plans
👉 Discovery option plans range from the most comprehensive private healthcare cover that will pay certain benefits to receivers of IVF to basic plans where a member just gets cost-effective private healthcare coverage through a network of providers.
👉 The following health plan options are available:
Executive Plan
👉 The Executive Plan offers customers the most extensive cover for in-hospital and day-to-day benefits, as well as extended chronic medicine coverage and an unlimited Above Threshold Benefit.
👉 The Assisted Reproductive Therapy Benefit is available on the Executive plans.
Comprehensive Series
👉 The Comprehensive series of plans provide comprehensive cover for in-hospital and day-to-day cover with extended chronic medicine coverage and unlimited Above Threshold Benefit. The Assisted Reproductive Therapy Benefit is available to members of this Comprehensive series of plans.
Priority Series
👉 The Priority Series of plans offer cost-effective in-hospital cover, essential chronic medicine cover and day-to-day benefits with a limited Above Threshold Benefit, but no Assisted Reproductive Therapy Benefits.
Saver Series
👉 The Saver series is economical and provides in-hospital cover, essential chronic medicine cover and day-to-day benefits through a Medical Savings Account. No Assisted Reproductive Therapy Benefits are available.
Core Series
👉 The Core Series is a value-for-money series of hospital plans that provide unlimited private hospital coverage and essential cover for chronic medicine but with no day-to-day cover or Assisted Reproductive Therapy Benefits.
Smart Series
👉 The smart series of plans provide the most cost-effective in-hospital cover, essential chronic medicine cover plus limited day-to-day cover if you use providers in a specified network. Assisted Reproductive Therapy Benefits like IVR are not available.
Keycare Series
👉 The KeyCare series of plans offer affordable but basic medical cover providing you make use of providers in a specified network for both in-hospital and out-of-hospital treatment. No Assisted Reproductive Therapy Benefits are provided.
Benefits under Discovery Medical Aid’s Assisted Reproductive Therapy Benefit Programme
👉 Discovery Health Medical Scheme recently announced the introduction of a new benefit designed to assist members who are struggling with infertility. Couples who are having difficulty conceiving will receive assistance under the newly introduced Assisted Reproductive Therapy Benefit, which is included in both the Comprehensive and Executive plans.
👉 Although infertility is one of the disorders that fall under the Prescribed Minimum Benefits (PMB) it condition includes a defined set of connected investigations as well as medicinal and surgical treatments that must be covered in accordance with regulations. PMB coverage, however, does not account for assisted reproductive technologies (ART) including in vitro fertilisation (IVF) and embryo transfer (ET).
👉 Discovery Health Medical Scheme now provides more comprehensive advantages in addition to insurance coverage for assisted reproductive technologies. This is done in cooperation and in close consultation with the Southern African Society of Reproductive Medicine and Gynecological Endoscopy (SASREG), which is an organisation that specialises in reproductive medicine and gynaecological endoscopy.
👉 Coverage for a predetermined “basket of care” is now included in the new Discovery Health Medical Scheme Assisted Reproductive Therapy Benefit.
👉 This coverage is available for a maximum of two cycles of therapy.
👉 For each cycle, this basket of care includes:
➡️ Assisted reproductive therapy consultations and medicine
➡️ Oocyte (egg) retrieval
➡️ Embryo transfer
➡️ Ultrasound scans
➡️ Admission costs, including the laboratory fees
➡️ Embryo and sperm storage
👉 Only female DHMS members aged 25 to 42 who are members of the Executive and Comprehensive Plans will have access to this benefit.
👉 Discovery will pay up to 75% of the Discovery Health Rate for treatment up to a limit of R110 000 per person per year. The member has to pay 25% of the cost of treatment and any other costs not covered by the benefit.
How to Join Discovery Medical Aid’s Assisted Reproductive Therapy Benefit Programme
👉 If you are a female member on an Executive or Comprehensive plan, aged 25 to 42, you can activate the Assisted Reproductive Therapy Benefit by contacting the fund via email with your membership details, as well as that of the male partner (if they are on a different policy).
