Is health insurance for hospital psychiatric care available in Australia? Compare policies that cover inpatient mental health services.
Psychiatric services include treatment for conditions like mood and personality disorders, eating disorders, addiction and other mental health issues. Many hospitals have their own psychiatric wards, while there are also a number of dedicated private psychiatric hospitals and private clinics that specialise in particular disorders.
In Australia, health funds are legally required to pay certain minimum benefits for psychiatric care in hospitals and cannot exclude it entirely. Generally, this minimum or restricted benefit will apply to mid-
Mental health issues are serious and can be costly, which is why Australian health funds are legally obligated to offer cover for treatment.
Compare health insurance that includes psychiatric treatment
As an example, below you'll find options from Finder partners that include in-patient psychiatric treatment in a private hospital. They come with a 2 month waiting period - but you may be able to access earlier if eligible for the Mental Health Waiver. Your chosen health fund can help you with this.
| Provider | Policy | Treatments included | Excess | Price | Apply |
|---|---|---|---|---|---|
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Hospital Gold |
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$500 | $164.05 | Go to Site |
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Top Hospital Gold |
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$750 | $168.90 | Go to Site |
*Price based on a single policy for a Sydney resident.
Which Australian health funds offer cover?
| Health fund | Hospital policies that cover psychiatric services | Waiting periods |
|---|---|---|
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| Australian Unity |
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| Health fund | Hospital policies that cover psychiatric services | Waiting periods |
|---|---|---|
| ahm |
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| Australian Unity |
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| Bupa |
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| Cessnock District Health Fund |
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| CUA Health |
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| GMF |
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| GMHBA |
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| HBF |
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| HCF |
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| Health Care Insurance |
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| health.com.au |
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| hif |
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| Latrobe Health Services |
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| Medibank |
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| Mildura Health Fund |
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| nib |
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| onemedifund |
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| Peoplecare |
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| Phoenix Health Fund |
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| Queensland Country Health Fund |
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| St. Lukes Health |
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| Transport Health |
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| ACA Health |
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| CBHS health fund |
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| Defence Health |
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| Doctors Health Fund |
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| Navy Health |
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| RT Health |
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| Teachers Health Fund |
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| TUH |
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How much of the cost does health insurance cover?
All health funds will cover psychiatric care costs in their hospital policies. This amount is generally called a minimum, restricted or limited benefit. This means that no matter what level of hospital cover you have it will at least pay a benefit towards the cost of being treated as a private patient in a public hospital. Additional out-of-pocket expenses you may incur can include:
- Any private hospital or psychiatric facility fees above the equivalent public hospital costs.
- Additional fees for treatments or pharmaceuticals.
- Extra costs associated with particular treatment regimes or optional inclusions.
More expensive mid and top hospital policies may offer additional benefits beyond the minimum amount required by law, or cover additional psychiatric treatments, although this will vary between funds. Also keep in mind that the cost of your health insurance will be inflated if you opt for a couples or family policy.
What should I be aware of when comparing policies?
If you are considering purchasing a hospital policy that covers inpatient psychiatric care, take the following into consideration.
- Restricted benefits. You may encounter this caveat next to psychiatric treatments in the vast majority of policies. Once again, this means the policy only pays the minimum benefits that are legally required. Because these minimum benefits are laid out by the government, it will be practically the same with every fund.
- Waiting period. This is how long you must wait between taking out a policy and being able to claim certain benefits. This will almost always be two months for in-hospital psychiatric benefits, no matter the policy. Two months is the maximum allowable waiting period for claiming psychiatric treatment on a private health insurance policy, even if it is a pre-existing condition.
- Exclusions. These are conditions or circumstances in which the fund will not pay a benefit. Common exclusions can include undergoing treatment outside of Australia, claims made for treatments carried out by unlicensed practitioners and medically unnecessary procedures. It is important to be aware of all exclusions that apply to your health insurance policy.
- Annual benefit limits. These are the maximum amounts that can be claimed for certain treatments in a given year. For example, a policy may apply a benefit limit of up to $400 for psychological treatments. This means the maximum you can claim per year is $400 regardless of whether your benefits are paid as a set fee or as a percentage of costs covered.
Does Medicare cover psychiatric care?
Medicare offers cover for some hospital psychiatric treatment, but only up to certain limits and under certain conditions.
- Up to ten individual and ten group sessions of psychiatric treatment are covered per year.
- Patients must be referred to specialist care by their GP, psychiatrist or pediatric, or they must be under a valid psychiatric treatment and management plan.
- All treatments must be carried out by appropriately qualified practitioners.
Medicare will cover costs related to diagnosis, focused psychological strategies, some medications and treatment assessments as long as they are connected to clinically diagnosable disorders that significantly interfere with a person’s cognitive, emotional or social abilities. Exceptions include dementia, delirium, tobacco addiction and mental retardation, which are not generally covered.
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Hi,
Im looking for a health fund that covers Mental health private hospital care,
Hi Janene.
Thanks for your question.
You may compare mental health insurance options by simply filling-in the e-form on this. Kindly note that not all policies provide full coverage and there may be a difference between what is covered and what you will have to pay yourself, so please make sure to check the policy’s terms and conditions and PDS carefully before purchasing to ensure you have the cover you need.
I hope this has helped.
Cheers,
Liezl