What You Are Covered For: A Breakdown of Benefits
How to Find and Choose a Therapist
How to Get Your Treatment Paid For: A Step-by-Step Guide
How to Claim for Therapy Sessions
Emergency Mental Health Coverage
Alternative Funding Options
Long-Term Therapy Planning
The Bottom Line: Is Discovery Health Good for Mental Health?
Global Helplines & Emergency Services
References
The Mental Health Care Programme: Your Gateway to Support
At the core of Discovery Health's mental health offering is the Mental Health Care Programme. This programme is available on all Discovery Health Medical Scheme plans, from the most comprehensive Executive Plan to the entry-level KeyCare plans. This is a significant advantage, as it ensures that all members have access to a baseline level of mental health support. The programme is designed to help you and your doctor manage episodes of major depression, but it also provides benefits for other mental health conditions. To access the full range of benefits, you need to be enroled in the programme by a Premier Plus GP or a network psychologist.
How to Join the Mental Health Care Programme
- Find a Network Provider: You can find a Premier Plus GP or a network psychologist on the Discovery website or app.
- Get Enroled: Your chosen provider will enrol you in the programme through HealthID, Discovery's digital platform.
- Give Consent: You will need to give your provider consent to access your Electronic Health Record (EHR) to complete the enrolment.
Once you are enroled, the programme runs for a six-month period, which can be extended to 12 months if your doctor deems it clinically appropriate.
What You Are Covered For: A Breakdown of Benefits
Discovery Health's mental health benefits are structured around a combination of the Mental Health Care Programme, Prescribed Minimum Benefits (PMBs), and plan-specific benefits. Here’s what that means for you.
In-Hospital Treatment
If you need to be admitted to a hospital or clinic for a mental health condition, your coverage will depend on whether it is a PMB condition. For PMB conditions like major affective disorders (including unipolar and bipolar depression) and schizophrenic and paranoid delusional disorders, you have unlimited cover for your hospital stay, as long as you use a Designated Service Provider (DSP). For non-PMB conditions, your coverage will be determined by your specific plan.
Key Points for In-Hospital Care:
- Pre-authorisation is essential. You must get approval from Discovery Health before being admitted to the hospital.
- Use a DSP. To ensure full coverage for PMB conditions, you must use a hospital in Discovery's network.
- Co-payments may apply. If you choose to use a non-DSP, you may have to pay a co-payment.
Out-of-Hospital Treatment
This is where the Mental Health Care Programme and your plan's day-to-day benefits come into play.
Prescribed Minimum Benefits (PMBs) - Covered on ALL Plans
|
PMB Code
|
Condition |
Coverage |
Professional Context |
| 902T |
Major affective disorders, including unipolar and bipolar depression |
Unlimited hospital + 15 outpatient sessions |
Executive function support and mood stabilisation |
| 907T |
Schizophrenic and paranoid delusional disorders |
Unlimited hospital + ongoing treatment |
Comprehensive psychiatric care with privacy protection |
| 908T |
Anorexia Nervosa and Bulimia Nervosa |
Hospital care + 15 outpatient sessions |
Stress-related eating disorder support |
| 182T |
Abuse or dependence on psychoactive substances, including alcohol |
Hospital rehabilitation + outpatient support |
Confidential addiction treatment for professionals |
| 901T |
Acute stress disorder accompanied by recent significant trauma |
Hospital care + 12 outpatient sessions |
Workplace trauma and acute stress intervention |
| 903T |
Attempted suicide, irrespective of cause |
Hospital care + outpatient support |
Crisis intervention with professional discretion |
How to Find and Choose a Therapist
Finding the right therapist who accepts Discovery Health can seem overwhelming, but here's a practical approach:
Step 1: Check Discovery's Provider Networks
- Premier Plus GPs: Can enrol you in the Mental Health Care Programme
- Network Psychologists: Can provide therapy and enrol you in the programme
- Psychiatrists: Available through Discovery's specialist network
Step 2: Questions to Ask Potential Therapists
When contacting a therapist, ask these essential questions:
- "Do you accept Discovery Health Medical Scheme?"
- "Are you part of Discovery's network or a non-network provider?"
- "What will my out-of-pocket cost be per session?"
- "Can you help me enrol in the Mental Health Care Programme?"
- "Do you bulk-bill Discovery, or do I need to pay upfront and claim back?"
