Medical aid and rehab in South Africa: a scheme-by-scheme guide

Finding out whether medical aid will pay for rehab is often the first practical hurdle a family faces, usually at a frightening time. This guide brings together what South Africa’s largest medical schemes publish about alcohol and drug treatment, explains the rules that apply to every scheme, and shows how an admission to Liberty Home works. Each scheme page links directly to the scheme’s own documents, so you can check every point yourself.

If someone is in danger right now (a seizure, severe confusion, hallucinations, chest pain, or they can’t be woken), don’t wait for an authorisation. Call an ambulance on 10177 (or 112 from a cell phone) or go to the nearest emergency unit. Schemes treat genuine emergencies differently from planned admissions.

Choose your medical aid

“We bill this scheme directly” means Liberty Home is registered with the scheme for direct payment: we obtain the pre-authorisation, send the account to the scheme, and the scheme pays us directly at a fixed rate for the authorised days. A co-payment applies; we’ll explain it before admission. The scheme’s own rules (DSPs and day limits) still apply. Status as at October 2026.

Don’t see your scheme? Call us anyway. The same PMB rules apply to every registered scheme, and we’ll help you find out how yours works.

What the law says every scheme must cover (PMBs)

Every registered medical scheme in South Africa must cover a defined list of Prescribed Minimum Benefits (PMBs) under the Medical Schemes Act 131 of 1998. The Council for Medical Schemes (CMS) lists the substance-use PMBs as:

Three points from the same CMS guidance matter most for families:

1. PMBs cover in-patient (“hospital-based”) care. The CMS states that the PMB regulations do not include out-patient treatment for substance abuse.
2. Schemes may appoint designated service providers (DSPs). If you choose a non-DSP voluntarily, the scheme may ask you to pay part of the bill as a co-payment. The CMS advises getting this clarified in writing, which we will help you do.
3. To be paid as a PMB, the diagnosis must be on the PMB list, the treatment must be PMB level of care, and the scheme’s rules (pre-authorisation, DSP, protocols) must be followed.

These are the minimums schemes must fund in general, not a promise about any particular clinic. South African medical aids don’t currently cover detox at Liberty Home, including the 3-day detox benefit; detox here is self-funded.

How it works at Liberty Home

1. Call or WhatsApp us on +27 60 014 4200 / +27 84 775 8623.
2. A clinical screen produces the diagnosis, ICD-10 code and treatment plan your scheme needs.
3. Pre-authorisation: we obtain it from your scheme, with the diagnosis and clinical motivation signed by our doctor or psychiatrist. The family doesn’t have to do this.
4. Billing and the co-payment. We bill your scheme directly, and it pays a fixed rate for the authorised days. A co-payment applies; we’ll explain it before admission. Detox isn’t covered: South African medical aids don’t currently pay for detox at Liberty Home, including the 3-day detox benefit, so it is self-funded.
5. Admission to Phase 1 at Liberty Home Manor, with on-site detox and 24/7 nursing.

Our minimum stay is 28 days per phase, and schemes usually authorise fewer in-patient days than that. We explain this in more detail on each scheme page and on rehab costs in South Africa.

About Liberty Home Manor

Liberty Home Manor is a residential addiction treatment centre for adults (18+) at 5 Boulder Road, Marina Da Gama, Cape Town. Here are the facts a medical scheme case manager, or a worried family, usually asks about first:

