Does Insurance Cover Mental Illness in South Africa?

2020 saw a rise in cases of depression and anxiety amongst South Africans

triggered by the Covid-19 pandemic. According to psychiatry.org, depression is a common and serious medical illness that negatively affects all areas of your life.

And while the condition is expected to rise globally with depression expected to become the second biggest cause of disability, between 76% and 85% of people in low- and middle-income countries receive no treatment for their disorder. 

Disability Insurance

Disability Insurance pays out a lump sum in the event of physical injury or illness where you are no longer able to work. 

It does not cover:

1. Compensation – this is covered by a worker’s compensation policy

2. Medical care bills – this is covered by medical aid insurance or dread disease policy.

3. Mental illness – while there is still a lot of confusion around what medical aid schemes will cover in this realm, certain chronic mental health conditions like schizophrenia and bipolar mood disorder require ongoing treatment and medical management and have Prescribed Minimum Benefits (PMBs) attached.  

Medical Aid Schemes PMBs

Prescribed Medical Benefits are a set of defined health service benefits that all members of a medical scheme have access to, regardless of the plan they opted for. 

There are eleven types of mental illnesses, each with its own PMB. Each mental diagnosis is assigned a treatment over a given time period. Treatments vary from hospital-based management to psychotherapy and counselling. 

Despite being legislated, not all medical aid schemes will honour the PMBs. The best medical schemes that cater for mental health are the ones that provide the most convenient access to care. As Allan Sweidan, CEO Akeso Clinics & Psychologist puts it, “Know Thine PMB Rights!”

List of Mental Illnesses and their Prescribed Treatment

This list includes all of the mental illness conditions which all medical schemes must cover, regardless of which plan a member is on. 

Terms:

• Medical schemes must pay in full, without a co-payment or the use of deductibles, for the diagnosis, treatment and care costs of the Prescribed Minimum Benefit conditions. 

• The medical scheme cannot use your medical savings account to pay for Prescribed Minimum Benefits. 

• Each option offered by a medical scheme must make provision for the Prescribed Minimum Benefits, including hospital plan options.

You can find more information in this excellent comprehensive PMB consumer booklet.

Disclaimer: This content is for informational, educational, or entertainment purposes only. We do not make any warranties about the completeness, reliability, and accuracy of the content. The views and opinions are those of the author and not necessarily those of the company.