Does Sasolmed cover rehab? The short answer is yes, but the details depend on your plan and pre-authorisation. Understanding your Sasolmed addiction treatment coverage is the first crucial step. Sasolmed Medical Aid provides comprehensive health coverage for its members, extending critical support for conditions including SUD & AUD (Substance Use Disorder &Alcohol Use Disorder).
If you or a loved one are covered by a Sasolmed plan and require treatment for drug or alcohol addiction, call use today, we’ll contact SasolMed for pre-authorisation and see if you can access specialised care at Changes Rehab.
Understanding Sasolmed’s Obligation: Prescribed Minimum Benefits (PMBs)
The basis of Sasolmed’s cover for addiction treatment lies in thePrescribed Minimum Benefits (PMBs), a set of defined benefits that all registered medical aid schemes in South Africa must legally cover.
Substance Use Disorder (SUD)—the clinical term for addiction—is classified as a PMB condition. This is critical because it means all Sasolmed members, regardless of the plan they are on (e.g., Sasolmed Prime, Sasolmed Value, or Sasolmed Network), are entitled to the necessary minimum level of care. Sasolmed must cover inpatient treatment for addiction as a PMB when clinically required. This usually includes up to 21 days per year in a registered rehab. Outpatient sessions may be paid from your day-to-day or psychiatric benefit, depending on your plan.
Families often ask us: does Sasolmed cover rehab for alcohol or drug addiction? The answer is yes, but with conditions.
Key PMB Cover Points for Addiction:
- Duration: PMB coverage typically guarantees a minimum of 21 days of in-patient treatment per year for detoxification and rehabilitation, provided the treatment is deemed medically necessary.
- Treatment Scope: Cover extends to the diagnosis, treatment, and care required to manage the acute phase of the disorder.
- Funding Source: PMB-related claims are generally paid from your scheme’s risk benefit and not from your day-to-day or savings accounts, protecting your funds for other medical needs. Paid from risk benefit, not day-to-day savings.
In-Patient vs. Out-Patient Addiction Treatment Cover
While the PMBs guarantee a minimum standard, the total scope of your cover will depend on your specific Sasolmed medical aid option and the availability of funds within your plan’s limits.
1. In-Patient Rehabilitation (The Priority)
In-patient treatment at Changes Rehab involves a full-time stay at the facility for intensive care, detox, and rehabilitation therapy. This is the gold standard for severe addiction and is where your PMB benefits will be primarily applied.
- Sasolmed Cover: Your plan will cover a significant portion, if not the entirety, of the approved stay, subject to the scheme’s rate and pre-authorisation. Cover typically includes accommodation, meals, medical supervision, therapeutic sessions (individual and group), and basic medication. Sasolmed usually pays scheme rate, not always full private rate.
2. Out-Patient Programmes (Essential Follow-up Care)
Out-patient programmes are crucial for maintaining sobriety after an in-patient stay. This involves regular sessions at the clinic but allows the patient to live at home.This includes counselling, follow-up group therapy and aftercare.
- Sasolmed Cover: Depending on your plan’s benefits and available mental health/psychiatric limits, Sasolmed often covers a portion of these sessions, which may be paid for from your general day-to-day benefits or a dedicated chronic/mental health benefit.
Securing Sasolmed Pre-Authorisation for Changes Rehab
Accessing your benefits requires one essential step: pre-authorisation. Medical aids require this process to ensure the treatment is medically appropriate and to secure funding before admission. If approved, Sasolmed issues an authorisation number confirming how long you can stay and what portion they’ll pay.
Step-by-Step Authorisation Process:
- Contact Changes Rehab: Your first step is to contact the Changes Rehab admissions team. We are highly experienced in dealing with all medical aid schemes, including Sasolmed.
- Clinical Assessment: A clinical assessment will be conducted by Changes Rehab’s professionals to determine the medical necessity and recommended duration of addiction treatment.
- Submission: Changes Rehab will typically submit the necessary clinical reports, ICD-10 codes (e.g., F10-F19 series for substance-related disorders), and treatment motivation to Sasolmed’s Managed Care division on your behalf.
- Authorisation Number: Once the claim is approved, Sasolmed will issue an authorisation number which confirms the duration of the approved stay and the rate at which the claim will be covered.
We’ll ensure that Substance Use Disorder (SUD) ICD-10 code is used for the pre-authorisation process to align with clinical and medical aid terminology, ensuring your claim is processed efficiently as a PMB benefit.
Does Sasolmed Cover Rehab Fully?
No, Sasolmed does not always provide full coverage for rehab. The level of funding for drug and alcohol treatment depends on your specific plan, benefit limits, and authorisation. Still, Sasolmed does include addiction rehabilitation as a Prescribed Minimum Benefit (PMB), which means inpatient treatment like detox and rehab is covered, although the duration and scope differ.
Key factors that affect coverage:
Your plan – The number of days and therapies paid for depend on your Sasolmed option.
Pre-authorisation – Admission must be authorised before treatment to unlock benefits.
Accredited provider – Cover applies at registered and recognised rehab centres.
What’s typically included:
Detoxification – Medically supervised withdrawal, sometimes up to three in-hospital days.
Inpatient rehab – Often up to 21 days per calendar year at an accredited facility.
Therapy and counselling – Group and individual sessions for substance use.
Medication – Certain withdrawal management medicines may be covered.
How to confirm your benefits:
Contact Sasolmed – Ask for exact details on your plan’s rehab cover and any restrictions.
Work with your rehab – Changes Rehab admissions staff can liaise with Sasolmed, secure authorisation, and explain what is funded.
Why Choose Changes Rehab with Sasolmed?
Changes Rehab is a leading facility that understands the nuances of working with medical aid schemes. We focus on providing evidence-based treatment while maximising your Sasolmed benefits.
- Direct Billing: We work to bill Sasolmed directly for the covered portion of your treatment, minimising your out-of-pocket expenses.
- Optimising Benefits: Our team ensures your PMB benefits are correctly applied and that all relevant limits (e.g., mental health, psychological, or drug treatment limits) are utilised.
- Comprehensive Care: Our programmes include medical detoxification, individual counselling, group therapy, family support, and aftercare planning, all of which are included in the treatment motivation submitted to Sasolmed.
Frequently Asked Questions About Sasolmed Rehab Cover
Does Sasolmed cover rehab for addiction?
Yes. Addiction treatment is recognised as a Prescribed Minimum Benefit (PMB). Inpatient rehab is typically covered when clinically necessary, usually for up to 21 days per calendar year.
How many days of rehab will Sasolmed pay for?
Most Sasolmed plans fund up to 21 days of in-hospital rehabilitation per year, subject to clinical authorisation.
Do I need authorisation before admission?
Yes. Pre-authorisation is required. Sasolmed must issue an authorisation number confirming the approved length of stay and payment terms.
Does Sasolmed cover outpatient rehab?
Outpatient therapy may be paid from day-to-day or mental health benefits, depending on your plan. Coverage and limits vary, and co-payments are possible once benefits are used up.
Where can I use my Sasolmed rehab benefits?
Cover applies at accredited and registered rehabilitation centres, such as Changes Addiction Rehab.
Do not let the complexity of medical aid funding prevent you from seeking help. Contact the Changes Rehab admissions team today to verify your specific Sasolmed benefits and start the pre-authorisation process immediately.
