Does Bankmed Pay for Rehabilitation?
Will your medical aid cover the clinical rehabilitation recommended for you, and what authorisation and eligibility steps will you need to take?
Talk to our admissions team
Yes. Bankmed funds inpatient addiction rehabilitation as a Prescribed Minimum Benefit, currently 21 days of inpatient treatment a year with a further 3 days of medical detox.
Bankmed is a closed scheme. Membership is limited to people employed by a participating employer in the banking and financial services industry, so anyone outside banking should check our medical aid hub for the scheme they are actually on.
Founded in 1914 for the banking sector, Bankmed is administered by Discovery Health, which has held the administration contract since 2016. Bankmed and Discovery Health Medical Scheme are separate schemes, so authorisation runs through Discovery’s systems while the benefits and rules are Bankmed’s own.
What Bankmed Covers for Rehab
Bankmed funds the inpatient rehab pathway under Prescribed Minimum Benefits. The cover includes up to 3 days of medically supervised detox and 21 days of structured inpatient treatment, along with psychiatric assessment and the counselling and group therapy delivered inside the facility.
This is a legal floor rather than a benefit the scheme chooses to offer. The Council for Medical Schemes requires every registered scheme to fund substance use disorders, ICD-10 codes F10 through F19, as a Prescribed Minimum Benefit, which is why cover cannot simply be declined.
Bankmed Medical Aid Overview
Bankmed has established itself as a trusted medical aid provider, offering a range of health plans designed to meet the diverse needs of its bank-employed members.
Drug and Alcohol Rehabilitation Services Covered by Bankmed
Bankmed recognises the importance of addiction rehabilitation in a patient’s recovery process. Medical aid typically covers various rehabilitation services, including inpatient care, outpatient psychologist sessions and psychiatric appointments. The extent of Bankmed coverage depends on the policyholder’s chosen plan and the specific services required.
Eligibility Criteria for Addiction Rehabilitation Coverage
To be eligible for addiction rehabilitation coverage, Bankmed policyholders must meet certain criteria. This includes an up-to-date policy, and for a rehab admission no formal referral is needed.
It is in Bankmed’s best interest to keep its members healthy. Addiction is a recognised brain disease and there is no shame in needing treatment.
How to Claim Rehabilitation Expenses from Bankmed
Claiming rehabilitation expenses involves a straightforward process. The rehabilitation centre will call Bankmed and get pre-authorisation on your behalf, and the rehab handles the documentation and reports for Bankmed to review.
Limitations and Exclusions
Bankmed offers coverage for rehabilitation services, currently 21 days of inpatient rehab and another 3 days of detox per year, and there are limitations within its policies.
Bankmed funds a defined package. What sits inside it, and what does not:
| Funded by Bankmed | Paid by the family | |
|---|---|---|
| Inpatient rehab | 21 days a year | Any stay beyond the authorised days |
| Medical detox | 3 days a year | Detox needed again later in the same benefit year |
| Therapy inside the admission | Individual and group sessions during the funded stay | Sessions once the allocation is used up |
| Psychologist and psychiatric sessions | Covered, subject to your plan’s limits | Sessions above those limits |
| Secondary care | Not funded | The full cost, usually at River Manor or similar |
| Halfway house and sober living | Not funded | The full cost |
Policyholders must be aware that long-term rehab is not covered. Relapse rates reduce at 90 days, and patients with severe addictions often need 90 days of inpatient treatment or more. The family will have to fund the patient’s secondary care and halfway house treatment out of pocket.
Does Bankmed Cover Secondary Care?
Bankmed funds primary inpatient care to the authorised length of stay. What happens after that is the question the exclusions raise but never answer.
Our secondary facility, River Manor, runs a 20-bed programme in Ruimsig with 24-hour clinical supervision. Families typically combine Bankmed-funded primary care at the Northcliff facility with a private arrangement for secondary care once the patient has stabilised.
Ask the treating team about step-down while the admission is still running, rather than at discharge. A review around week two shows whether the authorised days will be enough.
Admitting a Bankmed Member
Changes Rehab admits Bankmed members regularly, and we have strong outcomes in helping them into long-term recovery. Call 081 444 7000 for more on how Bankmed can fund your treatment.
How Bankmed Compares
Bankmed is administered by Discovery Health, which has held the contract since 2016, though Bankmed and Discovery Health Medical Scheme remain entirely separate schemes with their own rules and benefits.
Bankmed’s rehabilitation benefits compare well. Most other medical aids do not fund three days of detoxification the way Bankmed does.
Common Problems with Bankmed Claims
Facing challenges with medical aid claims can be daunting. Because Changes Rehab is fully licensed, we only need to give Bankmed three pieces of information to secure your pre-authorisation: our rehabilitation clinic practice number, our GP’s practice number and the ICD-10 code for the diagnosis.
Get Pre-Authorised With Bankmed
Bankmed member? Send your membership number and the main member’s ID to our admissions team on 081 444 7000 or start the pre-authorisation form. We handle the Discovery Health call for you.
Bankmed Cover FAQ
What types of addiction rehabilitation services does Bankmed cover?
All chemical addictions, including alcohol and drugs. Process addictions such as eating disorders, gambling and sex are covered under the psychiatric benefit, but treatment will be in a psychiatric hospital.
How do I know if I am eligible for rehabilitation coverage under my Bankmed policy?
Call us to find out. If your policy is fully paid up and you did not join recently, it should not be a problem.
What is the process for claiming rehabilitation expenses?
We call Bankmed on your behalf and get the pre-authorisation.
Are there any limitations to the rehabilitation coverage offered by Bankmed?
Long-term rehab is not covered, so secondary care and halfway house stays are funded privately.
How does Bankmed’s rehabilitation coverage compare to other medical aids?
Well. Most other medical aids do not cover three days of detoxification as Bankmed does.
Does Bankmed pay for rehab? Yes, 21 days of inpatient treatment a year under PMBs, with 3 days of detox. See what is funded and what is not.. Changes team counsellors are here to help you.Does Bankmed Pay for Rehab? Cover, Limits and Pre-Auth
