Does Medical Aid in SA Cover Psychologists’ Services

Are visits to a psychologist covered if you're on a Medical Aid? And which mental health services are available if you're not? Here's everything you need to know.

Medical Aid in SA — A Quick Rundown

In South Africa right now, many of us are under both financial and mental pressure, and Medical Aid provides the peace of mind that you won't be faced with unaffordable medical costs in a health crisis.

Right, but what about Medical Aid's role in covering psychologists' services? While it's mainly used for covering hospital expenses and visits to the doctor, not everyone knows that yes, you can use Medical Aid to access psychological care. This is great news for those who want to get professional help but are put off by the high costs of consultations with a psychologist, which can cost upwards of R1,250 per session. Yikes!

Priorities your mental health

We all know how vital regular health check-ups are for our wellbeing (we do, right?), but few of us know when (or how) to get professional help when we're experiencing mental health issues. Remember that if your mental health is suffering, the rest of your body can take strain too, yes, your mind can actually make your body sick. So, it's a good idea to keep your head in good shape. Cape Town-based clinical psychologist Amy Glover explains: "Professional help is incredibly important to aid with the assessment of mental health to get the correct treatment or for the overall promotion of mental health."

The nitty gritty

So, does Medical Aid cover psychologists' costs? You'll be pleased to learn that the short answer is yes, some do. Well, sort of... According to Director at Hippo Advisory Services Alexia Graham, "Medical Aids in SA are fully aware of the growing demand for mental health benefits and support as a result of the alarming increase in claims statistics over the past few years." But she explains that because it's not that easy for many South Africans to access mental healthcare, this "places an additional burden on Medical Aid schemes to provide a solution".

The solution, she says, is that they "pay for certain chronic depression medication if it's classified as a Prescribed Minimum Benefit (PMB)". This basically means that if you've got Medical Aid and are diagnosed with chronic depression by a professional, you'll probably get some of your expenses covered, depending on the provider or your chosen Medical Aid plan. Alexia says that Medshield for example, "offers a broader chronic condition coverage for depression across their options, as a means to differentiate their products".

Amy adds that Medical Aid hugely improves access to mental health services and that the PMB is an important benefit where certain mental illnesses are covered for 21 inpatient days or 15 outpatient contact sessions (shared by mental health practitioners like psychiatrists and psychologists). But a mental health practitioner must assess and diagnose you to apply for the benefit, and it requires approval from your Medical Aid scheme.

Amy says that not all mental illnesses qualify as PMBs. Plus, if your mental health issue does qualify, there can be limits to how much your medical scheme will pay: "Some conditions offer 15 contact sessions, others offer 12, or in other cases only one or two contact sessions are covered, depending on your Medical Aid's conditions." But even if you aren't covered, you can still use your available Medical Aid Savings or, Amy adds that for those who don't have cover, it's worth knowing that some mental health practitioners do offer reduced rates for cash patients who don't have Medical Aid.

Also read: Network vs Free Choice. Which one will work for you?

Types of coverage

You'll see on your Medical Aid contract that you're covered for certain 'inpatient' expenses and 'outpatient' costs. (An inpatient is someone who needs an overnight stay in a hospital, while an outpatient only comes to access care, then leaves.) So according to government regulations, all Medical Aids must cover either in-hospital or out-of-hospital mental healthcare by psychologists. Of course, each Medical Aid plan and provider has different coverage levels. So before signing up, it's a good idea to see what sort of cover they offer for mental healthcare like psychologists.

Choosing the right Medical Aid plan, Stan!

So what three things must I check for before selecting a Medical Aid plan to provide psychological care for myself and my family?

1. Look at how much coverage they give, and what this costs (Medical Aid rates), for starters. Everyone has different mental healthcare needs, so it's up to you to ask the right questions to ensure you get the care you need, when you need it.
2. Check the fine print. Alexia explains: "When comparing, it's important to understand that there's no standard benefit structure for mental health cover. Some medical schemes provide a defined annual limit for both in- and out-of-hospital claims and once the limits are reached, the member (that's you) pays or claims from available savings if they're on that type of product."
3. Ask what mental health support programmes the scheme offers, if any. "Discovery Health has additional mental health benefits that vary depending on your plan, if members enrol in their Mental Health Programme," says Alexia. The idea here is to get members to use a selected network of providers to access these benefits and use them as part of a "wellness path to recovery through expert care", and to get advice on how to improve your mental health. Think of it as being a 'gym for the brain'; much like you exercise your body to make it healthy.

Right, now take a look at your Medical Aid plan options all in one place on Hippo. It's super quick and easy and it beats having to Google until your mind's truly boggled. After all, the whole point here is to look after your mental health, not put a strain on your brain!

No Medical Aid, what now?

Ok, but not all of us can afford Medical Aid. That's ok because there are also options, such as government programmes, non-profit organisations like FAMSA, and low-cost clinics. So even if you don't earn much and are struggling with your mental health, you can visit the South African Depression and Anxiety Group (SADAG) and find useful numbers and links to get free mental healthcare, so moenie worry nie. Amy also shares the following useful numbers:

• The Counselling Hub (only R50 per session): 021 462 3902
• LifeLine South Africa (24-hour crisis line) 011 422 4242 or 0861 322 322
• Suicide Crisis Line: 0800 567 567, SMS 31393.

So, if you are on a Medical Aid plan, you can access mental health services like psychologists, and if you're not with a medical scheme, there are free, and affordable, mental health services available to you. Don't you feel better just knowing that these services are available if or when you need them?

This article is for informational purposes only and should not be construed as financial, legal or medical advice.