Does Medical Aid in SA Cover Psychologists' Services?

What Is Medical Aid Psychology Coverage?

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.

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.

Do You Really Need Medical Aid to See a Psychologist?

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: Does Medical Aid Cover Psychology?

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 medications if they're 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 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.

Cheat Sheet: What Does Medical Aid Typically Cover for Psychology?

PMB pathways: Certain conditions may qualify for 21 inpatient days or up to 15 outpatient contact sessions (shared across mental health providers), subject to assessment and approval.

Outpatient therapy: Paid from day-to-day benefits or defined mental health limits; some plans require network psychologists.

In-hospital care: Psychiatric admissions usually need pre-authorisation, clinical motivation, and may carry facility co-payments if out-of-network.

Meds: Some chronic formularies cover antidepressants/anxiolytics under PMB when criteria are met.

What’s Usually Covered — and What’s Not

Not all mental illnesses qualify as PMBs. Even when they do, session counts and limits differ by scheme and option (e.g., 15 sessions, 12, or only a few). If you’re not covered, you can still use available Medical Savings. Some practitioners also offer reduced rates for cash patients without medical aid.

Choosing the Right Medical Aid Plan

1) Benefits vs cost: Check how much psychological care is covered and at what scheme rate.

2) Read the fine print: There’s no standard structure. Many schemes set annual limits for in- and out-of-hospital claims; once reached, you pay (or claim from savings if your product has it).

3) Support programmes: Some schemes offer mental-health programmes with selected provider networks and guided care.