Discovery medical aid rehab cover at Houghton House

When treatment is approved, Discovery Health covers:

• Psychiatric assessments and diagnostic evaluations
• Medical detox and withdrawal management
• Inpatient rehabilitation, including accommodation and meals
• Individual and group therapy
• Family therapy (where appropriate)
• Consultations with registered psychologists, psychiatrists, and medical doctors
• Psychiatric medication and addiction-related prescriptions (within formulary limits)

All Discovery medical aid rehab admissions must be pre-authorised to ensure full benefit payment. At Houghton House, we guide you through this step with minimal effort required of you.

One of our qualified mental health professionals will perform a psychiatric evaluation or assessment and give you a provisional diagnosis. Once we’ve arrived at a provisional diagnosis, we submit the treatment authorisation request directly to Discovery on your behalf using the relevant PMB and ICD-10 codes.

If you’ve recently joined Discovery or switched plans, waiting periods may apply:

• 3-month general waiting period for new members
• 12-month condition-specific waiting period for pre-existing conditions
• No waiting period for PMBs if you have maintained continuous medical aid cover without a 90+ day break

We will help assess your eligibility and advise you upfront.

Houghton House is not currently listed as a Designated Service Provider (DSP) for Discovery Health. However, we are a registered provider with Discovery and bill all treatment at Discovery Health Scheme rates.

In most cases, Discovery will cover 80% of the treatment cost at non-DSP facilities. Houghton House waives the remaining 20% co-payment, which means your treatment is still fully covered.

There are no additional costs to you beyond the standard admission fee. Our team handles all the paperwork and authorisation to ensure a smooth, stress-free process.

With over 30 years of experience, Houghton House is one of South Africa’s most trusted and established addiction treatment centres.

We are:

• A registered Discovery service provider
• Licensed to treat dual-diagnosis cases (addiction with mental health conditions)
• Staffed by leading addiction psychiatrists, psychologists, and social workers
• Able to provide up to 42 days* of comprehensive care when clinically appropriate
• Fully committed to helping you access the cover you are entitled to

Our dedicated case management team works closely with Discovery throughout your stay, ensuring all treatment is pre-authorised, billed correctly, and reported as required. From your first call to the final day of care, we strive to make the process straightforward, supportive, and completely transparent.

* This may include 3 days of in-hospital detox, 21 days of psychiatric or dual-diagnosis treatment, and up to 18 additional days of step-down rehabilitation, depending on medical aid authorisation and clinical need.

Yes, but the structure of that cover depends on the condition being treated and whether care is inpatient or outpatient.

For addiction treatment, the relevant PMB (code 182T) covers hospital-based rehabilitation for up to three weeks per year. Therapy delivered within a residential programme, including individual counselling, group therapy, and other clinical modalities, is part of that inpatient benefit. There is no separate outpatient therapy PMB for addiction alone.

For qualifying psychiatric conditions, the picture is different. PMB code 902T covers major affective disorders, including unipolar and bipolar depression and schizoaffective disorders, through either up to three weeks of inpatient psychiatric care or up to 15 outpatient contacts per year, shared across psychiatrists and psychologists. These options are structured as an alternative to each other: the 15 outpatient contacts are not available in addition to an inpatient stay under the same PMB code. Discovery Health requires annual reapplication for PMB cover for conditions such as depression.

Where a patient has both an addiction and a qualifying co-occurring psychiatric condition, the two PMB codes apply independently. Houghton House’s dual licensing as both a rehabilitation facility and a registered psychiatric hospital means that addiction and qualifying co-occurring conditions can be assessed, treated, and claimed under the appropriate codes within the same admission.

Discovery Health also offers additional benefits above the PMB minimum for psychological services, including a dedicated psychotherapy benefit and plan-specific annual allowances for allied and therapeutic services. These are in addition to PMB entitlements and subject to your plan’s annual limits and scheme rules.

Houghton House rehab and private psychiatric hospital bills at scheme rates and typically waives any Discovery shortfalls or co-payments beyond the once-off admission fee. When treatment is pre-authorised, most members pay nothing beyond the R1,850 admission fee.

Note that any co-payments for medication remain the patient’s responsibility. Medication costs vary considerably, but this co-payment typically doesn’t exceed R2,000.

Possibly, yes — but with limits:

Gambling disorder or gambling addiction is not currently classified as a PMB. This means it doesn’t receive the same legally mandated medical aid coverage as substance abuse treatment.

However, your treatment for a gambling disorder may be covered under your psychiatric care benefit if you present with a dual diagnosis that is covered by PMBs, such as major depression, bipolar disorder, or schizoaffective disorder.

Yes, this is normal with pre-authorisation. Once admitted, the admitting doctor will complete and submit a diagnostic form (DSM form) to your medical aid, and your approved length of stay will be updated.

Yes. Drug and alcohol rehabilitation is a Prescribed Minimum Benefit (PMB) in South Africa, meaning all registered medical aid plans are legally required to cover it. Every Discovery plan qualifies, including KeyCare.