Step 3: Network vs Non-Network Decision: A Detailed Comparison
Your choice between a network and a non-network provider has significant financial and administrative implications. Here’s a detailed breakdown to help you make an informed decision:
| Feature |
Network Providers (DSPs) |
Non-Network Providers |
| :--- |
:--- |
:--- |
| Cost |
Lower out-of-pocket costs. You are only responsible for a small co-payment, if any. |
Higher out-of-pocket costs. You are responsible for the full fee upfront. |
| Billing |
The provider bills Discovery Health directly (bulk-billing). |
You pay the provider and then claim back from Discovery Health. |
| Mental Health Care Programme |
Can enrol you in the programme, unlocking additional benefits. |
Cannot enrol you in the programme. |
| PMB Coverage |
Full cover for PMB conditions, with no co-payments. |
You may be liable for a co-payment of up to 20% of the treatment cost. |
| Rates |
Charge at or close to the Discovery Health Rate (DHR). |
Can charge significantly above the DHR, and you are responsible for the difference. |
What is a Designated Service Provider (DSP)? A DSP is a healthcare provider (doctor, hospital, or pharmacy) that has a special agreement with Discovery Health to provide services at a pre-negotiated rate. For PMB conditions, you must use a DSP to get full cover. If you choose to use a non-DSP for a PMB condition, you may have to pay a significant co-payment.
Why We Recommend Network Providers For most members, using a network provider is the most cost-effective and hassle-free option. You will have lower out-of-pocket costs, less paperwork, and access to the full range of your benefits, including the Mental Health Care Programme. While non-network providers offer more choice, this comes at a significant financial cost.
Step 4: Practical Considerations
- Location and accessibility: Choose someone you can reach easily
- Specialisation: Ensure they have experience with your specific needs
- Therapeutic approach: Different therapists use different methods
- Availability: Check their appointment availability matches your schedule
Psychotherapy and Psychology
Once you are enroled in the Mental Health Care Programme, you have access to a specific benefit for psychotherapy sessions with a network psychologist. For 2025, this benefit is R3,479 per person per year. This covers individual or group therapy sessions of up to 60 minutes each. Additionally, your specific plan will have an overall annual limit for allied, therapeutic, and psychological services. This limit can be applied to a range of services, including psychological services. The amount varies significantly depending on your plan, from R9,300 on the Classic Essential plan to R49,700 on the Executive Plan for a family of four or more.
Psychiatry
Consultations with a psychiatrist are covered from your plan's specialist benefit. The amount of coverage you have will depend on your plan. On some plans, such as the Saver series, you will pay for these consultations using your Medical Savings Account (MSA). On other plans, like the Comprehensive and Executive series, you have a separate, generous benefit for specialist consultations.
Medication
The Mental Health Care Programme also provides a benefit for antidepressant medication (SSRIs). For 2025, this is:
- R130 per month for members on the Executive and Comprehensive plans.
- R110 per month for members on the Priority, Saver, Smart, Core, and KeyCare plans. [2]
For other chronic mental health conditions, your medication will be covered under the Chronic Illness Benefit (CIB).
Chronic Illness Benefit (CIB)
Discovery Health offers comprehensive coverage for chronic mental health conditions through its Chronic Illness Benefit. To access this benefit, you need to register your condition with the scheme. The PMB mental health conditions covered include:
- Major affective disorders, including unipolar and bipolar depression (PMB code 902T)
- Schizophrenic and paranoid delusional disorders (PMB code 907T)
- Anorexia Nervosa and Bulimia Nervosa (PMB code 908T)
- Abuse or dependence on psychoactive substances, including alcohol (PMB code 182T)
- Acute stress disorder accompanied by recent significant trauma (PMB code 901T)
- Attempted suicide, irrespective of cause (PMB code 903T)
Once your condition is registered, you will have access to medication, consultations, and tests related to your condition, subject to the scheme's rules and formularies.
How to Get Your Treatment Paid For: A Step-by-Step Guide
- Join the Mental Health Care Programme: This is the first and most important step to unlocking your benefits. Speak to your GP or a network psychologist to get enroled.
- Get Pre-Authorisation for Hospital Stays: If you need to be admitted to a hospital, make sure you or your doctor contacts Discovery Health for pre-authorisation. The contact number is 0860 99 88 77.
- Use Network Providers: To minimise your out-of-pocket expenses, always try to use providers in Discovery's network. You can find a list of network providers on the Discovery website or app.
- Submit Your Claims: For out-of-hospital services, your provider will usually submit the claim to Discovery Health on your behalf. You can track your claims on the Discovery app or website.
