Why medical aid schemes don't pay for chronic depression and anxiety meds

It is estimated that a third of South Africans suffer from some form of mental illness.

One of the major issues is that most medical aid schemes do not cover medication for depression and anxiety. This means that those who need to take medication for depression and anxiety need to fork out thousands of rand a year in order to function.

Dr Oluritini Modupe, senior manager at the Council of Medical Schemes, says depression is covered under Developmental Trauma Disorder (DTD) per code 91OT which is titled acute delusional mood anxiety personality and perception disorder and organic mental disorders.

Read: Traffic chief's stop to assist fellow motorist turns into traumatic experience

The care of that is provided for in the Act, the Prescribed Minimum Benefits Regulations to the Medical Schemes Act as hospital-based treatment for up to three days.

Dr Oluritini Modupe, Senior manager at the Council of Medical Schemes

Modupe says after three days, the patient will be assessed and if it is diagnosed that the patient still needs care it will then be referred to scheme rules. The scheme rules vary from one medical aid to another depending on the patient's plan options.

According to the Act, the medical aid should be able to pay for the minimum benefits but once the prescribed minimum benefits are exhausted, the scheme's rules that apply to the member's particular option kicks in.

Obviously, we need to try and rectify and we have been doing that since 2016 in a form of PMB review exercise just to come with a revision of the current package, cost it and ensure that it is affordable.

Dr Oluritini Modupe, Senior manager at the Council of Medical Schemes

To hear the rest of the conversation with Dr Oluritini Modupe, listen below:


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