Yes, and it comes out of risk benefits rather than your medical savings. Netcare Medical Scheme funds 21 days of inpatient rehab per benefit year, January to January, with up to 3 of those days as medically supervised detox. We handle the authorisation and usually have an answer within a day.
Netcare Medical Scheme is a restricted scheme for Netcare Ltd employees and their dependants, administered by Discovery Health. It runs a single benefit option, the Savings Option, which combines risk benefits with a medical savings account. Inpatient rehab is funded from the risk side as a Prescribed Minimum Benefit, not from your savings.
Call 081 444 7000 or start pre-authorisation online. Our admissions team handles the scheme call for you.
On a different scheme? Compare cover on our medical aid hub.
What Netcare Medical Scheme Covers For Rehab
The authorisation covers a single pathway: detox first where withdrawal needs managing, then structured inpatient treatment for the remaining days. Psychiatric assessment, individual counselling and group work happen inside that admission and are funded with it.
That entitlement is set in law rather than by the scheme. Substance use disorders sit on the Prescribed Minimum Benefit list under ICD-10 codes F10 to F19, which is why the benefit holds even on a single-option savings scheme. Because addiction is classified as a brain disease rather than a behavioural failing, the scheme has no discretion to refuse the benefit outright.
Because the Savings Option carries a medical savings account, it helps to know which side of the scheme pays. The 21-day inpatient allocation comes from risk benefits. Out-of-hospital therapy after discharge generally draws from savings, which is why members run out of aftercare funding faster than they expect.
Residential Inpatient Treatment
Inpatient drug rehab is vital to the treatment of severe substance use disorders. Individuals undergo intensive care in a safe and secure environment, free of triggers and distractions, which supports long-term recovery.
Netcare Medical Scheme provides its members extensive drug and alcohol rehabilitation coverage for this phase of treatment.
Outpatient Treatment Services
The outpatient programme is designed for individuals who need to attend to responsibilities outside of treatment, like work and school, while still receiving treatment for their addiction.
Members can claim specific services from the outpatient programme, such as individual counselling. Netcare does not pay for the entire outpatient programme.
Counselling and Therapy
Individual counselling and therapy play a significant part in a person’s recovery. Netcare Medical Scheme covers individual counselling and group therapy sessions.
Members should check their benefit schedule to see how those sessions are funded, since out-of-hospital therapy usually draws from the medical savings account rather than from risk benefits.
What Netcare Does Not Cover
Halfway houses and sober living are not funded. Members pay privately for that phase.
Treatment not deemed medically necessary by a healthcare professional falls outside the benefit, including homoeopathic and similar approaches.
Process addictions such as gambling, sex and pornography are not covered at a drug and alcohol facility. Treatment for those is handled through a psychiatric admission instead.
Cover applies only at registered facilities approved through pre-authorisation, so admitting first and asking afterwards is what creates co-payments.
Does Netcare Cover Secondary Care?
Netcare funds primary care to the 21-day PMB limit. It does not pay for extended secondary or long-term rehab beyond that allocation.
River Manor in Ruimsig is where clients continue after primary care. Members sometimes assume the medical savings account will cover it, but savings are meant for out-of-hospital claims and rarely stretch to a residential stay, so plan the funding early.
Have the conversation early in the admission. Waiting until discharge week means deciding about secondary care and money at the same time, which is when families tend to settle for going home too soon.
Pre-Authorisation In Under 24 Hours
Netcare Medical Scheme covers inpatient rehab treatment, but a member must go through a pre-authorisation procedure to gain approval.
At Changes Addiction Rehab, we prioritise our client’s well-being and want their transition into primary care to be smooth, which is why we do the pre-authorisation process on your behalf.
We will call the scheme and provide all the necessary details, including the ICD-10 codes for your specific addiction and our facility practice numbers.
You will not need a letter of motivation from a healthcare professional to be admitted into drug and alcohol inpatient rehab. Authorisation usually comes back within 24 hours with an authorisation number, the day limits and any co-payment, which we confirm with you before booking the admission slot.
Claims Procedure For Netcare Medical Aid
Members can submit their claims for the addiction treatment they received to Netcare Medical Aid. They will need to include their supporting documentation, which can contain invoices, treatment plans and medical reports.
Once Netcare Medical Aid receives the claim, it will undergo review. If approved, the member will be reimbursed for the amount claimed.
Challenges And Limitations With Netcare Cover
The 21-day allocation is annual. A member who uses it in full and relapses later in the same benefit year has no further inpatient PMB entitlement until January.
Co-payments are common. The scheme may fund only a portion of the inpatient stay, so the balance is billed to the member and should be confirmed in writing before admission.
Aftercare is the third gap. Follow-up psychology sessions generally draw from the medical savings account rather than the PMB, so aftercare is often self-funded once savings run low.
Get Pre-Authorised With Netcare
Netcare Medical Scheme member? Pre-authorisation typically takes less than 24 hours. Call 081 444 7000 or start the pre-authorisation form. We come back with the authorised days and anything you would carry yourself.
Netcare Cover FAQ
Is Netcare Medical Scheme open to the public?
No. Membership is limited to Netcare Ltd staff and the family members registered on their policy. Anyone else should check our medical aid hub for their own scheme.
Does rehab come out of my medical savings account?
No. Your savings stay intact for the inpatient portion, because the PMB is paid from the risk pool. Savings come into play for therapy once you are discharged.
Who administers Netcare Medical Scheme?
Discovery Health administers the scheme, so authorisation calls and claims run through Discovery’s systems even though the scheme itself is separate.
How many days of inpatient rehab treatment are covered?
Up to 21 days a year, including the 3-day medical detox, though a co-payment may apply.
Does Netcare provide coverage for the outpatient programme?
Only specific services, such as individual counselling, rather than the whole programme.
