Mental Health Insurance

health insurance psychology

Mental Health Insurance

If you or a family member suffers from mental health problems, then you know better than most that the cost of treatment and medicine can be extremely expensive. This is especially true for services like private psychiatry and child psychology.

Mental health insurance coverage is available from most health funds in Australia and can help you cover some of the high mental healthcare costs so you don’t have to pay for all the treatments and services out of your own pocket. Typically, an extras policy will cover you for ancillary treatments associated with mental health problems.

The levels of cover available vary between funds, so it’s important to compare policies and premiums.

You need to be comfortable and confident in your choice of policy. In this article we’ll look at:

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What is mental illness?

Mental illness generally refers to a wide range of mental health conditions that has a significant impact on how someone behaves, thinks, and feels. It is estimated that 45% of Australians aged 16 to 85 will experience a mental illness within their lifetime.

Examples of mental health illnesses include:

  • Substance abuse disorders, such as drug, alcohol, and gambling addictions.
  • Personality disorders, such as paranoia.
  • Psychotic disorders, like schizophrenia.
  • Eating disorders, like bulimia and anorexia.
  • Mood disorders, including depression, bipolar, and postpartum depression.
  • Anxiety/panic disorders, like panic attacks and phobias, such as claustrophobia or agoraphobia.
  • Obsessive-compulsive and anxiety related disorders.
  • Disorders relating to trauma, for example, post-traumatic stress disorder (PTSD).
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The general types of mental healthcare treatments and services available:

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Medication, such as antidepressants and antipsychotics.

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Counselling

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Therapy

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Psychotherapy

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Support groups and programs

The Mental health insurance bill

The Government has tackled the provision for mental health care on two fronts. First, they passed legislation that requires health insurers to include a minimum benefit for psychiatric care. This minimum benefit must be equal to the amount that a public hospital would charge a private patient for a shared room.

Secondly, they embarked on the National Mental Health Strategy 2003-2008 to help people get the treatment and services that they need. This strategy intends to ensure that our national health care system provides us with more access to mental health care. A further transformation of the mental health system in 2016 was made to improve healthcare access on a national scale, changes included:

  • Providing access to online counselling services to help people with mild mental health problems;
  • Medicare subsidies for psychology visits to help people with moderate mental health problems;
  • Ensuring access to a care plan for people with severe mental health problems. The care plan includes a combination of psychological services, mental health nursing, drug and alcohol services, vocational assistance and peer support, as determined by your Primary Health Care Network.
  • A new Mental Health Hotline to help people find the services that they need.
mental health insurance

What is mental health insurance?

Mental health insurance helps cover the cost of certain mental healthcare treatments and services when you purchase a private health insurance policy.

  • An extras policy generally covers the costs of psychology and counselling services.
  • A hospital policy will usually cover expenses associated with psychiatric treatment and/or drug and alcohol rehabilitation.

Keep in mind that there are different types of extras and hospital cover policies available. Each health fund generally offers different benefit levels. That’s why it’s so important to compare your options before making a decision.

How to get health insurance for psychological services

It’s often best to determine exactly what kind of mental illness you have and the treatment you need before starting your comparison. You might want to start by making an appointment with your GP, who will then usually recommend a mental health practitioner.

Referral and assessments:

  • If you are planning on seeing a psychiatrist you will need a referral from your GP.
  • You don’t need a referral from your GP if you’re planning on seeing a psychologist unless it is part of a Mental Health Plan.
  • Without a referral from your GP for either a psychologist or psychiatrist, Medicare won’t cover any of these costs.
  • The mental health care practitioner will talk to you about the treatment that is best for you, which will help you get quotes for the cover that you need.

Find mental health insurance quotes

Mental health insurance comparison

To find the best health insurance for psychiatric coverage, counselling, and other mental health treatments use this checklist when comparing policies:

  1. How a fund defines mental illness. This says a lot about how wide their scope of coverage will be.
  2. What exactly is covered: For example, counselling or psychological services, inpatient psychiatric care in private hospitals, and cover for the doctors you might see at the hospital, like psychiatrists or anaesthetists.
  3. Review their Product Disclosure Statement (PDS) to determine the waiting periods and exclusions they might have.
  4. Check how many times you can claim per year, and whether re-admission to a hospital within days of a previous hospital stay is covered, and if there are any limitations. Limitations mean that you may only receive restricted benefits for a particular treatment.
  5. Get a quote to see what your premium might be, as well as what the excess is and when you’ll need to pay this.
  6. Will you need to pay an additional premium to cover other treatments relevant to your mental health plan, for example, specific medication, day programs, or support groups.

