In response to a recent clarification circulated by Southern Cross to providers, the issue of ADHD and health insurance coverage has been highlighted. Below is ADHD New Zealand’s position:

ADHD care is variable across Aotearoa

ADHD care is highly variable across New Zealand. Affordability, access, and treatment options can depend on a person’s situation, service provider, and private insurance policies.

Currently, even what is available within the public health system varies considerably.

Good ADHD care should be accessible and affordable to all

It is ADHD New Zealand’s view that good care should be accessible and affordable to all people with ADHD, regardless of whether they have private health insurance.

We recognise people living with ADHD may have ongoing physical and mental health needs beyond diagnosis and medication. Unfortunately, the public health system does not fund additional ADHD-specific services, which can mean some people’s needs are not met.

This is why ADHD New Zealand continues to advocate for increased access to publicly funded diagnosis and treatment.

Insurance coverage

While our work is focused on improvements to publicly funded services, we also encourage insurance companies and other private providers to work with us to better understand the needs of New Zealanders with ADHD and develop solutions where possible.

Clarifications and changes to policies can be confusing and upsetting. We encourage anyone affected by such issues to seek full clarification from their insurer before making any changes to their policy or insurer. A key issue is that all insurance companies have limits on what services can be claimed for under health insurance policies and sometimes exclude people or conditions from any coverage.

We know many New Zealanders with private health insurance don’t have coverage for ongoing care for a wide range of mental health and neurodevelopmental conditions. 

ADHD diagnosis coverage

Some New Zealanders are fortunate to be able to access ADHD diagnosis through their health insurance, Southern Cross being one example. Diagnosis continues to be critical to supporting good outcomes for people with ADHD because it opens doors to effective funded medication and to improved understanding by the individual, their whanau, and their doctor.

However, health insurance is beyond the reach of many people with ADHD, so an equitable response requires publicly funded diagnosis and treatment, including both medication and any other care that people require.

ADHD is a neurodevelopmental condition

ADHD is a complex neurodevelopmental condition that often requires mental health support as part of a broader package of care.

The public system does not fund mental health services specifically for ADHD, but people with ADHD may access the same publicly funded mental health services other New Zealanders do.

While this is not always adequate, many will be able to have their mental health needs met within the public health system and should speak with their GP about this. The Mental Health Foundation website has a wide range of resources too:

Mental Health Foundation of New Zealand | Mauri tū, mauri ora (mentalhealth.org.nz)

ADHD care and the public health system

ADHD New Zealand advocates for ADHD care to be provided within the public health system and for improvements in service access and quality to be implemented on a nationally consistent basis.

We have made great strides in recent years with improvements in access to medication, expanded medication options, development of clinical guidelines, and the soon to be implemented expanded prescribing rights to allow adult ADHD assessment by a wider range of health professionals. However, there is still much work do to.