✅ Read more about the Discovery Health Maternity Benefits Article.
How Much Are Discovery Medical Aid Monthly Premiums?
👉 Monthly premiums start from R1,102 per member for the Keycare Series with medical cover for both in-hospital and out-of-hospital treatment by providers in a specified network and go up to R10,303 per member for the Executive Plan with extensive cover for in-hospital and day-to-day benefits, extended chronic medicine cover, and unlimited Above Threshold Benefit.
What Is the Waiting Period for Discovery Medical Aid’s Benefits?
👉 Discovery Health Medical Scheme’s general waiting period is 3 consecutive months and the condition-specific waiting period is 12 consecutive months.
How to Claim from Discovery
👉 You can submit a claim fast and easily in the following ways:
➡️ Scan and upload your claims on the website.
➡️ Scan and email your claims to [email protected].
➡️ Use the Discovery app on your smartphone. If the claim has a QR code, scan the QR code or alternatively take a photo of the claim from within the app.
➡️ You can also submit your claims by post.
Discovery Contact Details
PO Box 784262,
Sandton,
2146
Phone: 0860 99 88 77
📌 READ more about the Discovery Health versus KeyHealth Medical Aid
2. KeyHealth Medical Aid
Overview
👉 KeyHealth Medical Aid offers comprehensive medical aid options with a focus on providing value-for-money coverage across various plans.
👉They aim to deliver straightforward and effective medical aid solutions for individuals and families.
KeyHealth Medical Aid Option Plans
👉 Essence
- Coverage: This plan includes unlimited cover in private and state hospitals, organ transplants, oncology, and palliative care.
- Chronic Conditions: Covers the basic 26 chronic medical conditions.
- Starting Premium: From R1,814 per month.
- IVF Coverage: Not included in this plan.
👉Origin
- Coverage: Offers a balance of hospital and day-to-day benefits.
- Chronic Conditions: Includes coverage for chronic conditions.
- IVF Coverage: Not included in this plan.
👉Equilibrium
- Coverage: Provides comprehensive hospital and day-to-day benefits.
- Chronic Conditions: Covers a wide range of chronic conditions.
- IVF Coverage: Not included in this plan.
👉Silver
- Coverage: Offers extensive hospital and day-to-day benefits.
- Chronic Conditions: Includes coverage for chronic conditions.
- IVF Coverage: IVF coverage Not included in this plan.
👉Gold
- Coverage: Provides premium hospital and day-to-day benefits.
- Chronic Conditions: Comprehensive coverage for chronic conditions.
- IVF Coverage: IVF coverage specifics Not included in this plan.
👉Platinum
- Coverage: Offers the most extensive hospital and day-to-day benefits.
- Chronic Conditions: Covers a wide range of chronic conditions.
- IVF Coverage: IVF coverage is included in this plan.
Benefits under KeyHealth Medical Aid’s Option Plans for Assisted Reproductive Therapy (IVF)
👉 KeyHealth Medical Aid provides coverage for Assisted Reproductive Therapy, including IVF, under certain plans. The specifics of the coverage can vary, so it’s advisable to check the details of each plan.
How Much Are KeyHealth Medical Aid Monthly Premiums?
👉The monthly premiums for KeyHealth Medical Aid plans start from R1990. The exact premium depends on the chosen plan and the level of coverage required.
What Is the Waiting Period for KeyHealth Medical Aid Maternity Benefits?
👉There is a 12-month waiting period for maternity benefits for new members. This means that maternity-related services cannot be claimed during the first year of membership.
How to Claim Maternity Benefits from KeyHealth Medical Aid
👉To claim maternity benefits, members should contact KeyHealth Medical Aid directly. They will provide guidance on the necessary steps and documentation required for the claims process.
KeyHealth Medical Aid Contact Details
PO Box 14145
Lyttelton 0140.
