Does Bestmed cover inpatient substance abuse treatment and detox?

Yes. Bestmed provides cover for inpatient substance abuse treatment under its hospital and mental health benefits, with up to 21 days’ stay per year for in-hospital management.

What outpatient or therapy benefits does Bestmed offer for addiction?

Bestmed may cover outpatient psychotherapy, counselling sessions and therapy contact sessions, subject to option rules, designated service provider use and pre-authorisation.

Does Bestmed cover secondary treatment or halfway housing?

No. Neither is funded, so members carry those costs privately. Raise it with our admissions team early so the funding can be planned rather than decided at discharge.

How does Bestmed approach funding for addiction treatment overall?

Bestmed funds the clinically necessary inpatient pathway as a Prescribed Minimum Benefit and applies option rules to everything beyond it, which is why the authorisation matters more than the brochure.

What should Bestmed members check before agreeing to an admission?

Confirm the authorised days, whether the facility is approved, and any co-payment. Get all three in writing before a bed is held.

Bestmed Medical Aid Coverage Overview

Does your medical scheme cover up to 21 days of inpatient rehabilitation and a medically supervised detox for addiction?

Bestmed covers addiction rehabilitation. Inpatient rehab and medically supervised detox are Prescribed Minimum Benefits, so every Bestmed option is required by law to fund them, usually up to 21 days of inpatient treatment a year.

Bestmed is an open scheme, so membership is not tied to an employer, and it is the largest self-administered scheme in South Africa. That means benefits and authorisations are handled by Bestmed itself rather than by a third-party administrator.

Bestmed funds the treatment, but you need pre-authorisation first. What gets approved depends on your option and your clinical motivation. Call Changes on 081 444 7000 and we handle that authorisation with Bestmed directly.

Key Takeaways

Bestmed covers alcohol rehab with pre-approval
Coverage varies depending on the option
Members must use approved facilities to receive full coverage

Does Bestmed Cover Rehab?

Yes. Because addiction is a chronic condition, South African law classes substance use disorder as a Prescribed Minimum Benefit, and Bestmed must cover it on every option.

Eligibility For Alcohol Treatment Coverage

Members are eligible for alcohol treatment coverage once their membership is active and in good standing. Cover applies at approved facilities and is subject to pre-authorisation, and some options carry a co-payment on admission.

Extent Of Coverage For Alcohol Abuse Treatment

Bestmed Medical Aid offers options ranging from basic to comprehensive. The scheme covers inpatient rehabilitation and medically supervised detoxification on every option, because those are Prescribed Minimum Benefits. Outpatient services and counselling sessions are funded from day-to-day or mental health benefits, so what you get depends on the option you are on.

Cover centres on inpatient treatment, with detox included as part of the admission. The table below shows what comes standard as a Prescribed Minimum Benefit and what depends on your specific option.

Funded as a PMB	Depends on Your Option
Inpatient rehabilitation, up to 21 days a year	Outpatient therapy and counselling
Medically supervised detox	Aftercare and support-group sessions
Psychiatric and dual-diagnosis care	Day limits beyond the PMB minimum
Treatment for the member and dependants	Co-payments on certain options

Alcohol Abuse Treatment Programmes Covered

The options cover inpatient treatment facilities, certain outpatient services and counselling sessions. Each type of programme caters to different needs and severity levels of alcohol abuse.

Inpatient Rehab Treatment

Changes Addiction Rehab provides a highly structured environment with 24-hour care. Patients reside in our facility for a set period. This intensive approach is set in place to ensure individuals receive the best treatment and are free from distractions.

Bestmed Medical Aid extends cover to licensed facilities that offer services such as:

Medically supervised detoxes
Group therapy sessions
Individual counselling

It is important to note that coverage is subject to pre-authorisation, and members may be liable for a co-payment upon admission.

Outpatient Treatment Programme

The outpatient rehab programme serves as a transitionary phase of treatment after completing the inpatient rehab programme. An outpatient programme is a suitable option for members who need to attend to daily duties and responsibilities while still receiving an adequate level of treatment.

Bestmed Medical Aid may cover these treatments offered at the outpatient programme:

Individual counselling
Group therapy

Counselling And Therapy Coverage

Counselling and therapy matter in residential rehab treatment facilities. Bestmed Medical Aid provides benefits for these services, and members must review their options to understand the full extent of their coverage.

At Changes Addiction Rehab, our multidisciplinary team treats alcohol use disorder as a whole, covering the medical, psychological and social sides together.

Some of the therapeutic modalities used at our facility include:

Cognitive Behavioural Therapy
Motivational Enhancement Therapy
Family Therapy Sessions
Group Therapy

The number of sessions covered will vary depending on the option chosen.

Pre-Authorisation Process

Members must adhere to specific guidelines to receive coverage for residential inpatient treatment.

At Changes, we handle the pre-authorisation process on your behalf, making admission into our facility more comfortable. This process involves contacting Bestmed Medical Aid and providing them with your details, including your ICD-10 codes and other relevant information, as well as our facility’s practice numbers.

Claims Process For Alcohol Treatment

Once you have received your treatment, gather your receipts and any other relevant documentation and submit a claim through Bestmed’s online portal. Our team at Changes Addiction Rehab can assist where you have questions.

What Is Not Automatically Covered

All options offered by Bestmed Medical Aid are subject to limitations and exclusions. Out-of-network facilities may not be covered or may result in a larger co-payment, so it is recommended that the member choose one of Bestmed’s approved facilities.

Luxury rehabilitation facilities and alternative forms of treatment are not covered under the scheme’s policy. Repeat treatments within a short period may face certain limitations.

Secondary treatment and halfway housing are not funded, so members carry those costs privately.

Other Medical Aids We Work With

Changes handles pre-authorisation across most South African schemes. If your cover sits elsewhere, these pages explain how each one treats addiction rehab:

Confidential • Licenced • Support

Need help for yourself or a loved one?

Changes Rehab admissions for personal advice on treatment, medical aid or the next steps.

081 444 7000 WhatsApp

Bestmed member weighing up rehab for yourself or a family member? The fastest first step is to let us confirm your cover. Call Changes on 081 444 7000 or book an assessment, and we will deal with Bestmed’s pre-authorisation while you focus on the person who needs help.

Start Pre-Authorisation