How to Claim for Therapy Sessions
Understanding the claims process can save you time and ensure you get reimbursed quickly:
Option 1: Network Provider (Recommended)
- Book with a network provider who accepts Discovery Health
- Show your Discovery card at the appointment
- Provider submits claim directly to Discovery (bulk billing)
- You pay only your portion (co-payment if applicable)
Option 2: Non-Network Provider
- Pay the full session fee upfront to your therapist
- Get a detailed invoice with the following information:
- Your membership number
- Provider's practice number
- Date of service
- ICD-10 diagnosis code
- Procedure code (usually 0134 for psychology consultation)
- Amount charged
- Submit your claim within 4 months via:
- Discovery app (fastest)
- Online member portal
- Email to claims@discovery.co.za
- Post to Discovery Health, PO Box 784262, Sandton, 2146
Required Documentation for Claims
- Detailed tax invoice from your therapist
- Proof of payment (if paying upfront)
- Referral letter (if required by your plan)
- Diagnosis confirmation (may be requested)
Claims Processing Time
- Electronic claims: 5-7 working days
- Manual claims: 10-15 working days
- Complex claims: Up to 30 days
Emergency Mental Health Coverage
Mental health emergencies are covered under Discovery Health's emergency benefits:
What Constitutes a Mental Health Emergency
- Suicide attempts or ideation with immediate risk
- Severe psychotic episodes require immediate intervention
- Acute psychiatric conditions requiring immediate hospitalisation
- Severe substance abuse requiring emergency detoxification
Emergency Procedures
- Immediate Care: Go to the nearest hospital emergency department 2
- Contact Discovery: Call 0860 99 911 within 48 hours.
- Authorisation: Emergency admissions are covered, but you must notify Discovery
- Follow-up: Ensure proper authorisation for continued treatment
Emergency Contact Numbers
- Discovery Emergency Line: 0860 99 911
- Mental Health Crisis: Contact your nearest hospital emergency department
- Suicide Prevention: South African Depression and Anxiety Group (SADAG) - 0800 567 567
Alternative Funding Options
If you don't have medical aid or have exhausted your benefits, consider these options:
Government Mental Health Services
- Community Health Centres: Free basic mental health services
- Provincial hospitals: Free psychiatric services for South African citizens
- District hospitals: Basic counselling and psychiatric services
Non-Profit Organisations
- SADAG (South African Depression and Anxiety Group): Free telephonic counselling
- LifeLine: Crisis counselling and support groups
- Local community mental health organisations: Sliding scale fees
Training Institutions
- University psychology clinics: Reduced-rate therapy with supervised students
- Training institutes: Lower-cost therapy with trainee psychologists
- Internship programmes: Affordable therapy options
Employee Assistance Programmes (EAPs)
- Workplace EAPs: Many employers offer free counselling sessions
- Union benefits: Some unions provide mental health support
- Professional association benefits: May include counselling services
Payment Plans and Sliding Scales
- Therapist payment plans: Many therapists offer payment arrangements
- Sliding scale fees: Some therapists adjust fees based on income
- Pro bono services: Limited availability through professional associations
Long-Term Therapy Planning
If you need ongoing therapy, here's how to manage your Discovery Health benefits effectively:
Understanding Your Annual Limits
- Mental Health Care Programme: Covers approximately 3-6 sessions
- Day-to-day benefits: Varies by plan (R9,300 - R49,700 annually)
- Chronic benefits: Ongoing support for registered chronic conditions
Strategies for Long-Term Therapy
- Enrol in Mental Health Care Programme first to maximise initial sessions
- Register chronic conditions if applicable for ongoing medication support
- Budget for out-of-pocket costs once annual limits are reached
- Consider therapy frequency - weekly vs bi-weekly sessions
- Plan session timing around the benefit year (January to December)
Cost Management Tips
- Use network providers to minimise out-of-pocket costs
- Combine with other benefits like EAPs or university clinics
- Consider group therapy, which may be more cost-effective
- Discuss session frequency with your therapist based on your budget
The Bottom Line: Is Discovery Health Good for Mental Health?
Discovery Health offers some of the most comprehensive and well-structured mental health benefits in the South African market. The fact that the Mental Health Care Programme is available on all plans is a major advantage, ensuring that all members have access to a basic level of support. The likelihood of getting your mental health treatment paid for by Discovery Health is very high, provided you follow the correct procedures. The key is to join the Mental Health Care Programme, use network providers, and get pre-authorisation for hospital admissions. While the benefits are generous, it's still important to be aware of the limits and co-payments that may apply to your specific plan. By understanding your benefits and following the right steps, you can make the most of your Discovery Health membership and get the mental health support you need.
Global Helplines & Emergency Services
If you are in immediate distress, please reach out for help. You are not alone.
References
Discovery Health Medical Scheme Integrated Report 2024
PMB Definition Guidelines for Mental Health
Discovery Health. (2024). Mental Health Care Programme 2025
Discovery Health. (2023). Cover for allied, therapeutic and psychology healthcare professionals 2024
Disclaimer: The information in this article is based on 2024/2025 policy documents. Benefit amounts and contact details can change. Always verify current details with your medical aid scheme before making any healthcare decisions.