Phone: 0860 671 050 | Email: info@keyhealthmedical.co.za
For further details, you can visit the KeyHealth Medical Aid website or consult their customer service for personalized assistance.
📌 READ more about Health Insurance for Pregnancy in South Africa
3. Momentum Health
Overview
👉 Momentum Health is one of South Africa’s major open schemes.
👉 Momentum Medical Scheme Administrators, a subsidiary of Momentum Metropolitan Life Limited (MMI) Group (Pty) Ltd., is in charge of the scheme’s management and operation.
👉 Because it has a solvency ratio that is larger than 31%, the scheme is extremely sustainable and is in a good position to take care of the needs of its members both now and in the future.
👉 The Momentum Medical Scheme is an open medical plan that is not for profit and is registered in accordance with the Medical Schemes Act 131 of 1998, in its revised form.
👉 Its Board of Trustees is comprised of multiple persons who have experience and expertise in several medical, accounting, and legal sectors.
👉 These individuals are elected during the organisation’s Annual General Meetings.
Momentum Health Option Plans
👉 The Momentum Medical Scheme provides members with access to a comprehensive selection of health insurance policies and perks, which includes six different medical aid programs.
The Evolve Option
👉 The Evolve Option provides coverage for hospitalisation at any of the private hospitals that are part of the Evolve Network, and there is no yearly cap on the total benefit amount.
👉 Members have access to two consultations with virtual doctors, and any further day-to-day services will be subject to the Health Saver+ membership fee.
The Custom Option
👉 The Custom option offers full coverage for hospitalisation as well as chronic conditions from any and all related providers. Members have the option of receiving treatment at any hospital or choosing from a predetermined list of private hospitals to reduce the amount of required co-payment.
The Incentive Option
👉 When you select the Incentive option, you will receive comprehensive hospital and chronic cover from any of the connected providers. Your regular expenditures are taken care of by a separate savings account for medical purposes, which is funded by 10% of your monthly premiums.
The Extender Option
👉 The Extender offers comprehensive hospital coverage in addition to chronic disease coverage from any linked or unassociated doctors. Your dedicated medical savings account, which is used to pay for your day-to-day expenses, receives twenty-five per cent of the total amount that you contribute. Once you have reached your Threshold, the benefit of Extended Coverage becomes available to you.
The Summit Option
👉 The Summit option grants limitless access to private hospital coverage through any provider of your choice. A chronic cover is offered for an additional 36 conditions, and day-to-day benefits are covered up to a maximum of R29 700 per beneficiary per year.
The Ingwe Option
👉 The Ingwe option provides entry-level medical coverage that is both affordable and easily accessible. You have the option of receiving medical care at any hospital in the Ingwe Network of private hospitals or state hospitals.
Benefits under Momentum Health’s Option Plans for Assisted Reproductive Therapy (IVF)
👉 Even though infertility is a prescribed medical benefits (PMB) illness in South Africa, specialised fertility treatments like IVF are not covered by Momentum Health.
How Much Are Momentum Health Monthly Premiums?
👉 Momentum monthly premiums start at R1 539 for the main member on the Evolve Option and go up to R12 345 for the main member on the Summit Option.
What Is the Waiting Period for Momentum Benefits?
👉 The general waiting period is 3 months, but since pregnancy is considered a pre-existing condition, it is excluded from all benefits for the first 12 months of scheme membership.
How to Claim from Momentum
👉 You can submit a claim in several ways:
➡️ Use the Momentum App
➡️ Use the web chat facility in the bottom left corner.
➡️ Send an email to [email protected] or send normal mail to PO Box 2338, Durban, 4000
👉 To make sure your claim is processed quickly and accurately, include the following information:
➡️ Membership number.
➡️ Principal member’s surname, initials, and first name.
➡️ Patient’s surname, initials, and first name.
➡️ Date of treatment.
➡️ Amount charged.
➡️ ICD–10 code (code to indicate what condition you’ve been diagnosed with), tariff code (product-specific code for procedures and claims), and NAPPI code (unique identifier for a given ethical, surgical, or consumable product).
