woman undergoing hospital psychiatric care

Health insurance for psychiatric care

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 and basic hospital policies, with full cover only available in the most expensive top hospital policies offered by health funds.

Which Australian health funds offer cover?

Health fundHospital policies that cover psychiatric services Waiting periods
HIF health insurance
  • GoldStar Hospital
  • Gold Hospital
  • GoldSaver Hospital
    • GoldStarter Hospital
  • GoldVital Hospital
  • 2 months
health.com.au health insurance
  • High Hospital
  • HeartCare Hospital
  • Basic Hospital
  • Simple Essentials 60
  • 2 months
Health Care Insurance
  • Premier Hospital
  • 2 months
teachers health fund
  • Restricted health fund
  • Top Hospital
  • Mid Hospital
  • Basic Hospital
  • 2 months
CBHS Health Fund
  • Restricted health fund
  • Comprehensive Hospital
  • Active Hospital
  • Limited Hospital
  • Basic Hospital
  • 2 months
AHM health insurance
  • Top Hospital
  • White Deluxe
  • White Classic
  • White Boost
  • White Lite
  • White Starter
  • 2 months
Australian Unity
  • Platinum Hospital
  • Gold Hospital
  • Mid Hospital
  • Basic+ Hospital
  • Basic Hospital
  • 2 months
GMHBA health fund
  • Gold Hospital
  • Silver Hospital
  • Bronze Hospital
  • 2 months
HCF health insurance
  • Premium Hospital
  • Mid Plus Hospital
  • Mid Hospital
  • Basic Hospital
  • 2 months
nib health insurance
  • Top Hospital
  • Advantage Hospital
  • Standard Hospital
  • Basic Hospital
  • 2 months
Transport Health insurance
  • Top Hospital Cover
  • Healthy Choice Hospital Cover
  • Basic Hospital Cover
  • 2 months
Health fundHospital policies that cover psychiatric services Waiting periods
ahm
  • Top Hospital
  • White Deluxe
  • White Classic
  • White Boost
  • White Lite
  • White Starter
  • 2 months
Australian Unity
  • Platinum Hospital
  • Gold Hospital
  • Mid Hospital
  • Basic+ Hospital
  • Basic Hospital
  • 2 months
Budget Direct
  • Top Hospital
  • Mid Hospital
  • Public Hospital
  • 2 months
Bupa
  • Top Hospital
  • Standard Hospital
  • Budget Hospital
  • 2 months
Cessnock District Health Fund
  • Gold Hospital
  • Silver Hospital
  • Thrifty Hospital
  • 2 months
CUA Health
  • Premium Hospital
  • Premium Hospital - Non-obstetrics
  • Standard Hospital
  • Basic Hospital
  • 2 months
GMF
  • Complete Hospital Cover
  • Mid Hospital Cover
  • Lite Hospital Cover
  • 2 months
GMHBA
  • Gold Hospital
  • Silver Hospital
  • Bronze Hospital
  • 2 months
HBF
  • Top Hospital
  • Mid Family Hospital
  • Saver Hospital
  • Super Saver Hospital
  • 2 months
HCF
  • Premium Hospital
  • Mid Plus Hospital
  • Mid Hospital
  • Basic Hospital
  • 2 months
Health Care Insurance
  • Premier Hospital
  • 2 months
health.com.au
  • High Hospital
  • HeartCare Hospital
  • Basic Hospital
  • Simple Essentials 60
  • 2 months
hif
  • GoldStar Hospital
  • Gold Hospital
  • GoldSaver Hospital
    • GoldStarter Hospital
  • GoldVital Hospital
  • 2 months
Latrobe Health Services
  • Top Hospital
  • Member Share
  • Cover Wise
  • Loyal Members
  • Family Care
  • 2 months
Medibank
  • Top Hospital
  • Top Hospital Essentials
  • Standard Hospital
  • Basic Hospital
  • Hospital Essentials
  • 2 months
Mildura Health Fund
  • Five Star Hospital
  • 2 months
nib
  • Top Hospital
  • Advantage Hospital
  • Standard Hospital
  • Basic Hospital
  • 2 months
onemedifund
  • Private Plus Hospital Cover
  • 2 months
Peoplecare
  • Premium Hospital
  • Mid Hospital
  • Basic Hospital
  • 2 months
Phoenix Health Fund
  • Top Hospital
  • Mid Hospital
  • Basic Hospital
  • 2 months
Queensland Country Health Fund
  • Top Hospital
  • Intermediate Hospital
  • Public Hospital
  • 2 months
St. Lukes Health
  • Hospital Platinum
  • Hospital 300, 500, 1000
  • Budget 500
  • 2 months
Transport Health
  • Top Hospital Cover
  • Healthy Choice Hospital Cover
  • Basic Hospital Cover
  • 2 months
ACA Health
  • Restricted health fund
  • Deluxe Hospital
  • Private Hospital
  • Basic Hospital
  • 2 months
CBHS health fund
  • Restricted health fund
  • Comprehensive Hospital
  • Active Hospital
  • Limited Hospital
  • Basic Hospital
  • 2 months
Defence Health
  • Restricted health fund
  • Premier Hospital
  • Value Hospital
  • Essentials Hospital
  • 2 months
Doctors Health Fund
  • Restricted health fund
  • Top Cover
  • Prime Choice
  • Smart Starter
  • 2 months
Navy Health
  • Restricted health fund
  • Premium Hospital
  • Healthy Hospital
  • Saver Hospital
  • Saver Plus
  • 2 months
RT Health
  • Restricted health fund
  • Premium Hospital
  • Smart Hospital
  • Step Up Hospital
  • First Start Hospital
  • Public Hospital
  • 2 months
Teachers Health Fund
  • Restricted health fund
  • Top Hospital
  • Mid Hospital
  • Basic Hospital
  • 2 months
TUH
  • Restricted health fund
  • Total Care Hospital Cover
  • Mid Range Hospital Cover
  • Budget Hospital Cover
  • 2 months

Compare health insurance for psychiatric care from 30+ Australian funds

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.

Compare health insurance for psychiatric care

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Andrew Munro

Andrew writes for finder.com.au, comparing products, writing guides, sniffing out deals and looking for new ways to help people get the most out of their money.

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