Which medical aids in South Africa cover rehabilitation at Houghton House?

Did you know that all medical aid schemes in South Africa are legally obligated to cover substance abuse treatment as a prescribed minimum benefit (PMB)?

This means that if you’re a member of a recognised medical scheme registered in South Africa, your treatment at Houghton House is covered regardless of your plan tier. As a dual-licensed rehabilitation centre and private psychiatric hospital, Houghton House can claim under both addiction and psychiatric PMBs where applicable, which means broader coverage for members with co-occurring mental health conditions.

Below, we’ve summarised what each major medical aid covers at Houghton House, with links to scheme-specific detail pages.

If you’d like to confirm your own medical aid cover before making a decision, our admissions team can verify your benefits and manage pre-authorisation directly with your scheme.

Discovery Health

Discovery Health is South Africa’s largest open medical scheme. Under PMBs, Discovery covers up to 21 days of inpatient rehabilitation and up to 3 days of hospital-based detoxification per year, along with additional inpatient psychiatric care for qualifying conditions.

Discovery reimburses non-designated providers at 80% of scheme rates, but Houghton House waives the remaining balance, so members face no unexpected shortfalls or co-payments.

Note that Discovery excludes out-of-hospital substance abuse treatment, so the coverage applies to inpatient stays only.

Full details on our Discovery Health rehab cover page.

GEMS

The Government Employees Medical Scheme (GEMS) covers public sector employees and their dependants.

GEMS provides PMB cover for up to 21 days of inpatient rehabilitation, 3 days of hospital-based detox, and 21 days of inpatient psychiatric care per year.

For members with a dual diagnosis, additional days may be approved on clinical motivation. Houghton House handles all pre-authorisation directly with GEMS, and co-payments are waived.

Bonitas

Bonitas Medical Fund is one of South Africa’s largest open medical schemes. Its PMB cover includes up to 21 days of inpatient rehabilitation, 3 days of detox, and 21 days of inpatient psychiatric care annually.

Although Houghton House isn’t a designated Bonitas provider, the facility bills at Bonitas scheme rates throughout and waives any shortfalls that would otherwise apply. Waiting periods may apply for new members.

Full details on our Bonitas rehab cover page.

POLMED

POLMED is the medical scheme for South African Police Service members, pensioners, and their dependants.

As a National Hospital Network member, Houghton House bills at POLMED scheme rates with no co-payments or penalties.

POLMED’s PMB cover includes up to 21 days of inpatient rehabilitation, 3 days of detox, and 21 days of psychiatric care per year.

See our POLMED rehab cover page for more details.

Momentum

Momentum Medical Scheme covers up to 21 days of inpatient rehabilitation, 3 days of detox, and 21 days of inpatient psychiatric care per year under PMBs.

Members on premium plans, including Incentive, Extender, and Summit, may have access to additional mental health benefits beyond the standard PMB.

Houghton House waives any penalties that apply and manages all pre-authorisation directly with the scheme.

Visit our Momentum rehab cover page for further details.

Bestmed

Bestmed Medical Scheme contracts directly with the National Hospital Network, of which Houghton House is a member.

PMB cover includes up to 21 days of inpatient rehabilitation, 3 days of detox, and 21 days of psychiatric care annually. Houghton House waives co-payments and handles all pre-authorisation and clinical documentation.

Waiting periods of up to 12 months may apply for new members with pre-existing conditions.

Read more on our Bestmed rehab cover pages.

Medihelp

Medihelp provides PMB cover for up to 21 days of inpatient rehabilitation, 3 days of hospital-based detox, and 21 days of psychiatric care per year.

With Medihelp, we typically require pre-authorisation 48 to 72 hours before admission, or within 72 hours in emergencies. Houghton House manages this process on your behalf, and co-payments are waived. Waiting periods may apply for new members.

Further details are available on our Medihelp rehab cover page.

Fedhealth

Fedhealth’s PMB benefits are consistent across all plan options, with no variation between tiers for substance abuse or psychiatric treatment.

Cover includes up to 21 days of inpatient rehabilitation, 3 days of detox, and 21 days of psychiatric care annually. Houghton House waives co-payments and manages all pre-authorisation directly with the scheme.

See our Fedhealth rehab cover page for full details.

Profmed

Profmed provides PMB cover for up to 21 days of inpatient rehabilitation, 3 days of detox, and 21 days of inpatient psychiatric care per year. Houghton House is a member of the National Hospital Network and bills at Profmed scheme rates, and the facility manages all pre-authorisation and clinical documentation.

Additionally, Houghton House waives any penalties that might otherwise apply.

More details are available on our Profmed rehab cover page.

CAMAF

The Chartered Accountants (SA) Medical Aid Fund is a restricted scheme for accounting professionals and their dependants.

CAMAF provides 100% cover at scheme rates for up to 21 days of inpatient rehabilitation, 3 days of detox, and 21 days of psychiatric care per year. No co-payments apply, and Houghton House handles all pre-authorisation.

New members should be aware that a 3-month general waiting period and a 12-month condition-specific waiting period may apply.

Visit our CAMAF rehab cover page for more.

International medical schemes: Cigna, Pulamed, and BPOMAS

Houghton House accepts cover from several international medical aid schemes. These schemes serve expatriates, NGO and multinational staff, and government employees from across the region.

Cigna, Pulamed (Botswana), and BPOMAS (Botswana Public Officers’ Medical Aid Scheme) all provide cover for up to 21 days of inpatient rehabilitation, 3 days of detox, and 21 days of psychiatric care annually, subject to pre-authorisation.

Pulamed requires a 10% co-payment across all benefit options, but Houghton House typically waives this.

The facility manages all pre-authorisation and clinical submissions directly with each scheme.

Find full details on our international medical aid cover page.

A note on the pre-authorisation process for medical aid rehabilitation cover

Medical aid pre-authorisation before admission is essential. Luckily, this process is very straightforward. It simply involves a brief confidential assessment, after which we submit your documentation to your medical aid on your behalf.

We can do this assessment at Houghton House, where one of our qualified healthcare professionals will evaluate the clinical necessity of rehabilitation and/or psychiatric treatment.

There are no hidden fees or costs for medical aid members, other than a once-off R1850 admission fee not covered by medical aid.

Not sure about your cover?

If your scheme isn’t listed above, or if you’d like to confirm what your specific plan includes before making a decision, our admissions team can verify your benefits directly with your medical aid.

Calls are confidential, and no commitment is required. Our team is available around the clock.

Call us today at 079 770 7532 or use our contact form to get in touch.