Does Sasolmed Cover Rehab? Addiction Treatment at Changes Rehab
Does your medical aid plan and pre authorisation cover the inpatient addiction treatment you need?
Talk to our admissions team
Does Sasolmed cover rehab? The short answer is yes. How much is funded depends on your option and on pre-authorisation. Understanding your Sasolmed addiction treatment coverage is the first step, and Sasolmed provides comprehensive health cover that includes addiction treatment as a legal minimum.
Sasolmed is a closed scheme. Membership is limited to Sasol South Africa employees and pensioners and their dependants. Anyone else should check our medical aid hub for the scheme they are actually on.
Sasolmed is administered by Discovery Health, which took over administration in January 2024. Authorisation calls and claims run through Discovery’s systems even though Sasolmed is a separate scheme with its own rules and benefits.
Covered by Sasolmed and needing treatment for drug or alcohol addiction? Call us today. We will contact Sasolmed for pre-authorisation and confirm your access to specialised care at Changes Rehab.
Sasolmed’s Prescribed Minimum Benefits (PMBs)
The basis of Sasolmed’s cover for addiction treatment lies in the Prescribed Minimum Benefits (PMBs), a set of defined benefits that all registered medical aid schemes in South Africa must legally cover.
Substance Use Disorder, the clinical term for addiction, is classified as a PMB condition. This matters because every Sasolmed member holds that right regardless of which option they are on.
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 paid from your scheme’s risk benefit rather than from your day-to-day or savings accounts, which protects those funds for other medical needs.
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 option and the availability of funds within your plan’s limits.
| In-patient | Out-patient | |
|---|---|---|
| What it is | Full-time stay at the facility for intensive care, detox and rehabilitation therapy | Regular sessions at the clinic while living at home |
| Who it suits | Severe addiction, where a full-time stay is the gold standard | Maintaining sobriety after an in-patient stay |
| Typical length | Up to 21 days a year, including up to 3 days of detox | Ongoing, with no fixed end point |
| What Sasolmed funds | A significant portion, often the entire approved stay, subject to scheme rate and pre-authorisation | A portion of sessions, depending on your option’s mental health limits |
| Paid from | Risk benefit, as a Prescribed Minimum Benefit | Day-to-day benefits or a dedicated mental health benefit |
| What is included | Accommodation, meals, medical supervision, individual and group therapy | Counselling, follow-up group therapy and aftercare |
In-Patient Rehabilitation
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 are 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 and therapeutic sessions.
Out-Patient Programmes
Out-patient programmes matter for maintaining sobriety after an in-patient stay. This involves regular sessions at the clinic while the patient lives at home, and it includes counselling, follow-up group therapy and aftercare.
Sasolmed cover: depending on your option’s benefits and available mental health limits, Sasolmed often covers a portion of these sessions, which may be paid from your general day-to-day benefits or a dedicated mental health benefit.
Securing Sasolmed Pre-Authorisation for Changes Rehab
Accessing your benefits requires one essential step: pre-authorisation. Medical aids require this to confirm the treatment is medically appropriate and to secure funding before admission. Once approved, Sasolmed issues an authorisation number.
Step-by-Step Authorisation Process
- Contact Changes Rehab: your first step is to contact the Changes Rehab admissions team. We deal with all medical aid schemes, including Sasolmed.
- Clinical Assessment: a clinical assessment is conducted by Changes Rehab’s professionals to determine medical necessity and the recommended duration of treatment.
- Submission: Changes Rehab submits the clinical reports, ICD-10 codes from the F10 to F19 series for substance-related disorders, and the treatment motivation to Sasolmed’s managed care division on your behalf.
- Authorisation Number: once approved, Sasolmed issues an authorisation number confirming the duration of the approved stay and the rate at which the claim will be covered.
We ensure the correct Substance Use Disorder ICD-10 code is used for the pre-authorisation process, so that the submission aligns with both clinical and medical aid terminology.
Does Sasolmed Cover Rehab Fully?
No, Sasolmed does not always provide full coverage for rehab. The level of funding depends on your specific option, benefit limits and authorisation. Sasolmed does include addiction rehabilitation as a Prescribed Minimum Benefit, so the entitlement itself is not in question.
Key factors that affect coverage:
- Your option – the number of days and therapies paid for depends on which Sasolmed option you are on.
- Pre-authorisation – admission must be authorised before treatment to unlock benefits.
- Accredited provider – cover applies at registered and recognised rehab centres.
What is 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 option’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.
Does Sasolmed Cover Secondary Care?
Sasolmed funds primary inpatient care to the authorised length of stay, usually 21 days. Extended secondary and long-term rehab sit outside that authorisation, and halfway houses are not funded.
Our secondary facility, River Manor, runs a 20-bed programme in Ruimsig with 24-hour clinical supervision. Families typically combine Sasolmed-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. A review around week two shows whether the authorised days will be enough, which leaves time to arrange funding rather than deciding at discharge.
Why Choose Changes Rehab with Sasolmed?
Changes Rehab understands the nuances of working with medical aid schemes. We focus on providing evidence-based treatment while making full use of your Sasolmed benefits.
- Direct Billing: we bill Sasolmed directly for the covered portion of your treatment, which minimises your out-of-pocket expenses.
- Optimising Benefits: our team ensures your PMB benefits are correctly applied and that all relevant mental health, psychological and drug treatment limits are used.
- 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.
Get Pre-Authorised With Sasolmed
Sasolmed 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.
Sasolmed Cover FAQ
Does Sasolmed cover rehab for addiction?
Yes. Addiction treatment is a Prescribed Minimum Benefit, so inpatient rehab is covered when it is clinically necessary.
How many days of rehab will Sasolmed pay for?
Up to 21 days of in-hospital rehabilitation a year, subject to clinical authorisation.
Do I need authorisation before admission?
Yes, and Sasolmed must issue an authorisation number before you are admitted.
Does Sasolmed cover outpatient rehab?
Partly. Outpatient therapy is usually paid from day-to-day or mental health benefits, so limits and co-payments vary by option.
Where can I use my Sasolmed rehab benefits?
At accredited and registered rehabilitation centres, including Changes Addiction Rehab.