A stroke changes everything immediately. Once the acute crisis is managed, you need to understand exactly what your medical aid will and won't fund over the months ahead — because rehabilitation decisions made in the first weeks have lifelong consequences.
The Honest Starting Point
The acute stroke hospital admission is PMB-covered. That's the good news. The harder news is that post-discharge rehabilitation — the therapy that determines how much function you recover — is funded from limited day-to-day benefits that are typically grossly insufficient for a serious stroke. Most stroke survivors have significant out-of-pocket rehabilitation costs.
Plan for this from the moment of discharge.
Step 1: In-Hospital — Ensure Correct Treatment and Authorisation
If you are admitted following a stroke or TIA:
- Your treating neurologist or attending physician should contact your scheme for pre-authorisation within 24–48 hours (in a genuine emergency, you don't need pre-auth before presenting).
- Confirm the admission is coded under the stroke DTP (ICD-10: I63.x for ischaemic, I61.x for haemorrhagic, I64 for unspecified, G45 for TIA).
- Ask your gap cover provider to be notified of the admission — many policies require notification within 48–72 hours for cover to apply. This is easy to do from hospital — ask a family member to call if you are unable.
- Ensure all in-hospital rehabilitation (physiotherapy, OT, speech therapy) is initiated during the acute admission. Schemes are more likely to fund these as part of the in-hospital PMB than as post-discharge outpatient sessions.
Step 2: Understand Your Post-Discharge Rehabilitation Benefit
Before discharge, contact your scheme's managed care organisation and ask:
"I am being discharged following a stroke. What outpatient rehabilitation benefit do I have? Specifically: physiotherapy sessions, occupational therapy sessions, and speech-language therapy sessions per year. Is there a sub-limit or rand cap?"
Write down the answers. These numbers define your recovery funding.
Typical plan allowances (illustrative): - Physiotherapy: 10–15 sessions/year on standard plans; up to 30+ on comprehensive plans - Occupational therapy: 6–10 sessions/year - Speech-language therapy: 5–10 sessions/year
What stroke recovery actually requires: - Physiotherapy: 3+ sessions/week for months - OT: 2+ sessions/week for months - SLT: 2–3 sessions/week if significant aphasia or dysphagia
The gap is large. You will need to supplement. See Step 4.
Step 3: Register CDL Conditions Immediately
If you had hypertension, diabetes, or dyslipidaemia before the stroke (likely — these are the dominant risk factors), and they are not already registered on the CDL, register them now. This shifts your chronic medication funding from your MSA to the dedicated CDL benefit — freeing MSA funds for rehabilitation costs.
Call your scheme: "I would like to register my hypertension (and diabetes / dyslipidaemia) on the CDL. My treating doctor will provide the necessary documentation. What is the process?"
Your GP or specialist needs to complete a CDL application form, typically including the diagnosis, medication, and dosing. Once approved, chronic medications are funded at no cost to the MSA.
Step 4: Plan the Rehabilitation Programme — Funded + OOP
Build a realistic rehabilitation plan with your neurologist or physiotherapist that uses scheme-funded sessions strategically and supplements with OOP sessions:
Prioritise scheme-funded sessions for: The highest-impact interventions at the current stage of recovery. A physiotherapist experienced in neurological rehabilitation can advise on where sessions are most valuable.
OOP options to supplement: - Community health centres (CHCs) and government rehabilitation services: State physiotherapy and OT at subsidised rates. Quality varies; waiting times can be long. Register early. - University and teaching hospital outpatient departments: Stellenbosch, Wits, UCT, UL — offer physio and OT at reduced rates. Add your name to waiting lists immediately. - Community-based rehabilitation workers (CBRWs): DSD-deployed in many communities; can provide basic exercise programmes between formal therapy sessions. - Home physiotherapy: Some physiotherapists offer home-visit sessions — cost-effective for mobility-impaired patients who cannot travel to a practice.
Step 5: Secondary Prevention Medication — Get This Right
Stroke secondary prevention medications are lifelong. Ensure the following are in place before discharge:
For ischaemic stroke (non-AF cause): - Antiplatelet therapy: aspirin (75mg daily) + often clopidogrel for 3 months, then single agent - High-intensity statin (atorvastatin 40–80mg or rosuvastatin 20–40mg) - Antihypertensive (based on BP)
For AF-related ischaemic stroke: - DOAC (rivaroxaban or apixaban) or warfarin for lifelong anticoagulation — critical for preventing recurrence - Confirm DOAC is on your scheme's formulary. If warfarin is prescribed, INR monitoring (monthly pathology) is funded from the pathology benefit.
For haemorrhagic stroke: - Anticoagulation after haemorrhagic stroke is complex — your neurologist will guide timing and choice.
Request that hypertension, dyslipidaemia, and diabetes are registered as CDL conditions (if not already done) so that chronic medications are funded from the CDL benefit.
Step 6: Long-Term Monitoring and Annual Assessment
Post-stroke monitoring includes: - Annual neurologist review: day-to-day benefit (check specialist sub-limit) - Blood pressure monitoring: GP or self-monitoring device - Lipid and glucose control: pathology benefit - Echocardiography and carotid Doppler (if indicated): radiology benefit
If AF was identified as the cause, ongoing cardiologist review and anticoagulation monitoring are important.
Support Resources
SASHEF (SA Stroke Foundation): strokesa.co.za — patient and carer support Stroke Support Group South Africa: Contact your regional neurological rehabilitation unit SADAG (mental health support for stroke survivors and carers): 0800 567 567 | sadag.org Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za
Talk to Eldon
Stroke survivors need plans with strong rehabilitation session allowances and active gap cover. AURA helps identify the right plan combination for post-stroke needs.
Review your plan for post-stroke care →