3 Best Medical Aid Plans That Cover ADHD

💙 This is our guide to the 3 best medical aid plans that cover ADHD. Choosing the right medical aid plan is vital for individuals and families managing ADHD, a condition that requires ongoing treatment and support. In this guide you will learn:

• ☑️ How ADHD is covered under chronic illness benefits
• ☑️ The 3 best medical aid plans that cover ADHD
• ☑️ Frequently asked questions

💙 In South Africa, medical aid schemes vary widely in their coverage for ADHD, with some offering comprehensive benefits for medication, specialist consultations, and therapy, while others provide limited support.

💙 Given that ADHD is not considered a Prescribed Minimum Benefit (PMB) condition, coverage for it is not mandatory, making it important for those affected to select a plan that offers sufficient chronic illness benefits.

💙 This guide will explore how ADHD is covered by medical aid schemes and what treatments are typically included. By understanding the various levels of coverage available, individuals can make informed decisions so that their ADHD treatment needs are adequately met.

Best medical aid schemes that cover ADHD – A Comparison 2025

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How ADHD is Covered Under Chronic Illness Benefits

💙 ADHD (Attention Deficit Hyperactivity Disorder) is recognized as a long-term condition that often requires ongoing medical treatment and therapy. In South Africa, many medical aid schemes include ADHD under their Chronic Illness Benefits (CIB), which is a benefit designed to cover the treatment of conditions that require long-term medical intervention.

💙 These benefits see that individuals diagnosed with chronic conditions, such as ADHD, receive the necessary medical support without depleting their day-to-day healthcare savings.

Explanation of Chronic Illness Benefits and How They Apply to ADHD

💙 Chronic Illness Benefits cover the cost of ongoing treatment, including consultations, medications, and sometimes therapy, for conditions that are listed on a medical aid’s Chronic Disease List (CDL). ADHD is included as a chronic condition on many comprehensive plans. Coverage typically includes:

Medication

💙 Medical aids often provide cover for medications such as stimulants and non-stimulants, which are crucial for managing the symptoms of ADHD. Some schemes may require patients to use generic alternatives where possible to manage costs.

Consultations

💙 ADHD treatment usually requires consultations with specialists like psychiatrists, psychologists, or paediatricians. These specialists are often covered under the CIB, subject to the member’s plan limits.

Therapy

💙 Some medical aids also provide cover for cognitive behavioral therapy (CBT) or other forms of counselling, which are important for managing ADHD in both children and adults.

Conditions for Receiving Coverage for ADHD Treatment and Medication

💙 To access ADHD treatment under Chronic Illness Benefits, there are certain conditions that medical aid members must meet:

Diagnosis and Documentation

💙 A formal diagnosis from a qualified healthcare professional, such as a psychiatrist or pediatrician, is required. Medical aids typically need comprehensive documentation, including a treatment plan.

Pre-Authorization

💙 Many medical aid schemes require pre-authorization before members can access ADHD treatment. This involves submitting medical reports and getting approval for specific treatments or medications.

Treatment Protocols

💙 Some medical aids have strict protocols in place, which require members to adhere to prescribed treatments. For instance, they may only cover certain medications on their approved formulary or require the use of generic drugs unless there’s a medical reason to use a specific brand.

Network Restrictions

💙 In some cases, members may need to consult specialists within the medical aid’s network to access full coverage for ADHD treatment. Visiting out-of-network specialists could result in additional out-of-pocket expenses.

3 Best medical aid plans that cover ADHD

👉 Below are 3 leading medical aid schemes in South Africa that provide cover for ADHD.

KeyHealth Medical Aid

At a Glance

☑️ In 2025, KeyHealth Medical Aid offers ADHD coverage through its higher-tier plans, particularly under its chronic illness benefits. ADHD is considered a chronic condition on some of their plans, which include coverage for necessary medication and consultations.

☑️ Plans like Gold and Platinum provide a comprehensive level of chronic condition management, including ADHD, and these plans often include cover for medication, specialist consultations (such as pediatricians or psychiatrists), and therapy​.

☑️ However, it’s important to note that ADHD is not a Prescribed Minimum Benefit (PMB) condition under the South African Medical Schemes Act, meaning that medical aids like KeyHealth are not legally required to cover ADHD by default. The level of coverage for ADHD may vary based on the specific plan, with higher-tier plans offering broader support​.

👉 KeyHealth offers 6 medical aid plans, but these two top tier plans cover ADHD:

• ✅ Keyhealth Gold Medical Aid Plan
• ✅ Keyhealth Platinum Medical Aid Plan

Who will benefit from KeyHealth?

