Momentum medical aid rehab cover at Houghton House

Momentum Medical Scheme covers both substance use rehabilitation and psychiatric hospitalisation under Prescribed Minimum Benefits (PMBs). Qualifying treatment for substance-related and certain psychiatric conditions is funded when medically necessary and pre-authorised.

• Medically supervised detoxification for acute withdrawal
• Inpatient rehabilitation for alcohol, drug, and substance-related disorders
• Inpatient psychiatric care for conditions like schizophrenia, bipolar disorder, major depression, and acute psychotic disorders
• Up to 21 days of hospital care per year for rehabilitation or psychiatric admissions under PMB rules
• Psychiatric medication and addiction-related prescriptions (within formulary limits)

Certain Momentum plans (such as Incentive, Extender, and Summit) offer mental health benefits — including drug and alcohol rehabilitation — in addition to these Prescribed Minimum Benefits.

Houghton House is not currently a designated service provider (DSP) for Momentum. However, we are a registered provider and a member of the National Hospital Network (NHN), which means all services are billed at Momentum scheme rates.

While some Momentum options require that you use specific Associated providers, others allow you to use Any provider without co-payments or shortfalls.

In practice, not being a Momentum DSP doesn’t affect your cover at Houghton House, as we typically waive any penalties that might apply when not using an Associated provider.

No referral is required. You can contact Houghton House directly to begin the process. We start with a confidential assessment by one of our registered mental health professionals. Our case management team prepares the necessary documentation and requests pre-authorisation from Momentum on your behalf.

This means you don’t have to manage any paperwork, clinical coding, or admin. We ensure that your admission is authorised correctly and that your treatment is funded within Momentum’s rules and PMB framework.

No. As long as your admission has been pre-authorised and the treatment meets clinical criteria, your Momentum benefits will cover the cost of rehabilitation and psychiatric care at Houghton House.

Houghton House is a member of the National Hospital Network (NHN) and charges scheme rates. If a penalty or co-payment would normally apply — for example, when a particular plan requires you to use Associated providers — Houghton House typically waives these shortfalls. This means your treatment is fully covered, with no unexpected costs for you or your family.

All hospital admissions for rehabilitation or psychiatric care must be pre-authorised. At Houghton House, we handle this entire process for you.

Once your assessment confirms a diagnosis, our case management team submits the required documentation and motivation directly to Momentum. We also provide ongoing clinical reports to ensure your authorisation remains valid for the full duration of treatment.

This means you don’t have to manage any of the admin. We take care of authorisation, clinical coding, and communication with Momentum, so you can focus fully on your recovery.

Momentum Medical Scheme applies waiting periods in certain situations, such as when you are a new member, when you switch from another scheme, or if you have a recent break in medical aid cover. These waiting periods are set out in the

Medical Schemes Act and can include a general waiting period of up to three months, or a 12-month condition-specific waiting period.

Importantly, waiting periods do not apply to Prescribed Minimum Benefits (PMBs). This means that, if you require urgent psychiatric care or substance abuse treatment that qualifies as a PMB, you cannot be denied cover, even during a waiting period.

If you are unsure whether waiting periods apply in your case, Houghton House can help confirm your status with Momentum before admission

For 30 years, Houghton House has been trusted as one of South Africa’s leading addiction and mental health treatment centres. We combine clinical expertise with compassionate care to support both patients and families throughout the recovery journey.

We offer:

• Full-spectrum recovery assistance, from assessment and medical detox to inpatient rehab, family support, and relapse prevention
• Specialised dual diagnosis treatment for people facing both addiction and co-occurring mental health conditions
• Structured recovery in a safe and supportive environment staffed by a team of passionate, highly qualified addiction and mental health specialists
• Expert assistance in navigating Momentum authorisation and benefit structures

At Houghton House, you are supported every step of the way with expert care, financial peace of mind, and a clear path toward lasting recovery.