As a recognisable, diagnosable and treatable disease, substance abuse and dependence are deemed to be Prescribed Minimum Benefits. These are minimum benefits which, by law, must be provided to all medical scheme members, and include the provision of diagnosis, treatment and care costs.
Treatment is therefore covered to different extents by all medical aid schemes. Some medical aids pay out of the inpatient Mental Health Benefit, while others have a specialised Substance Abuse Benefit for inpatient treatment. It is important to note that outpatient treatment is generally not covered by the allocated Substance Abuse Benefit which is quoted by the medical aid consultant. Outpatient treatment is generally covered on a per-session basis under the Psychotherapy Benefit.
Although some treatment centres may be fully covered by a medical aid, the majority of privately run treatment centres require some self-payment which will need to be carried by the patient. It is certainly advisable to be guided as to the maximum benefits obtainable from your medical aid scheme.
Pre-authorisation is by no means a laborious task, and can be arranged by any competent rehabilitation facility. In order for a treatment centre to be covered by a medical aid scheme, it must be registered by the Department of Social Development. Below is a list of medical aids that provide differing substance abuse benefits.