why health insurance for psychology is important

Health insurance for psychology

Learn how mental disorders and illnesses are covered by health funds in Australia.

A mental illness or disorder significantly affects one’s ability to think, feel and/or interact with other people and the world at large. Major types of mental illness include:

  • Depression and anxiety disorders
  • Schizophrenia and related conditions
  • Personality disorders like clinical paranoia or obsessive compulsive disorder
  • Anorexia and other eating disorders

An estimated one in five Australians will experience mental illness at some point. They vary greatly in severity, so its important to seek help as soon as possible.

Which Australian health funds cover psychology?

Health fundExtras policies and annual benefit limits*Waiting periods
HIF health insurance
  • Premium Options. $1,000 per person
  • Super Options. $740 per person
  • 12 months
health.com.au health insurance
  • High. $200 per person
  • Middle. $200 per person
  • Extras 50. $250 per person
  • 2 months
Health Care Insurance
  • Premier Extras. $250 per person
  • 2 months
teachers health fund
  • Restricted health fund
  • Top Extras. $600 per person
  • 2 months
CBHS Health Fund
  • Restricted health fund
  • Top Extras. $450 per person
  • 2 months
AHM health insurance
  • Super Extras. $300 per person
  • Family Extras. $250 per person
  • Lifestyle Extras. $250 per person
  • No waiting period
Australian Unity
  • Gold Extras. $350 per person
  • 2 months
GMHBA health fund
  • Gold Extras. $500 per person
  • Silver Extra. $300 per person
  • 2 months
HCF health insurance
  • Platinum Extras. $600 per person
  • Gold Extras. $350 per person
  • 2 months
nib health insurance
  • Top Extras. $500 per person
  • 2 months
Transport Health insurance
  • Top Extras. $500 per person
  • 2 months

*The policies listed in this table are extras only. However, in most cases these can be combined with hospital cover.

Health fundExtras policies and annual benefit limits*Waiting periods
ahm
  • Super Extras. $300 per person
  • Family Extras. $250 per person
  • Lifestyle Extras. $250 per person
  • No waiting period
Australian Unity
  • Gold Extras. $350 per person
  • 2 months
Bupa
  • Silver Extras. $400 per person
  • Gold Extras. $500 per person
  • Platinum Extras. $750 per person
  • 2 months
Cessnock District Health Fund
  • Gold Extras. $600 per person
  • Silver Extras. $400 per person
  • Bronze Extras. $600 per person
  • 2 months
CUA Health
  • Total Extras. $500 per person
  • Classic Extras. $250 per person
  • 2 months
GMF
  • Complete Extras. $850 per person
  • Mid Extras. $850 per person
  • 12 months
GMHBA
  • Gold Extras. $500 per person
  • Silver Extra. $300 per person
  • 2 months
HBF
  • Flexi Extras Plus. $600 per person
  • Flexi Extras Mid. $450 per person
  • Flexi Extras. $300 per person
  • 2 months
HCF
  • Platinum Extras. $600 per person
  • Gold Extras. $350 per person
  • 2 months
Health Care Insurance
  • Premier Extras. $250 per person
  • 2 months
health.com.au
  • High. $200 per person
  • Middle. $200 per person
  • Extras 50. $250 per person
  • 2 months
hif
  • Premium Options. $1,000 per person
  • Super Options. $740 per person
  • 12 months
Latrobe Health Services
  • Premier Gold, Family Care Gold. $450 per person
  • Premier Silver, Family Care. $300 per person
  • Premier, Premier Plus. $300 per person
  • 2 months
Medibank
  • Top Extras. $200 per person
  • Growing Family Extras. $400 per person
  • Healthy Start Extras. $500 per person
  • 2 months
Mildura Health Fund
  • Five Star Extras. $650 per person
  • Ancillary Plus Extras. $540 per person
  • 2 months
nib
  • Top Extras. $500 per person
  • 2 months
onemedifund
  • Extras Plus. $500 per person
  • 2 months
Peoplecare
  • Premium Extras. $500 per person
  • High Extras. $400 per person
  • 2 months
Phoenix Health Fund
  • Top Extras. $500 per person.
  • 2 months
Queensland Country Health Fund
  • Premium Extras. $1,400 per person
  • Essential Extras. $900 per person
  • 2 months
St. Lukes Health
  • Super Extras. $400 per person
  • 12 months
Transport Health
  • Top Extras. $500 per person
  • 2 months
ACA Health
  • Restricted health fund
  • Complete Extras. $500 per person
  • 2 months
CBHS health fund
  • Restricted health fund
  • Top Extras. $450 per person
  • 2 months
Defence Health
  • Restricted health fund
  • Premier Extras. $1500 per person
  • Value Extras. $1100 per person
  • 2 months
Doctors Health Fund
  • Restricted health fund
  • Total Extras. $600 per person
  • Essential Extras. $900 per person
  • Basic Extras. $400 per person
  • 2 months
Navy Health
  • Restricted health fund
  • Premium Extras. $600 per person
  • Healthy Living Extras. $400 per person
  • 2 months
Police Health
  • Restricted health fund
  • SureCover Extras. $850 per person
  • 2 months
Reserve Bank Health Society
  • Restricted health fund
  • Extras Cover. $920 per person
  • 2 months
RT Health
  • Restricted health fund
  • Premium Extras. $500 per person
  • Smart Extras. $400 per person
  • 2 months
Teachers Health Fund
  • Restricted health fund
  • Top Extras. $600 per person
  • 2 months
TUH
  • Restricted health fund
  • Comprehensive Extras. $400 per person
  • Healthy Options 60% Extras. $1,000 per person
  • Mid Range Extras. $250 per person
  • 2 months

*The policies listed in this table are extras only. However, in most cases these can be combined with hospital cover.

