Mental health and private insurance - what's covered?

By Brandon Taylor

6 minutes

16 September 2020

Does PHI cover mental health blog image 

Your mental health affects how you feel, think, act and behave, so taking care of it should always be top of mind. Here’s how private health insurance can help you do that.

Almost half of Australians aged 16 – 85 will experience mental illness at some point in their life. That stat can sound scary, but the good news is, many mental health issues can be managed if you get help.

If you’re worried about your mental health, a good place to start is with a visit to your GP. Your GP can assess your symptoms, make a diagnosis, create a health treatment plan, or refer you to a mental health professional. Having a health treatment plan means Medicare might help with some of your costs.

The other good news is that private health insurance can help cover some of the cost of mental health treatment, too.

Here’s what can be covered by private health insurance, and how it works.

Psychology and Clinical Psychology

When you get mental health treatment outside of hospital, consultations with a Psychologist or Clinical Psychologist can be covered by extras cover.

What can a Psychologist or Clinical Psychologist help you with?

Psychologists and Clinical Psychologists can help manage a wide range of mental health issues such as depression, anxiety, stress, addictions and eating disorders.

Clinical Psychologists are psychologists who have completed specialised advanced education and supervised training in mental health. They’ve got particular skills to help solve complex problems that require more tailored treatment.

What’s covered under private insurance?

Some levels of extras cover include cover for both Psychology and Clinical Psychology. Some include just one or the other, and some don’t cover any psychology at all. So if you want extras cover for Psychology or Clinical Psychology, make sure to check specifically for it.

At HBF, extras cover that includes psychology provides benefits for individual, couple, family and group consultations.

Can Medicare cover Psychology too?

Yes, Medicare can cover psychology. In order to get covered, you’ll need to get an assessment from a GP first. Medicare can help cover some of the cost of GP appointments, mental health treatment plans and support from a social worker.

Medicare-funded mental health treatment plans include benefits for up to 10 sessions per year with a mental health professional.

Psychiatric treatment in hospital

When hospital treatment is required for a mental health condition, hospital cover can help.

What can Hospital Psychiatric Services help you with?

Hospital Psychiatric Services can help with treatment and rehabilitation for depression, eating disorders, drug and alcohol addiction and other conditions while you’re admitted to hospital. Sometimes this could require a day admission – but it could mean an extended stay if you require a longer course of treatment.

What’s covered under private insurance?

In Australia, all hospital insurance (besides overseas cover) is required to have some level of cover for Hospital psychiatric services. This can be full cover or restricted cover – and the difference between them is important.

Restricted cover means only the government-required minimum amount of benefits will be provided, and you could face large out-of-pocket costs.

Costs of hospital treatment when you are admitted can vary a lot depending on which hospital you go to and which specialists treat you. HBF has a large network of Member Plus hospitals and fully covered specialists. Choosing these providers can help keep your out-of-pocket costs to a minimum.

If you’re currently on restricted cover and want to upgrade, there’s an option to do so without facing waiting periods.

If you have held an eligible hospital cover for 2 months, and have restricted cover for Hospital psychiatric services, you can choose to upgrade your cover, so you are fully covered for these services. If you do, HBF will waive the usual 2 month waiting period on Hospital psychiatric services1. This mental health waiver can only be used once in your lifetime – even if you cancel your cover and re-join in the future, or switch health funds.

Consult the Australian Department of Health for more information on the mental health waiver.

Can Medicare cover Hospital psychiatric services?

Yes, Medicare can cover you if you require hospitalisation for mental health care. It can cover treatment in a public hospital, but you may be put on a waiting list before you can be admitted and the amount of time you are on the waiting list can vary by state and hospital.

If you’re unsure of what your HBF policy covers, or you want to know how private health insurance could benefit you, call us on 133 423 or visit us in an HBF branch near you.

There are also some great free services available through mental health organisations such as:

For a full list of services recommended by the government, check out the Head to Health service providers page.

If you or someone you know is struggling, you’re not alone and there are several places you can turn to for help.

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Disclaimer

This article contains general information only and does not take into account the health, personal situation or needs of any person. In conjunction with your GP or treating health care professional, please consider whether the information is suitable for you and your personal circumstances.

1. Mental health waiver can only be used once per person per lifetime. When you lower your excess, waiting periods for the reduced excess may also apply for all services including Hospital psychiatric services. Waiting periods may apply for other services not on your previous level of cover.For waiting periods that have been partly served, you may have to serve the remainder of the applicable waiting period.