💙 KeyHealth offers a fairly comprehensive medical cover that is well-suited towards individuals, families and pensioners. It offers comprehensive plans, with good coverage that is affordable.

FedHealth Medical Aid

☑️ Fedhealth offers ADHD cover under its chronic medicine benefit on several plans. ADHD is specifically listed for children aged 6 to 18 under the following plans:

✔️ Maxima PLUS

✔️ Maxima EXEC

✔️ FlexiFED 4

✔️ FlexiFED 3

💙 These plans cover medication for ADHD up to a specified annual limit, which varies by plan. For instance, the FlexiFED 4 and FlexiFED 3 options include a limit of R3,200 per family for ADHD, depression, generalized anxiety disorder, and post-traumatic stress disorder (PTSD) medications.

 At a Glance

💙 After exceeding this limit, medication will be subject to out-of-pocket payments or may be covered using the member’s medical savings account.

💙 For Maxima EXEC and Maxima PLUS,  members are covered for conditions on the Chronic Disease List (CDL) plus additional conditions. This is covered in full up to the Medicine Price List if the member uses medicine on the comprehensive formulary. Members can use any pharmacy to get their chronic medication. The chronic limits are R16 700 per beneficiary, subject to an overall limit of R31 300 per family per year. Thereafter unlimited cover for conditions on the CDL.

💙 To access this benefit, members need to follow the registration process for chronic conditions, checking that ADHD is recognized under their specific plan, and medication must be obtained through preferred providers at MPL (Medicine Price List) rates to avoid co-payments​.

MediHelp Medical Aid

💙 Medihelp offers ADHD coverage under its chronic medicine benefits, but it’s important to note that ADHD is not classified as a Prescribed Minimum Benefit (PMB) condition under the Medical Schemes Act. This means that coverage for ADHD is not mandatory across all plans. According to our research only the MedMove plan doesn’t cover ADHD.

💙 However, Medihelp does provide ADHD cover under some of its top-tier plans, which often include chronic condition benefits. Coverage for medication, therapy, and consultations is subject to plan limits and might require members to use the scheme’s designated service providers (DSPs) to avoid co-payments​.

💙 Plans like MedAdd Elect offer comprehensive coverage, which includes psychiatric care and access to chronic medications under certain conditions, but you may need to register ADHD as a chronic condition and adhere to Medihelp’s formulary for approved medications​.

At a Glance

👉 MediHelp has the following 11 plans to choose from with only the MedMove plan that doesn’t cover ADHD: 

• ✅ MediHelp Medprime
• ✅ MediHelp MedPrime Elect
• ✅ MediHelp MedPlus
• ✅ MediHelp MedElite
• ✅ MediHelp MedVital
• ✅ MediHelp MedVital Elect
• ✅ MediHelp MedSaver
• ✅ MediHelp MedMove
• ✅ MediHelp MedElect
• ✅ MediHelpMedAdd
• ✅ MediHelp MedAdd Elect

📌 You might also like to read more about Health Insurance for Kids

Frequently Asked Questions

Is ADHD considered a chronic condition under medical aid schemes?

ADHD is generally not classified as a Prescribed Minimum Benefit (PMB) condition under the Medical Schemes Act, meaning that medical aid schemes are not legally required to cover it. However, some plans offer chronic benefits for ADHD, usually under higher-tier plans that provide additional coverage beyond PMBs.

What type of ADHD treatments are typically covered by medical aid?

Coverage may include consultations with specialists (such as psychiatrists or pediatricians), prescription medications (like Ritalin or Concerta), and sometimes therapy (such as cognitive behavioral therapy). The exact coverage will depend on the specific plan, whether ADHD is recognized as a chronic condition, and if the medication is listed on the plan’s formulary.

Do medical aid plans cover all ADHD medications?

Not necessarily. Many medical aid schemes have formularies that list the medications they cover, and ADHD medications may be subject to these restrictions. If a prescribed medication is not on the formulary, there may be a co-payment, or the member may have to pay out of pocket. Some plans cover only generic versions of ADHD medications.

How can I register ADHD as a chronic condition on my medical aid plan?

To access chronic medication benefits for ADHD, members typically need to register the condition with their medical aid. This process usually requires a formal diagnosis, submission of medical reports, and pre-authorization for treatment. Your doctor or pharmacist may assist in completing the application process.

Are there any additional costs for ADHD treatment under medical aid?

Depending on the medical aid plan, there may be additional costs, such as co-payments for medications not on the approved formulary or for using out-of-network providers. Some plans may also have annual limits for ADHD treatment, after which the member may need to pay out-of-pocket. It’s essential to check the specific plan details to understand any potential costs.

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