• Registration. The Manor is registered with the Department of Social Development under the Prevention of and Treatment for Substance Abuse Act 70 of 2008: certificate 15/10/3/4/2-17/2026, for a maximum of 21 adults, valid until 14 July 2031. You can see the certificate on our licensing and clinical governance page.
• Detox on site. We detox all substances on site, with registered nurses on duty 24/7 and doctors on call around the clock. If withdrawal becomes medically acute, our doctors refer to hospital and we stay involved until the person can safely return.
• Medication and therapy. Registered nurses dispense all medication. Psychological care is led by an HPCSA-registered clinical psychologist, and we treat co-occurring conditions such as depression, anxiety and trauma alongside the addiction (see dual diagnosis treatment).
• A phased programme. Phase 1 (primary care) and Phase 2 (secondary care) take place at the Manor. Phase 3 (supported, tertiary living) takes place at our Lodge in Kenilworth. Each phase has a minimum stay of 28 days. More on our phases of recovery.
• Medical aid. We bill your medical aid directly for the programme. We obtain the pre-authorisation for you, and the scheme pays us directly at a fixed rate for the authorised days. A co-payment applies; we’ll explain it before admission. Detox is not covered: South African medical aids don’t currently pay for detox at Liberty Home, including the 3-day detox benefit, so detox is self-funded, and we’ll give you the cost before admission. Liberty Home Manor’s practice number is 1355821, and we are registered for direct payment with many South African schemes, including Discovery, GEMS, Bestmed, Medihelp and Profmed. Registration with Momentum and the Medscheme-administered schemes (such as Bonitas, Polmed and Fedhealth) is in progress. Under Prescribed Minimum Benefits, medical aids pay for 21 days of inpatient treatment; the balance of the programme is a co-payment. How many days your scheme authorises depends on its rules and your option, and we go through this with you before admission.

Frequently asked questions

Does medical aid cover rehab in South Africa?

Every registered medical scheme must cover the Prescribed Minimum Benefits, which include hospital-based management of abuse of or dependence on a psychoactive substance (including alcohol) for up to 3 weeks a year, according to the Council for Medical Schemes. Schemes can set rules such as pre-authorisation, designated service providers and protocols, and the PMBs don’t include out-patient treatment.

Does Liberty Home accept medical aid?

Yes. We bill your medical aid directly for the programme. We are registered for direct payment with many South African schemes, including Discovery, GEMS, Bestmed, Medihelp and Profmed, and registration with Momentum and the Medscheme-administered schemes (such as Bonitas, Polmed and Fedhealth) is in progress. Under Prescribed Minimum Benefits, medical aids pay for 21 days of inpatient treatment; the balance of the programme is a co-payment. How many days your scheme authorises depends on its rules and your option. We obtain the pre-authorisation for you, and the scheme pays us directly at a fixed rate for the authorised days. A co-payment applies; we’ll explain it before admission. Detox isn’t covered: South African medical aids don’t currently pay for detox at Liberty Home, including the 3-day detox benefit, so it is self-funded.

What is a designated service provider (DSP)?

A DSP is a provider a scheme has appointed to treat PMB conditions. If you choose a different provider voluntarily, the scheme may charge a co-payment. Some schemes name specific networks for rehab: GEMS names the State, and Profmed names SANCA.

Do I need pre-authorisation for rehab?

Yes, for a planned admission. Every scheme we reviewed requires pre-authorisation, and admitting without it can lead to a penalty or a reduced payment (for example, Discovery pays up to 70% of its rate and Momentum applies a 30% co-payment). At Liberty Home we obtain the pre-authorisation for you. If a longer stay is needed, we can apply for an extension, which needs a new pre-authorisation.

Which ICD-10 codes apply to addiction treatment?

Substance-use conditions are coded in the ICD-10 block F10–F19. The assessing clinician chooses the code based on the person’s clinical picture.

Does medical aid pay for a full 28-day programme?

Not always. The PMB for substance dependence is up to 3 weeks a year, and some schemes publish a 21-day limit. Our minimum stay is 28 days per phase, so we show you any self-funded days before admission.

Talk to us before you decide

You don’t need to understand your medical aid benefits before you call. That’s our job. Phone admissions on +27 60 014 4200 or WhatsApp +27 84 775 8623. We’ll talk you through the next safe step and deal with your scheme for you. You can also use our contact form.

Sources

• Council for Medical Schemes, CMScript: Focus on Substance Use Disorders
• Council for Medical Schemes, CMScript 3 of 2023: Focus on Alcohol and Drug Abuse
• WHO ICD-10, F10–F19
• Scheme sources are listed on each scheme page.

All sources accessed 11 October 2026.

This page explains publicly available scheme information as at October 2026 and is not financial or medical advice. Scheme rules, options and benefit amounts change every January, and your own option’s rules always take precedence.