➡️ Service provider’s name and practice number.
➡️ Proof of payment if you’ve paid the claim out of your own pocket.
Momentum Contact Details
201 Umhlanga Ridge Blvd
Cornubia
Blackburn
PO Box 2338
Durban
📌 READ more about Best Health Insurance Plans for Pregnant Women
4. Bonitas Medical Aid
Overview
👉 Bonitas has been in operation for several decades and developed a solid comprehension of the South African private healthcare market.
👉 Its team of professionals is continually looking into new ways to ensure that members are provided with health care that is both inexpensive and of high quality. Keeping up with technological advances, managing treatment in such a way that lifestyle diseases are detected before they develop into chronic conditions, and negotiating better rates are all necessary steps.
👉 In addition, the company’s finances are sound, it has a sufficient amount of money set aside as a buffer, and its key indications of fiscal health are healthy.
👉 The management staff of Bonitas has a great deal of experience, and the organisation is overseen by an independent Board of Trustees consisting of professionals from the medical, legal, financial, and business disciplines who are not members of the organisation.
Bonitas Medical Aid Option Plans
👉 Bonitas offers a wide variety of plans so that any family can find one that fits their needs perfectly.
👉 The plans are easy to understand and use while helping the customer to get the most out of their benefits.
👉 The Edge Option gives access to day-to-day benefits including unlimited GP consultations, layers of virtual care, dental and optical consultations, a private hospital network and more.
👉 The BonStart and BonStart Plus Options are designed for economically active singles, living in the larger metros, with a drive to succeed and young, economically active couples, living in the larger metros, and looking to expand their family.
👉 Traditional plans give an overall day-to-day limit with sub-limits for GP and specialist consultations, acute and over-the-counter medicine, X-rays and blood tests and other out-of-hospital medical expenses. The Standard Option offers day-to-day benefits and comprehensive hospital cover while the Standard Select Option uses a network of quality providers to offer the same day-to-day benefits and hospital cover.
👉 The Primary Option offers simple day-to-day benefits and hospital cover while the Primary Select Option uses a network of quality providers to offer the day-to-day benefits and hospital cover.
👉 Bonitas’ Savings Plans give you a set amount to use however you want for out-of-hospital costs like doctor visits, optometry, and dentistry. They also cover you while you’re in the hospital and give you extra benefits for maternity, wellness, and preventative care.
👉 The BonFit Select Option offers essential hospital cover and basic cover for day-to-day medical needs, the BonSave Option offers sufficient savings to use for medical expenses and extensive hospital cover and the BonComplete Option is a savings option with generous savings, an above-threshold benefit and rich hospital cover.
👉 The BonClassic Option offers a wide range of medical benefits, in and out of the hospital and the BonComprehensive Option is a first-class savings plan with ample savings, an above-threshold benefit and extensive hospital cover.
👉 Bonitas Hospital Plans cover members for emergency and planned procedures in the hospital with some additional benefits for wellness and preventative care.
👉 The Standard Hospital Option offers general hospital coverage with some value-added benefits while the BonEssential hospital plan offers comprehensive hospital benefits with some value-added benefits. The BonEssential Select Option uses a provider network for comprehensive hospital benefits and some value-added benefits.
👉 The BonCap income-based entry-level plan offers basic day-to-day benefits and hospital cover when using the set network of doctors, hospitals and providers.
Benefits under Bonitas Medical Aid Option Plans for Assisted Reproductive Therapy (IVF)
👉 Even though infertility is a prescribed medical benefits (PMB) illness in South Africa, specialised fertility treatments like IVF are not covered by Bonitas Medical Aid.
How Much Are Bonitas Medical Aid Monthly Premiums?
👉 Bonitas monthly contributions start at R 2 033 for a Principal Member, R 1 555 for a spouse/adult dependant and R 596 per child (max 3) on the BonEssential Hospital Plan and go up to R 8 217 for a main member, R7 749 for additional adult, and R 1 672 for a child for the BonComprehensive plan that offers abundant savings, an above threshold benefit and extensive hospital cover.
