Medical Aid for ADHD

Adhd medical aid

ADHD or Attention Deficit Hyperactivity Disorder is a common neuro-developmental disorder that manifests in early childhood. According to the Attention Deficit and Hyperactivity Support Group of Southern Africa (ADHASA), up to 5.5 million South Africans are living with ADHD.

Genetics, environmental factors and abnormalities in the structure and function of the brain are identified as triggers. Symptoms vary from hyperactivity and inattention, to impulsive and disruptive behaviour.

Managing ADHD

After years of research, the consensus is that a combination of medication, diet, supplements and counselling is the best way to treat and manage ADHD.

Psycho-stimulant medications with methylphenidate as the active ingredient, such as Ritalin and Concerta, have proved to be effective solutions in the majority of cases.

Avoiding processed foods with artificial flavourants and colourants, and supplementing a whole food diet with essential fatty acids, should be part of a prescribed treatment plan.

Life skills training, occupational therapy, counselling and exercise are all helpful interventions that focus on teaching people diagnosed with ADHD more appropriate behaviour.

How medical aid schemes in South Africa cover ADHD

ADHD is not considered life threatening. It is consequently not a Prescribed Minimum Benefit (PMB) or Chronic Disease List (CDL) condition as outlined by the Medical Schemes Act.

As a result, medical aid schemes in South Africa are not required by law to cover the medical costs associated with the diagnosis and treatment of ADHD.

Discovery Health, for instance, has followed the letter of the law and does not offer chronic benefits for ADHD. Instead, any associated costs are paid from the members’ savings accounts.

Chronic condition benefits

There are, however, medical aid schemes that do offer chronic benefits for beneficiaries diagnosed with ADHD. These benefits are usually limited to the more expensive top tier medical aid plans. Providers such as Momentum Health, Fedhealth and Resolution Health are among those that offer such plans.

As with all chronic benefits, you may have to use designated service providers (DSPs), or network GPs, specialists and pharmacies in order to avoid co-payments.

Furthermore, there’s usually only cover for medicines listed on the scheme formulary, and benefits are paid according to the Medicine Price List (MPL).

Where to find chronic benefits for ADHD

As benefits, contributions and the level of cover for ADHD differ widely from scheme to scheme, it’s essential you get professional advice.

Specialist medical aid brokers have all the facts and figures available on demand. Chat with one of our qualified medical aid brokers today to find the best medical aid for ADHD.