How to determine whether your insurer covers therapy

If you already have health insurance and want to find out if therapy is covered, then it’s just a matter of checking your Product Disclosure Statements (PDS).

The PDS should lay out all the details of what is and what is not covered in your policy, so look out for keywords like ‘psychology’, ‘counselling’ and ‘psychiatry’. It’s also a good idea to check with your insurer and speak with a specialist if you’re uncertain.

List of mental health insurance providers

As part of your search to finding the best health fund for mental health benefits, it’s helpful to review what each fund has to offer.

  • Top Hospital includes a restricted psychiatric benefit, meaning that if you choose to be treated in a private hospital or as a private patient in a public hospital, you will have some out-of-pocket expenses.
  • Top Extras covers recognised psychologists, including diagnosis and treatment of conditions like Obsessive Compulsive Disorder (OCD, depression and anxiety.
  • A 2-month waiting period applies before you can claim or receive these mental health benefits.
  • Comprehensive psychiatric cover is available in their Mid and Top Level hospital and extras packages products.
  • The lower level hospital products cover a lower benefit for mental health services, which could result in out-of-pocket costs, especially when attending a private hospital or a public hospital as a private patient.
  • You may need a referral from your GP if you need to see a mental health practitioner, although some can be seen by booking an appointment.
  • All their Hospital products offer benefits for rehabilitation and psychiatric care, but the limits and benefits change depending on the policy and level of cover you choose and how long you’ve been an HBF member.
  • Their clinical psychology treatment includes couple or family treatment, group treatment, initial individual assessments, and ongoing individual treatments or management.
  • A 2 month waiting period is typical for a clinical psychologist and psychiatric care.
  • All hospital products pay a minimum benefit for mental illness, but their Top Hospital products offer psychiatric treatment as an included service.
  • As a nib member, you get access to their MindStep program which delivers phone-based low intensity and prevention-focused Cognitive Behaviour Therapy (CBT) for people who have depression or anxiety and have been discharged from the hospital.
  • Mental health hospitalisation is only fully covered under their top policies.
  • As an HCF policyholder who is 18 or over and has held hospital cover for a minimum of 12 months, you have access to THIS WAY UP courses which are run by the Clinical Research Unit for Anxiety and Depression at St Vincent’s Hospital in Sydney and cost less than single visit to a mental health practitioner.
  • You can get cover for psychology, and psychiatric services through their more comprehensive products, including Silver Hospital Plus, Gold Hospital, Silver Extras, and Gold Extras policies.
  • Be careful to check the benefit limits, which can be up to 24 months for some policies.
  • While all their hospital policies offer partial cover for psychiatric services, only Top Hospital covers this in full, including hospital charges in a partner private hospital in a shared or private room for overnight or day treatment programs.
  • Their psychology benefit is included with most extras policies and includes hypnotherapy and your choice between policies that offer both individual and family annual limits.
  • 2 Month waiting period for psychiatric services, but there is no waiting period for psychology and hypnotherapy.
  • Both their Essential and Premium Hospital policies cover psychiatric services, while Premium Extras policy covers psychology.
  • There is a 2-month waiting period for both psychiatric and psychological treatments.
  • Some policies have a Minimum Benefits Payable (MBP), meaning that they’ll pay the minimum required under the Private Health Insurance Act.
  • Their psychology benefit won’t pay for tests, like psychometric testing.
mental health insurance coverage

Health cover for mental health facilities

Sometimes it’s necessary to be admitted to a hospital that specialises in the kind of treatment that will provide you with the mental care and support you need.

When you do need to be admitted to a mental hospital or a mental ward in a hospital make sure what your fund will cover so that your recovery won’t be burdened by unforeseen hospital fees.

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Check that your mental health care provider and hospital are registered with your health fund. Health funds usually have agreements with different hospitals to keep costs down, so if your hospital doesn’t have an agreement, you may have more out-of-pocket costs.

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Contact the hospital and get clarity on the costs and whether there are any gap payments for your hospital accommodation or the doctor’s fees.

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Contact your health insurer to check which of these costs will and won’t be covered by your health insurance policy.

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Psychiatric hospitals in Australia

Mental hospitals are also called psychiatric hospitals, and can exist as a standalone facility or as a specialised ward in a public or private hospital.

These institutions or wards specialise in the treatment of serious mental illnesses, such as bipolar disorder, clinical depression and schizophrenia.

