Houghton House
Medihelp medical aid rehab cover at Houghton House
Medihelp medical aid rehab cover ensures access to quality inpatient treatment at Houghton House, one of South Africa’s leading rehabilitation centres. If you’re seeking rehabilitation through Medihelp, Houghton House provides professional addiction treatment and inpatient psychiatric care. Keep reading to learn how your Medihelp rehab benefits work for substance abuse and related psychiatric conditions.
About Medihelp medical aid
Founded in 1905, Medihelp is one of the oldest medical schemes in South Africa.
Originally named the Civil Service Medical Benefit Association (CSMBA), the scheme was renamed in 1973 to the Public Service Medical Aid Association (PSMAA). PSMAA served as the official medical scheme for state employees, administrating both Polmed and Prismed from 1981.
In 1992, PMSAA changed its name to Medihelp and became an open medical scheme, allowing any South African to become a member. Today, Medihelp is one of South Africa’s top five open medical schemes, with 101,633 members and 216,786 beneficiaries, according to the most recent Council for Medical Schemes (CMS) industry report.
Does Medihelp cover rehabilitation?
Yes. Medihelp covers substance abuse treatment, in line with the Prescribed Minimum Benefits (PMBs) mandated by the Medical Schemes Act 131 of 1998. This includes:
- Up to 21 days of inpatient rehabilitation per beneficiary per year
- Up to 3 days of hospital-based detoxification per year
- Treatment for both drug and alcohol dependency
- Additional support for psychiatric conditions when clinically indicated
These benefits apply across all Medihelp plans and are guaranteed under South African law. Additional days may be considered on motivation if clinically justified, especially where dual-diagnosis (e.g., addiction and depression) is present. Additional cover for alcohol or drug addiction treatment may vary between plans
Does Medihelp cover psychiatric care?
Yes. Inpatient psychiatric treatment for specific mental health conditions is also covered as a Prescribed Minimum Benefit, ensuring Medihelp members have access to essential care when hospitalisation is medically necessary.
This includes up to 21 days of hospital-based psychiatric treatment per year for the following psychiatric conditions covered by PMB:
- Brief reactive psychosis
- Major affective disorders, including major depression and bipolar depression
- Schizophrenic and paranoid delusional disorders
As with Medihelp’s rehabilitation cover, this applies across all benefit options, as long as the treatment is deemed clinically appropriate and pre-authorisation is granted. Additional psychiatric benefits may vary between plans, but all members are entitled to the PMB minimum.
How Houghton House works with Medihelp medical aid
Houghton House is dual-licensed as both a psychiatric hospital and as a rehabilitation facility. We are a registered provider with Medihelp and a member of the National Hospital Network (NHN), so all services are billed at Medihelp scheme rates.
Our team handles pre-authorisation directly with Medihelp on your behalf, and all clinical services are provided by registered professionals within Medihelp’s PMB framework. This ensures:
- No upfront payments are required, except a once-off admission fee
- No co-payments or shortfalls
We work closely with Medihelp to make sure all treatment is fully funded within your plan’s benefit limits, and we guarantee there are no unexpected shortfalls or co-payments. This means even if Medihelp covers only 80% of the scheme rate, we’ll waive penalties that may otherwise apply for out-of-network care.
FAQs
Medihelp covers substance abuse rehabilitation and inpatient psychiatric treatment as part of its Prescribed Minimum Benefits (PMBs). This means members are entitled to:
- Up to 21 days of inpatient rehabilitation per year
- Up to 3 days of hospital-based detoxification per year
- Psychiatric evaluation, diagnosis, and medication for PMB conditions
- Up to 21 days of hospital-based management per year for specific psychiatric conditions
- Cover for alcohol and drug dependency as well as dual-diagnosis treatment for co-occurring mental health conditions
Treatment is covered at the Medihelp scheme rate, provided it is pre-authorised and at a registered facility like Houghton House. If a longer stay is required, additional days may be considered on motivation, but these are subject to clinical review and scheme rules.
Houghton House is not currently a designated service provider (DSP) for Medihelp. However, we are a registered provider and part of the National Hospital Network (NHN).
While DSP rules may vary between benefit options, all services at Houghton House are billed at Medihelp scheme rates. Any co-payments or penalties that might otherwise apply are typically waived, ensuring no unexpected costs for patients or their families.
No referral is required. You can contact Houghton House directly. Our process begins with a confidential assessment by one of our registered professionals. Our case management team handles the full pre-authorisation process with Medihelp, including clinical coding and supporting documents. This means there’s no administrative burden on you or your loved ones.
No. Apart from a once-off admission fee, all approved services are fully covered by Medihelp when treatment is authorised and clinically appropriate. If Medihelp only covers a portion of scheme rates, Houghton House waives any shortfalls or co-payments, guaranteeing no out-of-pocket expenses for the duration of your authorised treatment.
Medihelp requires that all hospital admissions be pre-authorised 48–72 hours in advance (or within 72 hours of admission in emergencies). This involves submitting documentation detailing your medical diagnosis and treatment plan, including the correct ICD-10 codes.
At Houghton House, Medihelp members can access the treatment they need without financial stress or administrative hurdles. Our admissions team manages this entire process on your behalf. We provide the clinical motivation, diagnosis, and supporting documentation to Medihelp, and we keep them updated with progress reports throughout your stay.
Medihelp may apply general waiting periods or condition-specific waiting periods if you recently joined Medihelp or rejoined after a gap in membership. These include:
- A 3-month general waiting period for new members or dependents
- A 12-month condition-specific waiting period for pre-existing conditions
During this time, planned admissions for rehabilitation or psychiatric care may not be covered. However, PMB-related care (including treatment for substance use and psychiatric conditions) may still be covered during waiting periods. Houghton House will verify your benefit status and advise you upfront if any waiting periods affect your admission or coverage.
By choosing Houghton House, Medihelp members gain access to professional, evidence-based care that meets the highest clinical standards. Our close collaboration with Medihelp ensures that members receive the benefits they are entitled to, while we handle the administrative process to make admission as seamless as possible.
We are:
- Dual-licensed as both a psychiatric hospital and a rehabilitation facility
- A member of the National Hospital Network, billing at Medihelp scheme rates
- Specialists in dual diagnosis treatment for co-occurring addiction and psychiatric conditions
- Experienced in securing pre-authorisation and managing claims directly with Medihelp
- Staffed by highly qualified professionals providing trusted, evidence-based care
With 30 years of experience in addiction treatment, Houghton House combines clinical expertise with a patient-first approach. We support you every step of the way with expert care, financial peace of mind, and a clear path toward lasting recovery.
If you’re a Medihelp member and need help for addiction or mental health, we’re here to help. Our team will support you with every step, from assessment to authorisation and admission.
Contact us today at 011 787 9142 to start your treatment.
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