Quick answer: Yes, if your hospital plan is an option of a registered medical scheme. Treatment for alcohol and drug dependence is a Prescribed Minimum Benefit, which every scheme must cover on every option, including hospital plans: up to 21 days of inpatient rehabilitation a year, with pre-authorisation and usually at a network facility. Health insurance policies and gap cover are not medical schemes and do not have to pay.
Last reviewed: October 2026.
Why does a hospital plan have to cover rehab?
The Medical Schemes Act requires every medical scheme to cover a set list of Prescribed Minimum Benefit conditions, whichever plan or option the member has chosen. Dependence on alcohol or drugs is on that list. A hospital plan is simply a scheme option with few day-to-day benefits, so the rehab benefit still applies in full.
What does a hospital plan pay for?
| Treatment | Cover on a medical scheme hospital plan |
|---|---|
| Inpatient rehabilitation | Up to 21 days per person per year |
| Detox in hospital | Up to three days for severe withdrawal |
| Outpatient rehab | Not part of the minimum benefit. Depends on the scheme |
| Stays longer than 21 days | For your own account, unless your option offers more |
How do I know if my plan is a real medical scheme?
Check three things:
- The provider is registered with the Council for Medical Schemes.
- Your documents call it a medical scheme option, not an insurance policy.
- You pay a contribution to a scheme, not a premium to an insurer.
Products sold as health insurance, hospital cash-back plans or primary care plans are insurance. They pay only what the policy lists, and many exclude addiction treatment. Gap cover is also insurance: it tops up shortfalls on medical scheme claims according to its own rules, so read the exclusions.
What are the conditions for full cover?
- Pre-authorisation. Get an authorisation number before admission.
- Network facility. Many hospital plans, especially lower-cost network options, pay in full only at the scheme’s designated service providers.
- Registered facility. The centre must be properly registered for this treatment.
- Days available. The 21 days are per person per year.
Our guide to getting medical aid to approve rehab explains each step.
Does a waiting period affect rehab cover?
It can. Schemes may apply waiting periods to new members, and these can limit what is paid in the first months. If you joined recently, ask your scheme in writing whether a waiting period applies to this admission.
How do the big schemes handle it?
The minimum is the same everywhere, but the network and authorisation rules differ. See how it works on Discovery, Momentum and Bestmed, or read our medical aid cover page.
Frequently asked questions
Does a hospital plan cover alcohol rehab?
Yes. Alcohol dependence is a Prescribed Minimum Benefit condition, so a medical scheme hospital plan must cover up to 21 days of inpatient rehabilitation a year.
Does a hospital plan cover drug rehab?
Yes, on the same terms as alcohol rehab: up to 21 days a year in hospital, with pre-authorisation and usually at a network facility.
Does gap cover pay for rehab?
Do not assume so. Gap cover is an insurance policy with its own exclusions, and many policies exclude addiction treatment. Ask your insurer.
Will my hospital plan pay for outpatient rehab?
Usually not. The minimum benefit is for treatment in hospital, and hospital plans have few out-of-hospital benefits. Ask your scheme.
How Rehab Bridge can help
Rehab Bridge is not a rehab centre and is not affiliated with any medical scheme. We listen to your situation, explain your options and connect you to rehab centres in Gauteng and Cape Town that work with your medical aid. Contact us, send us a WhatsApp or email info@rehabbridge.co.za.
Benefits and scheme rules change every year. This article is general information, not advice. Confirm your cover with your scheme before admission.