You have been diagnosed with infertility. Or you are about to start treatment. And before you go any further, you need to know: will any of this be covered?
The honest answer is: probably not much — but more than most people realise. South Africa’s medical aid landscape for fertility treatment is patchy, frequently misunderstood, and changing. This guide gives you the complete, accurate 2025 picture so you know exactly where you stand before you make any treatment decisions.
The Bottom Line Upfront
| South Africa has only one open medical aid that currently covers IVF as a treatment benefit: Discovery Health Medical Scheme (DHMS). It covers up to two ART cycles per year for qualifying members on Executive or Comprehensive plans, at 75% of the Discovery Health Rate up to R135,000 per year. Every other major open medical aid — Bonitas, Momentum, Medihelp — does not cover IVF treatment. All medical aids must cover infertility investigation (diagnosis) under Prescribed Minimum Benefits (PMB) law — but investigation is not the same as treatment. |
What Is a Prescribed Minimum Benefit (PMB) — and Why It Matters
The Medical Schemes Act requires all registered South African medical aids to cover certain conditions regardless of plan level. These are Prescribed Minimum Benefits (PMBs). Infertility is PMB code 902M — it is classified as a disease of the female reproductive system.
This matters enormously — but it is widely misunderstood. PMB coverage for infertility means:
- Your medical aid must cover the diagnosis and medical management of infertility — blood tests (AMH, FSH), semen analysis, HSG, transvaginal ultrasounds, and specialist consultations
- Surgical treatments for the underlying causes of infertility (endometriosis surgery, fallopian tube procedures, varicocele repair) must be covered
- These must be paid from the PMB benefit — not deducted from your medical savings account
What PMB coverage does NOT include:
- Assisted Reproductive Technologies (ART) — IVF, IUI, ICSI, FET, embryo freezing
- Fertility medications for treatment cycles
Discovery Health: The Only Open Medical Aid Covering IVF (2025)
Which Plans?
The Assisted Reproductive Therapy Benefit is available on Discovery Health Executive and Comprehensive plans only. It is not available on Classic, Essential, Smart, KeyCare, or any other Discovery plan.
What Is Covered?
Once activated, the benefit covers a defined basket of care per ART cycle, including:
- ART consultations and medicine (at 75% of Discovery Health Rate)
- Ultrasound monitoring scans during treatment
- Oocyte (egg) retrieval
- Laboratory fees (fertilisation and embryo culture)
- Embryo transfer
- Embryo and sperm storage relating to the approved ART procedures
- Egg-donated IVF cycles — including the egg donor matching fee (agency fees excluded)
- Members on the Oncology Programme: cryopreservation and egg/sperm storage for up to 5 years
How Many Cycles?
- Age 25–39: up to two ART cycles per year
- Age 40–42: one ART cycle per year
- Age 43–50: one egg-donated IVF cycle per year (including donor matching fee)
The Financial Reality
Discovery covers 75% of the Discovery Health Rate (DHR) up to R135,000 per person per year. The member pays the remaining 25% co-payment plus any amounts the provider charges above the DHR. Given that a full IVF cycle in SA ranges from R45,000 to R100,000, the Discovery benefit is meaningful but does not eliminate out-of-pocket costs.
| IMPORTANT: This benefit is only accessible at SASREG-accredited facilities. It requires pre-authorisation before starting treatment. You must have been a member for at least 12 months to activate the benefit. Discovery’s own data shows 70% of members using the benefit fell pregnant in 2021, and 50% gave birth — higher than US SART benchmarks. |
How to Activate
Log in to the Discovery app or website → Medical Aid → Benefits → Assisted Reproductive Therapy → Activate. Alternatively, call Discovery at the number on your membership card. You will be required to provide clinical documentation of your infertility diagnosis from your specialist.
Bonitas: No IVF Cover, But PMB Diagnosis Cover Applies
Bonitas is one of South Africa’s largest open medical aids with a strong reputation for day-to-day benefits and hospital cover. As of 2025, Bonitas does not offer any ART treatment benefit on any plan. Infertility investigation is covered as a PMB requirement across all plans — but once diagnosed, treatment is self-funded.
Surgical procedures for conditions that cause infertility (such as endometriosis surgery or fibroid removal) are covered on relevant plans — check your specific benefit schedule. Bonitas’s 2026 plans continue to prioritise affordability and hospital cover but do not extend to IVF.