✅ Read more about the Bonitas maternity benefits in this article.
What Is the Waiting Period for Bonitas Medical Aid Benefits?
👉 The minimum general waiting period for Bonitas medical aid is three months for all benefits. Some plans, however, have a waiting period of 12 months, especially regarding a pre-existing condition.
How to Claim for Benefits From Bonitas Medical Aid
👉 You can send in your claim in the following ways:
➡️ Email your claims to [email protected].
➡️ Post your claims to Bonitas Claims Department, PO Box 74, Vereeniging, 1930.
➡️ Submit your claims in person at one of the walk-in centres.
👉 Follow these simple steps to get your claims paid quickly:
➡️ Ensure your banking details are correct for refunds by electronic transfer (EFT) into your bank account
➡️ Make sure that your account and receipt show your name and initials, membership number, treatment date, the name of the patient as shown on your membership card, the amount charged and the ICD-10 code.
Bonitas Medical Aid Contact Details
34 Melrose Blvd, Birnam
Johannesburg
2196
Phone for General Queries: 0860002108
Email: [email protected]
Email: [email protected]
📌 READ more about 5 Best Hospital Plans for Pregnancy Coverage in South Africa revealed.
5. Medihelp Medical Aid
Overview
👉 Medihelp is a reliable and consistent medical aid organisation.
👉 Medihelp is self-administered and aims to provide members with care and satisfy their requirements for medical services. No matter if you are a student, newly hired and wishing to join a medical aid for the first time, self-employed and seeking a trustworthy healthcare solution for your employees, or providing for a family with rising demands, you should feel at home at Medihelp.
👉 Since its founding more than a hundred years ago, Medihelp has been dedicated to putting the needs of its members first. Medihelp continues to be one of the top five choices of medical aids in the industry due to its capacity to adapt to shifting requirements and advance how it provides services by incorporating cutting-edge technology.
👉 As a self-administered scheme, Medihelp is owned by its members and handles administrative duties as processing and paying claims, pre-authorisation and communication with members in-house. You are therefore assured of top-quality service by dedicated Medihelp employees.
Medihelp Medical Aid Option Plans
👉 Medihelp offers the following option plans:
MedElect Student
👉 MedElect makes use of a quality network of service providers to enable comprehensive cover at an affordable premium for those who still have to concentrate on their studies. Among its benefits count extensive in-hospital cover, screenings and additional benefits.
MedVital
👉 MedVital is a healthcare solution that offers affordable coverage for minor medical expenses, private hospitalisation and emergency medical services.
MedMove
👉 Medmove provides health essentials cover such as private hospitalisation and emergency medical services through quality networks. Members also have access to virtual and in-person doctors’ consultations and medicine, as well as a selection of other medical services they may need.
MedAdd
👉 MedAdd offers the flexibility of a 15% savings account, additional insured cover once savings are depleted, cover for dental and eye care, as well as pregnancy benefits, but no IVR benefits.
MedSaver
👉 MedSaver provides cover for private hospitalisation at any hospital, while the 25% savings account covers medical expenses incurred out of the hospital. Once savings are depleted, the additional out-of-hospital cover is unlocked.
MedElect
👉 MedElect offers comprehensive care at premium quality networks at an affordable rate.
MedPrime
👉 With MedPrime members get private hospitalisation, excellent cover for out-of-hospital services through a savings account and insured pooled benefits, as well as comprehensive dental and optometry benefits.
MedElite
👉 The MedElite is an all-inclusive plan, the ideal solution for families and individuals with extensive healthcare needs.
MedPlus
👉 MedPlus is Medihelp’s top-of-the-range plan and offers the most extensive cover for medical emergencies, private hospitalisation and preventive care, as well as extensive provision for acute and chronic medicine, radiology, pathology and other day-to-day medical expenses.
