Health insurance for psychiatric care

How does health insurance cover mental health?

Hospital (psychiatric services)

All health funds will cover psychiatric care costs in their hospital policies. This is generally referred to as a restricted benefit which means that no matter what level of hospital cover you have, it will pay a benefit towards the cost of being treated as a private patient in a public hospital. If you want psychiatric care with no restrictions, gold tier hospital cover is the only tier that must offer full cover. Private health insurance won't cover you for out of hospital psychiatric services though.

Extras (psychology and counselling)

Top extras policies can give you access to therapy or counselling sessions with a psychologist without the need for a referral. It can also cover you for other out-of-hospital services including dental, optical and physio.

No waiting periods on psychology consultations

Some health funds, such as Medibank, let you skip waiting periods for psychology and counselling consultations if you're a new member or you've upgraded your cover to include mental health support. There's typically a 2-month waiting period for this.

What psychiatric services does health insurance cover?

Hospital insurance covers inpatient care. This means you're covered when you check into a mental health facility to be in the direct care of medical professionals. A policy can pay for your hospital accommodation and a portion of your medical fees. It can cover the treatment of the following:

How mental health is covered by Medicare

Medicare offers cover for some mental health services but there there are limits:

• You get up to 20 sessions with a mental health professional each year. Your doctor or psychiatrist will refer you for up to 6 sessions at a time.
• You will need to be referred to specialist care by your GP and get a mental health treatment plan from your GP.
• If the doctor bulk bills, Medicare can cover the cost of the appointment. Otherwise, you'll need to the full cost or the difference between what they charge and what Medicate covers.

Health insurance with psychiatric cover

All of these hospital policies cover you for psychiatric services as an impatient, while psychology consultations are covered by extras.

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Name	Product	Treatments	Price	Apply
Frank Gold Hospital Gold$750 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$226.63 per month	Go to Site All treatments	Compare	loading Fetching your data...
GMHBA Gold Optimum $750 Gold$750 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$228.93 per month	Go to Site All treatments	Compare	loading Fetching your data...
Gold Hospital Elevate $750/$1500 Excess Gold$750 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$237.33 per month	Go to Site All treatments	Compare	loading Fetching your data...
Qantas Gold Top Hospital $750 Excess Gold$750 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$245.25 per month	Go to Site All treatments	Compare	loading Fetching your data...
advanced hospital gold Gold$750 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$249.32 per month	Go to Site All treatments	Compare	loading Fetching your data...
Promoted Gold Hospital Elevate $500/$1000 Excess Gold$500 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$253.17 per month	Go to Site All treatments	Compare	loading Fetching your data...
advanced hospital gold Gold$500 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$273.07 per month	Go to Site All treatments	Compare	loading Fetching your data...

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All prices are based on a single individual with less than $90,000 income and living in Sydney.

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Things you should know about health insurance for psychiatric treatment

Looking for the right policy can be tricky. Here are some things worth looking out for that'll make searching easier.

• Waiting periods. You'll usually have to serve a 2-month waiting period for psychiatric services and rehabilitation, even if your condition is pre-existing.
• Out-of-pocket expenses. Even with Medicare and health insurance, you might still have gap costs – that is, whatever is left after Medicare and your health insurer pays the benefit you're entitled to, if your doctor charges more than MBS fee.
• Restricted benefits. 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.
• 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.

Psychiatric support

There are several places and resources that can provide mental health services and psychiatric support in Australia. We've listed some below:

• Lifeline. (13 11 14) A national charity providing 24-hour crisis support and suicide prevention services.
• Australian Government: AIHW MHSA. The Australian Government website provides information on mental health services in Australia.
• beyondblue Support Service - Support. Advice. Action. Help for depression and anxiety related matters.
• Black Dog Institute. Provides resources and support if you're suffering from depression, anxiety and more.
• Gambling Helpline. Help for various gambling issues.
• Mindframe-Media. Information about suicide in Australia.
• PANDA - National Perinatal Depression Helpline. Helpline for any new parent struggling during pregnancy or after the birth of their baby.
• SANE Australia. A national charity that helps all Australians affected by mental illness lead a better life.
• Headspace. Helps young people manage their mental health issues. It has over 100 centres across Australia.

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Frequently asked questions

• Am I covered for inpatient mental health services?

  Yes, inpatient care comes under hospital cover and all gold tiered policies must offer inpatient psychiatric care.

  Medicare, on the other hand, will cover you for treatment in a public hospital if you require hospitalisation for mental health care. This includes up to 10 individual and 10 group sessions of psychiatric treatment per year.

• Am I covered for outpatient mental health services?

  Private health insurance generally won't cover you for out-of-hospital psychiatric services. However, extras cover can pay for some therapy or counselling sessions outside of hospital with a psychologist. You also don't need a referral from your GP.

• Are psychiatrists covered by health insurance?

  Yes, but only for in-hospital treatment. You can get cover on a restricted basis with basic, bronze and silver policies (meaning you will have out of pocket expenses) or you can get a gold policy with little or no additional expenses.

• Will I have out of pocket expenses?

  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.

• Will I have to serve a waiting period for psychiatric care?

  Yes, but it's only 2 months, even if you have a pre-existing condition. The Mental Health waiver also allows you to upgrade your policy without serving the usual 2-month waiting period to access in-hospital psychiatric services.