Understanding Discovery Medical Aid and Mental Health Benefits
Mental health care is vital—and thankfully, many South Africans have access to support through their medical aid. If you’re wondering, “Does Discovery cover counselling sessions?” the answer is yes—but with a few important considerations. Here’s a comprehensive guide on what’s covered, what isn’t, and how to get the help you need.
Initial Counselling Assessment – Not Covered Under PMBs
Most Discovery Health Medical Aid plans do not cover the initial counselling session under Prescribed Minimum Benefits (PMBs). This first session, also known as the intake or assessment session, is typically paid out-of-pocket or from your day-to-day benefit pool.
Why? This session is used to evaluate your mental health needs and determine whether your condition qualifies as a PMB diagnosis. After this, your psychologist will assess whether you’re eligible to apply for further sessions under PMB.
When Can You Apply for PMB Coverage?
If your psychologist diagnoses a mental health condition that is classified under PMBs, you may be eligible to apply for PMB funding. This includes diagnoses such as:
- Major depressive disorder
- Generalized anxiety disorder
- Post-traumatic stress disorder (PTSD)
- Bipolar disorder
- Schizophrenia
- Substance use disorders
Your psychologist will guide you through this process, helping you gather the necessary documentation for Discovery to process your application.
Required Documentation for PMB Applications
To apply for counselling sessions under PMBs, the following documents are typically required:
- A clinical diagnosis by a registered psychologist or psychiatrist
- A detailed motivation letter from your treating professional
- Discovery’s PMB application form, filled in by the practitioner
- A copy of your medical aid membership details
- Supporting documents such as past treatment history (if applicable)
How Many Sessions Are Usually Covered?
The number of counselling sessions covered under PMBs depends on your diagnosis and the motivation provided. However, most medical aid schemes—including Discovery—cover 15 to 20 sessions annually for qualifying conditions.
Discovery may first approve a limited number of sessions, typically 6 to 8, with the possibility of extending the number after a progress review.
What Happens After Submission?
After submitting your PMB application:
- Discovery reviews the documentation.
- If approved, a set number of sessions will be authorized.
- Your psychologist will invoice Discovery directly, or you may need to pay upfront and claim back, depending on the arrangement.
- Additional sessions can be motivated for, if needed.
Important Notes for Patients
- Not all Discovery plans cover mental health equally. Higher-tier plans may allow broader access.
- Even if you don’t qualify for PMBs, you can still use day-to-day funds or savings for psychological care.
- Children, teens, and adults can all qualify for PMBs depending on the diagnosis.
Can You Apply More Than Once?
Yes. If your sessions are exhausted but you’re still receiving active treatment for a qualifying condition, your psychologist can submit a motivation for additional sessions. This is assessed on a case-by-case basis.
Getting Started with a Registered Psychologist
It’s essential to begin your journey with a registered psychologist who understands the PMB process and Discovery’s guidelines. At Mental Health Benoni, our professionals, including experienced counseling psychologists like Laurika Lubbe, can guide you from assessment to treatment and through the entire PMB application process.
Let Us Help You Navigate Discovery Medical Aid
If you’re ready to take the first step in your mental health journey but unsure how to proceed with your medical aid, we’re here to help. Contact Mental Health Benoni today and schedule your first session. We’ll assist with your initial assessment and guide you through the process of applying for PMBs through Discovery Medical Aid.
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Our supportive admin team is ready to help you check your plan benefits and get started on your path to mental wellness.