Bankmed, a trusted medical aid provider, offers a variety of plans tailored to meet its members’ diverse needs and budgets. One of the most significant advantages of these plans is the coverage for drug and alcohol rehabs, a vital support system for those seeking treatment for their substance use disorders. This coverage can provide a profound sense of relief and security, knowing that the financial burden of treatment is being shared.

Addiction is classified as a chronic condition that needs to be managed long-term. Bankmed covers 21 days of inpatient treatment and 3 days of detoxification per year. The extent of coverage for these services will depend on the plan the policyholder is on. 

Bankmed policyholders need to meet specific criteria to be eligible for rehabilitation coverage. This includes having an up-to-date policy. The good news is that no rehab admission referral is required. By fully understanding these eligibility criteria, you can feel empowered and prepared, knowing exactly what is required to access your coverage.

Navigating medical aid claims, policies, and all the nitty-gritty between can be tiresome and confusing. This article will explain everything you need about Bankmeds addiction treatment coverage.

Bankmed Coverage For Drug And Alcohol Rehab

Bankmed is a closed Medical Aid Scheme offering its employees different plans with varying coverage levels and benefits.

Scope of Coverage

Bankmed covers inpatient rehab facilities and recognises the importance of treating substance use disorders. Bankmed covers various rehabilitation services, such as inpatient treatment, group therapy, outpatient psychologist sessions, and psychiatric appointments.

Duration Of Drug And Alcohol Rehab Treatment

Understanding your Bankmed plan is crucial to understanding the extent of your coverage. Bankmed covers 21 days of inpatient rehab treatment, including a 3-day medical detoxification per year. 

Before admitting yourself to an inpatient rehab, it’s important to note that pre-authorisations are required. This means you need to get approval from Bankmed before your treatment begins. To start this process, call us at We Do Recover, and we will guide you through the necessary steps.

Treatment Programs Supported By Bankmed Medical Aid

Bankmed Medical Aid offers comprehensive coverage for rehabilitation services, including inpatient rehab, outpatient psychologist sessions, and psychiatric assessments for members who are suffering from substance use disorders.

Benefits and coverage may vary depending on the member’s plan.

Inpatient Rehab 

Bankmed covers a full 21 days of inpatient treatment, including a 3-day detox once per year. Members must be aware that Bankmed does not cover long-term treatment. 

Long-term treatment has many benefits, including reducing relapse rates at the 90 days mark. If policyholders wish to do long-term treatment, it must be paid out-of-pocket.

Outpatient Program Services

Bankmed covers several psychologist sessions and psychiatric appointments per year; these can be claimed during the outpatient program. 

Different plans will have varying benefit caps and exclusions; the more comprehensive the plan, the more benefits the member will receive. For example, a member on a comprehensive plan may receive more therapy session benefits per year. 

Therapies And Counselling

Bankmed covers various therapies used to treat substance use disorders, including individual counselling, group therapy, and psychiatric assessments.

Policyholders must meet certain criteria to be eligible for rehab coverage. At We Do Recover, we will assess you and start the pre-authorisation process from Bankmed on your behalf.

Exclusions And Limitations

While Bankmed offers its members coverage for rehabilitation services, including inpatient treatment, certain outpatient services, and detoxification, it’s important to be aware of the limitations and exclusions to their plans. For instance, long-term addiction rehab is not covered under any of the policies. Additionally, certain rehabilitation facilities may not be covered.

In this section, we will discuss what those limitations and exclusions are:

Treatments Not Covered By Bankmed Medical Aid

While Bankmed does have comprehensive coverage for inpatient treatments, it needs to be noted that long-term addiction treatment is not covered under any of the policies. 

Patients struggling with severe substance use disorders may need long-term care, and, as a result, families may need support with secondary treatment and halfway house expenses. 

Benefit Caps

Bankmed’s rehabilitation coverage is subject to benefits caps. For example, Comprehensive plan members have a wider range of treatments and benefits available, while Essential plan members can only claim the treatments listed under the prescribed minimum benefits (PMBs). PMBs are a set of defined benefits that all medical schemes must cover by law. 

The cover is limited to prescribed minimum benefits obtained in South Africa per regulation 8 of the Act. If the member’s underlying diagnosis is a PMB, they qualify for treatment.

Conclusion

Bankmed offers several medical aid plans to its bank employees that pay for addiction treatment services. The specific benefits and coverage available will depend on the policyholder’s plan of choice. It is important to note that Bankmed medical aid plans do not cover some addiction treatment centres or certain rehabilitation services.

Members seeking treatment at an inpatient facility must review their options, coverage, and benefits to ensure a smooth admissions process. Alternatively, you may call us at We Do Recover, and we can start the admissions process via a short phone call. We are here to assist you and ensure you understand the process.

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