List of mental institutions in Australia:

  • Cumberland Hospital (New South Wales)
  • Morisset Hospital (New South Wales)
  • Macquarie Hospital (New South Wales)
  • Wolston Park Hospital (Queensland)
  • Baillie Henderson Hospital (Queensland)
  • Ipswich Mental Hospital (Queensland)
  • James Nash House (South Australia)
  • Glenside Hospital (South Australia)
  • Cascades Female Factory (Tasmania)
  • Royal Derwent Hospital (Tasmania)
  • Thomas Embling Hospital (Victoria)
  • Graylands Hospital (Western Australia)
private health insurance psychiatric

Mental hospitals are also called psychiatric hospitals and can exist as a standalone facility or as a specialised ward in a public or private hospital.

These institutions or wards specialise in the treatment of serious mental illnesses, such as bipolar disorder, clinical depression and schizophrenia.

More questions about mental health insurance

How do I pay for my mental health care treatments?

Mental health care treatments can be extremely costly, especially if you have to pay out of your own pockets. One way to reduce costs is by purchasing an appropriate private health insurance policy.

Another option to consider is bulk billing some of your mental healthcare treatments. To make sure that you can bulk bill treatments, you must first call your psychologist, psychiatrist, counsellor, or the clinic, and check if they offer bulk billing and whether you qualify. The reason for this is because each provider has their own criteria to whom they will offer bulk billing.

No matter what type of mental health care practitioner you want to see, it’s a good idea to first call their office and ask about their fees before you make an appointment.

Is counselling covered by health insurance (personal, marriage, and family)?

Counselling is usually covered by private health insurers, under an extras or ancillary policies. Some insurers, like AHM, give you a choice of extras policies that cover personal counselling and/or family (including marital) counselling so that you can pay for higher levels of coverage.

If this treatment is relevant to you, then it’s important to check whether the counselling benefit offered by the health fund includes personal, marital, or family sessions – or a combination of these types of counselling.

Does health insurance cover psychiatric visits?

Usually, a private hospital policy will cover you as a private patient for the cost of accommodation and a portion of the medical fees associated with a psychiatric visit.

The amount that your health fund will pay depends on the kind of policy and the level of cover that you have. If you think that there’s a chance that you might in the future need to be admitted to the hospital, you should contact your health fund, your doctor, and the hospital to check which costs are covered and how much you might have to pay.

How can a Mental Health Plan pay for my mental health care costs?

One way to pay for psychology and psychiatry appointments is through a Mental Health Plan. This plan is part of the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative.

This plan is for those who have a mental health disorder and have been diagnosed by a GP. It identifies the type of healthcare that you need and specifies what you and your doctor have agreed on in order to help you recover.

You’ll get up to ten visits a year for mental health services, like a psychologist, counsellor, social worker, etc. and receive Medicare rebates for ten support group sessions in a year. Take note, after your first 6 visits, your doctor will need to give you another referral.

While Medicare pays the bulk of the cost, it depends on the psychologist and whether he or she offers bulk billing. Typically, though, you’ll get money back for up to 10 individual or 10 group appointments.

Do you need a referral to see a psychologist?

If you need to see a psychologist, you can make an appointment without a referral from your GP. It’s important to note that if you do see a psychologist without a referral from your GP, then Medicare won’t cover these costs. It also won’t be covered under your Mental Health Plan.

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Find the best health insurance for mental health coverage today

The best place to start when you’re looking for mental health insurance is to compare policies from the top health funds in Australia. This helps ensure you have cover for the treatments and services you need to live your healthiest life.

If you have any questions about mental health insurance that you couldn’t find answers to in this article, then please ask an expert below.

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2 Comments

  • joe |

    Hey guys
    I’m 30 and looking to get health insurance. My main reason is that I want to undertake the TMS program and have been told I need a fund with psychiatric extras.

    Medibank have publicised that they will cover this but when I read their policies it isn’t clear. Any advice would be greatly appreciated.

    • SPECIALIST
      Anneke Van Aswegen |

      Hey Joe
      Thanks for reaching out.

      Medibank offers a range of Extra’s cover options, which includes a psychology benefit that generally pays for a consultation with a recognised psychologist only. However, there is a 2 month waiting period which you need to complete before claiming this benefit.

      Whether or not Medibank is the right health insurer for your specific requirements depend on various factors, including the state you live in.

      To help you find a right cover type for your needs and budget please fill in the quote form above and a health insurance consultant will give you a call to help you make a fully informed decision.