Medihelp: Mental Health Benefits and Support Options
TherapyRoute
Clinical Editorial
Cape Town, South Africa
❝Medihelp, a well-established South African medical aid, provides comprehensive mental health coverage through its Mental Health Programme, offering detailed benefits for therapy, psychiatry, and in-hospital treatment across its diverse plans.❞
Medihelp is a well-established medical aid in South Africa with a history of over a century. It holds a market share of 3.5% and is known for its wide range of plans and its focus on providing comprehensive care. This article will provide a detailed look at Medihelp's mental health coverage, based on their 2024 and 2025 policy documents. We will explore their Mental Health Programme, the benefits available on different plans, and how you can access them.
Table of Contents | Jump Ahead
Therapy should be personal. Our therapists are qualified, independent, and free to answer to you – no scripts, algorithms, or company policies.
Find Your TherapistMedihelp's Focus on Comprehensive Mental Health Care
A Detailed Look at Your Medihelp Mental Health Benefits
How to Access Your Medihelp Mental Health Benefits
Network vs Non-Network Providers: A Detailed Comparison
How to Claim for Therapy Sessions
The Verdict: Is Medihelp a Good Choice for Mental Health?
Global Helplines & Emergency Services
Medihelp's Focus on Comprehensive Mental Health Care
Medihelp has a strong focus on providing comprehensive mental health care, with a dedicated programme for depression and generous benefits for psychiatric treatment on its higher-end plans.
The Mental Health Programme for Depression
Medihelp has a specific Mental Health Programme for members who have been diagnosed with depression. To access the benefits of this programme, you need to register with the scheme. Once you are registered, you will have access to a range of services, including:- Consultations with psychiatrists, psychologists, social workers, and occupational therapists
- A monthly benefit for medication
This programme is a valuable resource for members with depression, as it provides a structured and supportive approach to managing their condition.
HealthPrint: A Wellness Programme for All
All Medihelp members have access to the HealthPrint wellness programme. This programme provides a range of benefits, including health screenings and preventative care. By registering for HealthPrint, you can also activate additional benefits, such as an extra GP consultation and a benefit for self-medication.A Detailed Look at Your Medihelp Mental Health Benefits
Medihelp's Mental Health Benefits vary significantly depending on the plan you have chosen. Here is a breakdown of what you can expect.
In-Hospital Treatment
Medihelp offers generous benefits for in-hospital psychiatric treatment, especially on its more comprehensive plans. The annual benefit for psychiatric treatment ranges from R23,900 per person on the MedMove! plan to R53,900 per person on the MedElite plan. [4] Key Points for In-Hospital Care:- Pre-authorisation is essential. You must get approval from Medihelp before being admitted to the hospital.
- Use a network hospital. To ensure you are fully covered, it is always best to use a hospital in the Medihelp network.
- Co-payments may apply. If you choose to use a non-network hospital, you may have to pay a co-payment.
Out-of-Hospital Treatment
Medihelp's out-of-hospital benefits for mental health are a combination of the Mental Health Programme for depression and your plan's day-to-day benefits.Psychology and Psychiatry
Consultations with psychologists and psychiatrists are covered from your plan's day-to-day benefits. On the savings plans, you will pay for these consultations from your Medical Savings Account. On the comprehensive plans, you have a separate benefit for these services.The Mental Health Programme for Depression
If you are registered on the Mental Health Programme for depression, you have access to an additional out-of-hospital benefit. This benefit ranges from R3,000 to R6,000 per year, depending on your plan. You also receive a monthly benefit for medication, ranging from R95 to R160 per month.
Prescribed Minimum Benefits (PMBs) - Covered on ALL Plans
|
PMB Code |
Condition |
Coverage |
What This Means for You |
|---|---|---|---|
| 902T | Major affective disorders, including unipolar and bipolar depression | Unlimited hospital + 15 outpatient sessions | Full coverage for mood disorders and therapy |
| 907T | Schizophrenic and paranoid delusional disorders | Unlimited hospital + ongoing treatment | Complete psychiatric care and medication |
| 908T | Anorexia Nervosa and Bulimia Nervosa | Hospital care + 15 outpatient sessions | Medical stabilization and psychological support |
| 182T | Abuse or dependence on psychoactive substances, including alcohol | Hospital rehabilitation + outpatient support | Detox, rehab, and ongoing recovery support |
| 901T | Acute stress disorder accompanied by recent significant trauma | Hospital care + 12 outpatient sessions | Crisis intervention and trauma therapy |
| 903T | Attempted suicide, irrespective of cause | Hospital care + outpatient support | Crisis intervention and ongoing support |
How to Access Your Medihelp Mental Health Benefits
- Register for the Mental Health Programme: If you have been diagnosed with depression, contact Medihelp to register for the Mental Health Programme.
- Get Pre-Authorisation: For any planned hospital admissions, make sure you get pre-authorisation from Medihelp.
- Use Network Providers: To minimise your out-of-pocket expenses, use providers in the Medihelp network.
- Register for HealthPrint: All members should register for the HealthPrint wellness programme to access additional benefits.
Network vs Non-Network Providers: 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 Medihelp directly (bulk-billing). | You pay the provider and then claim back from Medihelp. |
| 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 cost of treatment. |
| Rates | Charge at or close to the Medihelp Rate. | Can charge significantly above the Medihelp Rate, 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 Medihelp 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. While non-network providers offer more choice, this comes at a significant financial cost.
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 Medihelp
- Show your Medihelp card at the appointment
- Provider submits claim directly to Medihelp (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:
- Medihelp app (fastest)
- Online member portal
- Email to claims@medihelp.co.za
- Post to Medihelp Claims, PO Box 26004, Arcadia, 0007
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
The Verdict: Is Medihelp a Good Choice for Mental Health?
Medihelp is an excellent choice for individuals and families who are looking for comprehensive mental health coverage, particularly for psychiatric treatment and depression. The likelihood of getting your mental health treatment paid for by Medihelp is high, especially if you are on one of their more comprehensive plans. The dedicated Mental Health Programme for depression is a standout feature, providing structured and supportive care for members with this condition. If you are looking for a medical aid that offers generous benefits for psychiatric treatment and a specialised programme for depression, Medihelp is a strong contender.Global Helplines & Emergency Services
If you are in immediate distress, please reach out for help. You are not alone.- Find a helpline, suicide hotline, or crisis line in your country: https://www.therapyroute.com/article/helplines-suicide-hotlines-and-crisis-lines-from-around-the-world
- Find an emergency ambulance number in your country: https://www.therapyroute.com/article/ambulance-emergency-numbers-worldwide-list-by-therapyroute
References
Medihelp Mental Health Benefits 2025 (Official Document)
Medihelp. (2024). Mental Health Benefits 2025.
Medihelp HealthPrint Wellness Programme (Official)
Medihelp Mental Health Benefits 2025 - Detailed Benefit Amounts (Official Document)
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.
Important: TherapyRoute does not provide medical advice. All content is for informational purposes and cannot replace consulting a healthcare professional. If you face an emergency, please contact a local emergency service. For immediate emotional support, consider contacting a local helpline.
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About The Author
TherapyRoute
Cape Town, South Africa
“Our in-house team, including world-class mental health professionals, publishes high-quality articles to raise awareness, guide your therapeutic journey, and help you find the right therapy and therapists. All articles are reviewed and written by or under the supervision of licensed mental health professionals.”
TherapyRoute is a mental health resource platform connecting individuals with qualified therapists. Our team curates valuable mental health information and provides resources to help you find the right professional support for your needs.
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