Compare extras policies from Australian health funds

How is psychology covered by health insurance?

Many health funds will cover psychology to a certain extent, albeit with low benefits – typically a few hundred dollars per year. Mental health treatment is usually performed outside of hospital, so extras cover will be required if you want to be able to claim for these services. If you are considering taking out health insurance to for psychology, be aware that:

  • You will most likely have to purchase a comprehensive extras policy to get covered for mental health treatments which attract higher premiums.
  • Some health funds allow you to be treated by any provider as long as they are licensed and registered to the same standard as Medicare, while others will only cover treatment if you visit a provider approved by them.
  • The limited benefit amounts may not cover the cost of treating pervasive developmental disorders (PDD) or other serious mental conditions and illnesses. Also, if you claim for psychology on your health insurance you cannot claim on Medicare.

So why take out health insurance for psychology?

The advantage of the psychology cover provided by health funds is that you can claim for a wider range of conditions without needing a referral or diagnosis of a PDD or definable condition. Some examples of claimable treatments are outlined below.

Are there any treatments that are excluded?

Yes, even with health insurance there are still some psychology related treatments that are not covered, a number of which can be found below. Note that health insurance can cover in-hospital psychological treatment but you will require a hospital policy.

What costs can I claim from Medicare?

The benefits offered by Medicare will vary depending on whether the person receiving treatment is a child or adult, and the nature of their mental condition.

Adults

What Medicare coversConditions of cover
  • Five psychology sessions per calendar year.
  • 85% of a session fee up to a maximum of $62.25.
  • Pregnancy support counselling and other specific practices may also be covered.
    • The patient requires a referral from a registered doctor.
    • The treatment must not involve hospital admission.
    • Treatments must be delivered individually and in person to the patient.
    • The psychologist must provide a written report to the referring doctor.
    • The patient must be recognised as having a PDD or complex needs.

Children

What Medicare coversConditions of cover
  • Under 13. Four psychology sessions
  • Under 15. Twenty psychology sessions
  • The child needs a referral from a registered doctor.
  • The treating psychologist must be licensed in their state or territory.
  • The treating psychologist must also hold general registration with the Psychology Board of Australia or the Royal Australian and New Zealand College of Psychiatrists.

Who can benefit from psychology cover?

One in five Australians will experience a diagnosable mental illness at some point in their lives, while a staggering 50% will suffer from some kind of mental health issue. This means most people are able to benefit in some way from including psychology in their extras policy. Here are some other reasons for considering cover:

  • Knowing you can cover the cost of treatment means you are likely to seek help when needed.
  • A family history of illnesses like dementia and Alzheimer’s Disease increases the chance of you suffering from them.
  • Mental health issues can be very unpredictable, so having some form of cover may be prudent.
  • Depending on your level of cover you may have access to additional therapies and treatments, like marriage counselling.

How do I claim for mental health treatment?

Most Australian health funds offer multiple options for lodging extras cover claims. Depending on who you are insured with, you may be able to claim by:

  • Swiping your health insurance card when paying.
  • Using your health fund’s mobile app.
  • Filling out a claims form and faxing, emailing or posting it to your fund.
  • Visiting your health fund's office in person with your claims form.
  • Getting treated by a provider affiliated with your health fund who will lodge your claim directly.

Policy conditions to be aware of

When comparing health insurance policies keep an eye out for these terms, as these can impact the level of psychology cover available to you:

  • Benefit limits. These are the maximum amounts claimable for treatments and services every year. Other policies have lifetime limits, which is the total amount you can claim over the course of the entire policy.
  • Waiting periods. This is how long you must have held a policy before you can start claiming certain treatments. For psychology this is often two months but never assume this is the case without checking to make sure.
  • Exclusions. These are services that your health fund does not cover. For example, there might be an exclusion for hypnotherapy, meaning you cannot claim for this treatment on health insurance.

Compare extras cover for psychology

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Richard Laycock

Richard is the Insurance Editor at finder, and has been wrangling insurance Product Disclosure Statements for the last 4 years. When he’s not helping Aussies make sense of the fine print, he can be found testing the quality of Aperol Spritzes in his new found home of New York. Richard studied Journalism at Macquarie University and The Missouri School of Journalism, and has a Tier 1 certification in General Advice for Life Insurance. He has also been published in CSO Australia and Dynamic Business.

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