Medical Aid and Rehab Admission
What South African schemes typically cover, how authorisation works, and how our team helps you get a decision quickly.
Substance-use disorder is recognised as a Prescribed Minimum Benefit condition in South Africa, which means most registered medical schemes must fund a defined level of treatment regardless of plan type. In practice, whether a specific admission is funded depends on the clinical motivation, the facility's registration and the scheme's designated service provider rules.
Our admissions team deals with these applications daily. We prepare the clinical motivation, submit the authorisation request with your consent, and follow up directly with the case manager so a family in crisis is not left chasing a call centre.
- Assistance with pre-authorisation from your scheme
- Clinical motivation prepared by our treating team
- Guidance on PMB pathways for substance-use disorder
- Direct follow-up with your case manager
- Confidential discussion of alternatives if cover is limited
- Admission possible while authorisation is being finalised
Step 1 — Clinical assessment
Before any scheme will consider an authorisation, there must be a clinical basis for admission. Our team completes a telephonic assessment covering substance history, medical risk, previous treatment and any psychiatric symptoms, and determines whether medically supervised detox is required.
Step 2 — Authorisation request
With your written consent we submit the motivation and supporting clinical detail to your scheme. Schemes typically respond within a few working days, sometimes faster where withdrawal risk is documented as urgent.
Useful questions to ask your scheme directly: is substance-use disorder covered as a PMB on my plan, is a designated service provider required, how many days of residential care are authorised, and what co-payment applies?
Step 3 — Admission
Where a person is at medical risk, we do not wait for paperwork to complete before admitting. Treatment starts, and the administrative process continues in parallel with our team handling the correspondence.
If scheme cover turns out to be limited or already exhausted for the year, we discuss the remaining options with the family privately by phone.
Editorial standards & clinical review
Author
Jeroen Decker
Founder, Hillhouse Clinics
Founder of Hillhouse Clinics with 15+ years building licensed residential addiction treatment in Cape Town. Personal lived experience of recovery.
Reviewed by
David McNamara
Clinical Director
Clinical Director with 20+ years in addiction medicine. Oversees ASAM-aligned treatment protocols, medical detox and the multi-disciplinary clinical team supporting both treatment paths at The Hillhouse and a move to The Re-entry House.
Medically reviewed by
Bryan Hellmann
Clinical Psychologist
Registered Clinical Psychologist specialising in trauma, dual diagnosis and evidence-based therapies (CBT, DBT, EMDR) for substance use disorders.
Last clinically reviewed: May 7, 2026 · Next review scheduled: November 2026 · Hillhouse Clinics is licensed by the South African Department of Social Development. Content is informational and does not replace medical advice.
Frequently asked questions
Is rehab a Prescribed Minimum Benefit?+
Substance-use disorder is listed among PMB conditions, so registered schemes must fund a defined level of care. The exact benefit, provider requirements and any co-payment depend on your scheme and plan.
How long does authorisation take?+
Usually a few working days. Urgent cases with documented withdrawal risk are often expedited, and we escalate directly with the case manager where needed.
Can I be admitted before authorisation comes through?+
Yes, where there is medical risk. We will not delay a clinically urgent admission for administration.
What if my scheme declines?+
We review the reason for the decline, correct or strengthen the clinical motivation where appropriate, and assist with an appeal. If cover remains unavailable, we discuss alternatives confidentially with the family.
A confidential conversation — on your terms
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Last reviewed: September 2026. Admissions: +27 63 335 1185. Hillhouse Clinics is licensed by the South African Department of Social Development. Outcomes vary; no treatment guarantees recovery. For emergencies in South Africa call 10177 (ambulance) or SADAG on 0800 12 13 14.