Houghton House
Profmed medical aid rehab cover at Houghton House
Profmed medical aid rehab cover ensures access to quality inpatient treatment at Houghton House, one of South Africa’s leading rehab centres. If you’re seeking rehabilitation through Profmed, Houghton House provides professional addiction treatment and inpatient psychiatric care. Keep reading to learn how your Profmed rehab benefits apply to substance abuse and related psychiatric conditions.
About Profmed medical aid
Profmed Medical Scheme is a restricted medical aid, available only to graduate professionals and their dependents. It has 34,691 members and 70,971 beneficiaries, according to the most recent industry financial performance report published by the Council for Medical Schemes (CMS).
The scheme was launched by the Professional Provident Society (PPS) in 1959 and formally became known as Profmed Medical Scheme in January 1970. It is registered with the Council for Medical Schemes (CMS) and operates on a not-for-profit basis in line with the Medical Schemes Act of 1998.
Profmed offers a range of benefit options — including ProPinnacle, ProSecure Plus, ProSecure, ProActive Plus, and ProActive — as well as Savvy variants that use network hospitals to reduce contributions. Its benefits are tailored to meet the needs of working professionals and their families, with a focus on providing comprehensive hospital cover and preventative care.
Does Profmed cover rehabilitation?
Yes. Profmed covers inpatient rehabilitation for substance use disorders as part of the Prescribed Minimum Benefits (PMBs) guaranteed under the Medical Schemes Act of 1998. These benefits apply across all Profmed plans and include:
- 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
Additional days of treatment may be approved on motivation if clinically justified, particularly in cases of dual diagnosis (for example, addiction accompanied by depression or anxiety). While rehabilitation coverage beyond PMBs may differ depending on your chosen Profmed option, all members are entitled to the minimum PMB benefits.
Does Profmed cover psychiatric care?
Yes. Inpatient psychiatric treatment for specific mental health conditions is also covered under PMBs, ensuring that Profmed members can access essential psychiatric care when hospitalisation is medically necessary. This includes:
- Up to 21 days of inpatient psychiatric treatment per beneficiary per year
- Conditions covered under PMBs include brief reactive psychosis, major affective disorders (such as major depression and bipolar disorder), and schizophrenic and paranoid delusional disorders
These PMB entitlements apply across all Profmed options. Additional psychiatric benefits may vary by plan, but every member has a legal right to the PMB minimum.
How Houghton House works with Profmed medical aid
Houghton House is dual-licensed as both a psychiatric hospital and a rehabilitation facility. We are also part of the National Hospital Network (NHN), which means all services are billed at Profmed scheme rates.
Our admissions team works directly with Profmed to handle all pre-authorisation and claim submissions, ensuring that members and their families face no administrative burden. All clinical services are provided by registered professionals within Profmed’s PMB framework.
- No upfront payments are required, except a once-off admission fee
- No co-payments or shortfalls, even if Profmed reimburses below 100% of scheme rates
- Seamless authorisation and claims management handled entirely on your behalf
We work closely with Profmed to make sure treatment is fully funded within your plan’s benefit limits. Even if penalties or shortfalls would normally apply, Houghton House typically waives these so members can access the care they need without financial barriers.
FAQs
Profmed provides cover for substance abuse rehabilitation and inpatient psychiatric care in line with the Prescribed Minimum Benefits (PMBs) required by law. Profmed covers:
- Up to 21 days of inpatient rehabilitation per year, including treatment for drug and alcohol dependency
- Up to 3 days of in-hospital detoxification per year
- Psychiatric evaluation, diagnosis, and medication for PMB conditions
- Up to 21 days of inpatient psychiatric care per year for PMB mental health conditions (including major depression, bipolar mood disorder, schizophrenia, and other serious psychiatric conditions)
- Treatment for dual-diagnosis cases, where addiction co-occurs with psychiatric conditions, when clinically indicated
These benefits apply across all Profmed plans as part of the PMB framework, with additional benefits available on some options.
Houghton House is not currently listed as a Profmed DSP. However, as a member of the National Hospital Network (NHN), all our services are billed at Profmed scheme rates. Additionally, we typically waive penalties that could otherwise apply, ensuring members can access treatment without financial barriers. This means you won’t face co-payments for approved admissions — even if we are not formally listed as a Profmed DSP.
No referral is needed. You can contact Houghton House directly. Admission begins with a confidential assessment by one of our registered professionals.
Our case management team prepares and submits the required motivation to Profmed for pre-authorisation. We manage the paperwork, coding, and communication with Profmed, so there’s no administrative burden on you or your family.
No. Apart from a once-off admission fee, all approved services are fully covered by Profmed when treatment is authorised and clinically appropriate. If Profmed only covers a portion of scheme rates, Houghton House waives any shortfalls or co-payments, guaranteeing Profmed members can access treatment without unexpected financial shortfalls.
Before admission, Profmed requires pre-authorisation for rehabilitation or psychiatric hospitalisation. At Houghton House, our team manages this process entirely on your behalf — from compiling the necessary clinical motivation to liaising directly with Profmed’s managed care team. We also provide ongoing updates to ensure continued approval throughout your stay.
If you recently joined Profmed or rejoined after a gap in membership, Profmed may apply waiting periods. These include:
- A 3-month general waiting period for all benefits
- 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 confirm your benefit status upfront and guide you if any waiting periods apply to your membership.
Houghton House has been trusted for 30 years as one of South Africa’s leading addiction and mental health treatment centres. Our team combines professional expertise with compassionate care to support Profmed members and their families through every stage of recovery.
We are:
- Dual-licensed as both a psychiatric hospital and a rehabilitation facility
- A member of the National Hospital Network, billing at Profmed scheme rates
- Experienced in securing pre-authorisation and managing claims directly with Profmed
- Specialists in dual diagnosis care for co-occurring addiction and psychiatric conditions
- Staffed by highly qualified addiction and mental health professionals
By choosing Houghton House, Profmed members gain access to evidence-based treatment, seamless administrative support, and the assurance of no unexpected financial shortfalls — so you can focus entirely on recovery.
Proud member of
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