Does my medical aid cover addiction treatment?

Which medical aids cover addiction treatment and what this coverage entails.

South Africa is facing an addiction epidemic, with around 15% of the population struggling with substance abuse to varying degrees. Chances are, you or someone you love may face addiction during your lifetime. It can be daunting to try and figure out the best treatment options while considering what can be a sudden and unexpected financial burden. Knowledge of what coverage your medical aid provides is necessary should you need to schedule an admission into treatment. Does my medical aid cover addiction treatment?

Medical aid exists for this very reason—to help lighten your stressful load. At Houghton House, we accept different medical aids to cover treatment costs, including Discovery Health, Bonitas and the Government Employees Medical Scheme (GEMS). These schemes cover rehabilitation services, as addiction is recognised under Prescribed Medical Benefits (PMBs) for all medical aid schemes. Houghton House has the unique advantage of licencing to cover up to 42 days of inpatient treatment per year, but specific benefits can vary between schemes and plans. Houghton House’s dual licensing means that you can get access to comprehensive, high-level treatment (plus any additional therapies) without any cost to you.

Discovery Health

Discovery Health is one of South Africa’s most popular medical aid providers and offers a range of plans that cater for addiction treatment. This medical aid covers varying days of inpatient treatment per year, as well as three additional days of medically supervised detox.

Bonitas Medical Aid

Bonitas also recognises the importance of accessible rehabilitation and provides comprehensive coverage for addiction treatment services. Inpatient rehabilitation is covered, allowing Bonitas members to receive the intensive therapy they require while being medically supervised in a facility.

At Houghton House, this includes detox, counselling, group therapy, educational lectures, family involvement and DBT & CBT, amongst other things.

Outpatient services, either partially covered or paid from savings, can act as a step-down from inpatient care, enabling members to continue therapy while being at home.

With Bonitas, the specifics of coverage may vary depending on which plan you’re on. For instance, a hospital plan offers essential hospital benefits with certain limits, while comprehensive plans include more extensive coverage for those needing broader health services.

Government Employees Medical Scheme (GEMS)

Addiction can be exacerbated by every day stresses, such as work in high-pressure environments. GEMS is a medical aid scheme tailored for government employees and offers accessible and comprehensive coverage for treatment.

Inpatient treatment is covered for up to 21 days, while outpatient coverage allows members access to individual counselling sessions, depending on the member’s specific plan.

Pre-authorisation process

The pre-authorisation process is essential for each medical aid preceding admission and involves an assessment, documentation and approval.

The assessment can be done at Houghton House, and entails undergoing an assessment done by one of our qualified healthcare professionals to determine the necessity of rehabilitation.

Your medical aid will require relevant medical documentation and details of the facility, and finally, approval can be obtained after all the required information has been submitted to confirm coverage of treatment costs. Houghton House will assist with the pre-authorisation process and submit the necessary documentation straight to your medical aid on your behalf.

At Houghton House, there are no hidden fees or costs other than a R1850 admission fees that isn’t covered by medical aid.

Contact us today

Accessing treatment in South Africa is far more feasible through the support of medical aid schemes. Understanding the specifics of your plan and engaging thoroughly in the necessary pre-authorisation processes are vital steps towards a successful and fulfilling recovery journey.

Please contact your medical aid provider to obtain additional information regarding your plan and coverage.