Benefits under Medihelp Medical Aid’s Option Plans for Assisted Reproductive Therapy (IVR)
👉 Even though infertility is a prescribed medical benefits (PMB) illness in South Africa, specialised fertility treatments like IVF are not covered under any options of Medihelp Medical Aid.
📌 Read more in this article about MediHelp Medical Aid maternity benefits.
How Much Are Medihelp Medical Aid Monthly Premiums?
👉 Medihelp monthly premiums start with Medmove’s R1 254 per month per member for health essentials cover such as private hospitalisation and emergency medical services through networks and go up to R10 980 per month for the top-of-the-range MedElite plan that offers the most extensive cover for medical emergencies, private hospitalisation and preventive care, as well as extensive provision for acute and chronic medicine, radiology, pathology and other day-to-day medical expenses.
What Is the Waiting Period for Medihelp Medical Aid’s Benefits?
👉 Medihelp may apply a general waiting period or a condition-specific waiting period.
👉 A general waiting period of up to three months applies from the date that a member joined. During this period, a person is not entitled to any benefits except prescribed minimum benefits (PMB). Claims submitted during this waiting period, will not be paid by the scheme.
👉 During a condition-specific waiting period of up to 12 months, a member will not be entitled to benefits for a particular condition for which the person receives medical advice, a diagnosis, care or treatment (excluding PMB).
👉 Upon joining Medihelp, members receive a document with the conditions under which they are enrolled as beneficiaries, indicating any waiting periods and/or late-joiner penalties.
How to Claim Benefits From Medihelp Medical Aid
👉 To submit a medical aid claim with Medihelp, a member can use one of the following options:
➡️ Use Medihelp’s member app to upload the account and proof of payment and submit.
➡️ Email the account and proof of payment to [email protected].
➡️ Submit your claim by logging in to Medihelp’s Member Zone and clicking on “Claims” – “Submit a claim”.
👉 To guarantee that your claim is valid according to the Medical Schemes Act and Medihelp’s Rules, ensure that you have provided the following details:
➡️ Your membership number
➡️ The member’s name and surname
➡️ The name, surname and date of birth of the patient
➡️ Medihelp Medical Scheme – not “Private” (this has tax implications)
➡️ The healthcare practitioner’s name and practice code number
➡️ The amount charged per item
➡️ The amount you have paid
➡️ Your proof of payment (attached)
➡️ The relevant codes such as ICD-10, NAPPI and item code(s)
➡️ The date on which the service/procedure was rendered/performed
👉 The account should not be modified by hand in any way, as this will cause your claim to be invalid.
👉 Your claims must reach Medihelp on or before the last workday of the fourth calendar month after the month in which the service was rendered.
Medihelp Medical Aid Contact Details
Medihelp Head Office
Postal address
PO Box 26004
Arcadia, 0007
Street address
189 Clark street,
Brooklyn, 0181
Customer care
- General enquiries – 086 0100 678
- International – +27 12 336 9000
- Email: [email protected]
- Claims submission: [email protected]
Frequently Asked Questions
Can you join a medical aid in South Africa for IVF benefits?
No, you cannot join a medical aid in South Africa for IVF benefits, since they don’t cover that.
Are there medical aids in South Africa that cover IVF?
There are currently only one medical aid, Discovery, that conditionally covers IVF.
How much does it cost to receive IVF treatment at a private hospital in South Africa without medical aid?
The cost of IVF treatment can range anywhere from R70,000 to R80,000 per cycle.
Does medical insurance cover the cost of IVF?
No, IVF is not covered by medical insurance since many fertility treatments are not considered “medically necessary” by insurance companies.
How long do you have to be a member of a medical aid to get Assisted Reproductive Therapy (IVR) covered?
Since infertility is not a disease as such, you will have to be a member of an Aid longer than 12 months to receive any benefit on Assisted Reproductive Therapy (IVR), providing it is offered by the medical aid.
📌 Discover more in-depth about what Maternity Benefits is and how it applies to medical aid schemes.
