If you are searching for Genesis medical aid addiction treatment, your plan entitles you to in-patient rehab at accredited centres such as Changes Addiction Rehab in Johannesburg. Addiction is covered as a Prescribed Minimum Benefit (PMB), which guarantees a minimum of 21 days of funded treatment each year. This guide shows you how Genesis applies cover, what is included, and how to complete the pre-authorisation process.
This guide explains how Genesis medical aid pays for addiction rehab, what the 21-day rule means, and how to secure pre-authorisation for admission. It also clarifies what your plan covers for in-patient rehab, out-patient therapy, and aftercare. Use it as the only guide you need when considering treatment at Changes Addiction Rehab.
PMB’s and Genesis’s Obligation
Genesis, like every registered medical aid scheme in South Africa, must provide cover for PMBs. Substance Use Disorder (ICD-10 codes F10–F19) is included.
Key PMB cover rules:
21 days in-patient care per year for detox and rehabilitation
Cover when treatment is medically necessary and supervised
Paid from risk funds, not your day-to-day savings
This ensures all Genesis members, regardless of plan option, are guaranteed a minimum standard of addiction treatment.
How Genesis Medical Aid Covers Rehab
Genesis is a self-funded medical aid scheme with transparent benefit rules. Here’s how cover works:
1. In-Patient Addiction Treatment
Genesis pays a set scheme rate for in-patient rehab, including accommodation, meals, detox, and therapy
PMBs guarantee 21 days of funded treatment per calendar year
Additional days depend on your plan limits and authorisation
2. Out-Patient and Aftercare
Follow-up therapy with addiction psychologists and psychiatrists can usually be paid from your day-to-day benefits or savings
These sessions are vital for relapse prevention and sustained recovery
Confirm your plan’s annual limits to maximise cover
Why Pre-Authorisation is Essential
Genesis medical aid addiction treatment requires pre-authorisation for addiction rehab admissions. Without it, claims are declined.
The 4-step process at Changes Rehab:
Contact admissions. Our team knows exactly how to work with Genesis.
Clinical assessment. We confirm diagnosis and required level of care.
Submission. We send a treatment plan with ICD-10 codes (F10–F19) to Genesis Managed Care.
Authorisation number. Genesis approves the admission and issues a number that guarantees funding for the approved stay.
Important: Always use the clinical term Substance Use Disorder. This ensures claims are treated as medical, not lifestyle, cases.
What Genesis Funds at Changes Rehab
With pre-authorisation, Genesis medical aid typically funds addiction treatment:
Medically supervised detox
In-patient rehab with counselling, groups, and medical oversight
Relapse prevention and coping skills training
Family therapy where benefits apply
Discharge planning and structured aftercare
At Changes Rehab we:
Bill Genesis directly for approved benefits
Align all treatment to recognised medical aid codes
Advise you in advance about any possible co-payments
Maximising Your Genesis Benefits
Addiction treatment often requires more than 21 days. Here’s how to get the most from your medical aid:
Use out-patient mental health benefits for follow-up therapy
Check gap payments. If the facility charges more than the scheme rate, we tell you upfront
Explore secondary or extended care where clinically justified. Our team negotiates with Genesis for additional approval
Why Genesis Medical Aid Addiction Treatment at Changes Rehab
Accredited by Department of Health, fully compliant with PMBs
Experienced in Genesis claims, with proven authorisation success
Comprehensive treatment, including detox, therapy, relapse prevention, and aftercare
Family support services, guiding loved ones through the process
Direct liaison with Genesis, so you focus on recovery while we handle admin
FAQs: Genesis Medical Aid Addiction Treatment
Does Genesis cover substance abuse treatment?
Yes. SUD is a PMB condition. Genesis funds at least 21 days of in-patient treatment each year.
Do I need pre-authorisation?
Yes. Without it, claims are declined. Our team secures approval before admission.
Which Genesis plans cover rehab?
All options cover PMBs. Specific limits vary by plan type.
Will I face a co-payment?
Sometimes. Genesis pays scheme rates. If facility rates exceed this, a gap may apply.
Does Genesis cover aftercare therapy?
Yes. Out-patient psychology or psychiatry sessions are usually funded from savings or day-to-day benefits.
What codes are used for addiction claims?
ICD-10 codes F10 to F19 for Substance Use Disorders are submitted in treatment motivations.
For different medical aid drug & alcohol rehab coverage, see below:
- LA Health
- Remedi
- Bestmed
- Medscheme
- Momentum
- Discovery
- Multi-Choice
- Compcare
- Medshield
- Gems
- Polmed
- Fedhealth
- SABC
FAQ: Genesis Medical Aid Rehab Cover
Does Genesis cover addiction rehabilitation and detox?
Yes, but only under Prescribed Minimum Benefits (PMBs). Genesis excludes rehabilitation services in its standard benefits, except where required by PMB law. Genesis Medical
How many days of rehab does Genesis cover under PMBs?
Typically up to 21 days of inpatient rehabilitation + detoxification may be covered under PMB entitlements (per scheme and plan limits).
Are outpatient counselling or therapy services covered?
No. Genesis excludes rehabilitation and related outpatient services from its non-PMB benefits. Only PMB entitlements apply. Genesis Medical
Is pre-authorisation required?
Yes. For any claims under PMB entitlement, you must follow the scheme’s authorization process, supply ICD-10 codes, and obtain approval before admission.