Momentum Health: PMB Only
Momentum Health is an open medical aid offering six plan options ranging from entry-level (Ingwe) to comprehensive (Extender). As of 2025, Momentum Health does not cover ART procedures including IVF, IUI, or embryo freezing on any plan. Infertility investigation is covered as a PMB requirement across all plans. Comprehensive maternity programmes cover antenatal and postnatal care but do not extend to fertility treatment.
CAMAF: A Closed Scheme Worth Knowing About
CAMAF (Cape Medical Aid Fund) is a restricted scheme (not open to everyone) that offers notably strong infertility benefits on its premium plans. CAMAF covers IVF on selected plans including Double Plus, Double Network, Alliance Plus, and Alliance Network. This is a closed scheme available to specific employee groups — check if your employer offers CAMAF membership.
Other Medical Aids: The General Position
Medihelp, KeyHealth, Fedhealth, Resolution Health, and most other open schemes do not cover ART procedures. Some cover surgical treatment of infertility-causing conditions. All must cover PMB-compliant infertility diagnosis. Check your scheme’s benefit schedule directly — benefits evolve annually.
The PMB Workaround: What You Can Claim
Even without an ART benefit, every South African medical aid member can and should claim the following under PMB:
- Specialist consultation for infertility assessment
- AMH, FSH, Estradiol, and LH blood tests
- Transvaginal ultrasound and antral follicle count
- Semen analysis and sperm assessment
- HSG (hysterosalpingogram) or HyCoSy
- Surgical management of endometriosis, tubal procedures, uterine surgery if clinically indicated
Important: Request that all investigation be coded under PMB 902M. These cannot be deducted from your savings account.
What About Medical Loans?
For the majority of South Africans who don’t have Discovery Executive or CAMAF cover, fertility treatment is self-funded. Medical loans are increasingly common. South African options include:
- FNB Personal Loan: Up to R300,000 with 60-month terms. Not specific to fertility — used by some couples for treatment financing.
- Absa Personal Loan: Up to R250,000 with flexible terms.
- Capitec: Widely accessible personal loan option for qualifying applicants.
Before taking out a loan for fertility treatment, get written quotes from your clinic and confirm exactly what the loan covers. Interest rates, terms, and qualifying criteria vary significantly.
→ IVF Cost in South Africa: Complete Breakdown 2025
→ Public sector fertility treatment
| KEY TAKEAWAYS |
| ✓ Discovery Health Executive and Comprehensive plans are the only open medical aid plans in SA that cover IVF treatment — up to 2 cycles/year at 75% of rate, max R135,000. |
| ✓ ALL medical aids must cover infertility investigation under PMB 902M — tests, scans, specialist consultations, and relevant surgery. |
| ✓ Bonitas, Momentum, Medihelp, and most other open schemes do not cover IVF or ART treatment. |
| ✓ CAMAF (restricted scheme) offers strong IVF cover on premium plans — check if you qualify. |
Frequently Asked Questions
Can I join Discovery just before starting IVF to get the benefit?
No. You must be a member of Discovery Health for at least 12 months before activating the Assisted Reproductive Therapy Benefit. Joining in anticipation of treatment will not result in cover.
Does my medical aid have to pay for my semen analysis?
Yes — under PMB 902M, semen analysis to diagnose male infertility is a required PMB service. It cannot be deducted from your savings account. Ensure it is coded correctly by your provider.
My doctor said surgery for endometriosis is covered — is that correct?
Yes. Surgical treatment of conditions causing infertility — including laparoscopic surgery for endometriosis, fibroid removal, and tubal procedures — falls under PMB coverage and must be covered by your scheme, subject to designated service provider rules.
What is the Discovery Health Rate and why does the 25% gap matter?
The DHR is Discovery’s benchmark rate for medical services. If your fertility clinic charges more than the DHR (which many do), the difference above the DHR is charged entirely to you — on top of the 25% co-payment. Always ask your clinic if they charge at DHR before committing.
References
- Discovery Health Medical Scheme (2025). Assisted Reproductive Therapy Benefit. discovery.co.za
- Vitalab (2025). Discovery funding page. vitalab.com/discovery-funding/
- BioART Fertility (2025). SASREG accreditation and Discovery benefit. bioartfertility.co.za
- Fembryo Clinic (2025). Finances page. fembryo.co.za
- Cape Fertility (2022). Medical schemes that cover fertility treatment. capefertility.co.za
- medicalaid.com (2025). Best medical aids for fertility treatment SA.
⚕ Medical Disclaimer: This content is for educational purposes only and does not constitute medical or financial advice. Always consult qualified professionals before making healthcare or financial decisions.
