In short: ADHD and autism are not Prescribed Minimum Benefit (PMB) or Chronic Disease List (CDL) conditions, so schemes are not required to cover them. Usually only comprehensive or executive plans pay for ADHD medicine from a chronic benefit; otherwise it comes from savings or your pocket.
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Whether medical aid covers ADHD depends entirely on your scheme and plan. Here is how it works and how the main schemes compare.
Is ADHD a PMB?
No. The Chronic Disease List under the Medical Schemes Act covers 27 conditions; ADHD and autism are not among them. Schemes may still choose to cover ADHD on higher plans, often through an “additional disease list”.
Medical aid ADHD comparison (2026)
| Scheme | Plans most likely to cover ADHD | Chronic medicine | Therapy & assessments |
|---|---|---|---|
| Discovery Health | Executive and Comprehensive plans (Additional Disease List cover) | Only if ADHD is on the plan’s ADL; otherwise from Medical Savings Account | Usually savings; psycho-educational assessments rarely covered |
| Bonitas | BonComprehensive | Selected plans, formulary and DSP rules | Specialist and therapy limits |
| Fedhealth | flexiFED 3 and higher | Selected options | Specialist limits; referral needed |
| Bestmed | Pace4 | Chronic registration possible | Specialist limits |
| Medihelp | MedElite | Stronger psychiatric benefits | Limits apply |
| Momentum Health | Higher-tier options | Chronic ADHD benefit on some options | Specialist limits |
Important: benefits change every January. This table is a guide only — confirm in your scheme’s 2026 benefit brochure or by phoning the scheme before you rely on it.
How to register ADHD as a chronic condition
- Ask your psychiatrist or paediatrician to complete your scheme’s chronic application form, including the ICD-10 code (F90.x for ADHD).
- Submit it with the prescription.
- Use the scheme’s formulary medicine (often a generic) and network pharmacy to avoid co-payments.
What medical aid usually does not cover
- Psycho-educational and adult diagnostic assessments (often self-funded)
- ADHD coaching and tutoring
- Occupational therapy beyond your savings or therapy limit
Tax relief
Out-of-pocket medical expenses may qualify for the additional medical expenses tax credit. If ADHD or autism substantially limits daily functioning, a medical practitioner may complete SARS’s ITR-DD form to confirm disability, which can increase the credit. See SARS medical tax credits.
Frequently asked questions
Does Discovery cover ADHD?
Discovery covers additional chronic conditions on its Executive and Comprehensive plans. Check whether ADHD is on the ADL for your plan by calling 0860 99 88 77.
Does medical aid cover Concerta?
Only on plans that cover ADHD as chronic, and often only the formulary product (which may be a generic). See Concerta prices.
Sources & further reading
- Discovery — Chronic Illness Benefit
- Medical Aid Quotes — Medical aid for ADHD
- Medicalaid.com — Plans that cover ADHD (2026)
- Council for Medical Schemes — PMBs
Last checked: 31 October 2026. If you spot something out of date, tell us.