Psychology session

Is Mental Illness Covered by Health Funds?

What you need to know about mental health treatment and private health insurance.

While those who have been treated for a mental illness can often have difficulty obtaining general insurance (particularly income protection and travel insurance), private health insurance does cover some of the treatment costs for mental illness, although the level of cover varies widely between funds.

This guide looks at how to shop wisely for insurance with a mental illness, what cover is available, what other assistance is out there in the community and what’s being done to bring mental health up to speed with the rest of the healthcare system.

Compare your mental health insurance options online

How treatments for mental illness are covered by health insurance

TreatmentMental health insurance that can include cover*Additional information
Psychology and counselling
  • Combined policy (hospital and extras)
  • Extras only
More info
In-hospital psychiatric care
  • Combined policy (hospital and extras)
  • Hospital only
More info
Drug and alcohol rehabilitation
  • Combined policy (hospital and extras)
  • Hospital only
More info

*Please note that some policies may restrict or exclude cover for these mental health services. Always check the policies product disclosure statement or use the comparison engine above to request a call back from an adviser to confirm if specific treatments are covered by the policy you are interested in.

What is mental illness?

Mental illness is defined as a health problem which significantly affects how we think, feel and behave. One in five Australians will experience a mental illness and one in two of us will experience a mental health problem at some time in our lives.

Some of the main types of mental disorders include:

  • Mood disorders (e.g. depression, bipolar disorder)
  • Anxiety disorders (e.g. agoraphobia, claustrophobia)
  • Personality disorders (e.g. paranoia, obsessive-compulsive disorder)
  • Psychotic disorders (e.g. schizophrenia)
  • Eating disorders (e.g. anorexia, bulimia)
  • Trauma-related disorders (e.g. post-traumatic stress disorder)
  • Substance abuse disorders (e.g. alcoholism, drug addiction)

Private hospital insurance for psychiatric services and rehabilitation

If you are admitted to a private hospital for treatment or rehabilitation for a mental illness, it is possible to obtain cover under private hospital insurance. This will cover the cost of accommodation as a private patient, psychiatric services and rehabilitation, depending on the policy. Unlike other pre-existing conditions which are only covered after a 12 month waiting period, mental illness is covered just two months after purchasing a policy.

However, not all policies provide full coverage and there may be a difference between what is covered and what you will have to pay yourself. This could include the cost of psychiatric consultations outside of hospital or an excess or co-payment for some hospital services, so it pays to check your policy carefully before purchase to ensure you have the cover you need.

Can I get a Medicare rebate or private health fund rebate for psychologists’ fees?

While treatment by a psychiatrist is covered by Medicare, if you see them as a public patient in a public hospital or clinic, treatment by a psychologist is only covered by Medicare when it is part of a government scheme and only if you are referred by a psychiatrist or GP.

Most private health funds offer cover for psychologists’ fees, but the level of cover varies and only the more comprehensive policies tend to include full cover for psychological services.

Insurance shopping tips

If you have been treated for a mental health problem and are looking for insurance, the following tips can help you find the right cover for your needs:

  • Rather than filling out an online form (and possibly disqualifying yourself from cover), call the fund and put your case to a representative in person.
  • Find out the fund’s stance on mental illness; how they define it, what is included and excluded in their policy and whether you will need to pay an additional premium to obtain cover.
  • Read the Product Disclosure Statement (PDS) carefully, as the devil is in the detail. Make sure the cover you need is clearly stated in writing before purchasing a policy.

Does my extras cover psychology?

Many health funds provide optional cover for psychology services and counselling in their extras packages. The percentage of costs they will pay will depend on the policy and whether the psychologist is a preferred provider who is registered with the health fund.

Is community care available?

As well as help from psychiatrists and psychologists, those suffering from mental illness can also receive assistance from health professionals in the wider community such as doctors, social workers, therapists and community health workers.

Community mental health services are free and offer specialised help for different groups experiencing their own unique problems, such as the elderly, young people and the homeless. Organisations such as Lifeline also provide counselling, not only for those affected by mental illness, but for those who care for them as well.

State of mental healthcare in 2016

While mental healthcare falls short in a number of areas, a recent government shakeup of the mental health system will see the following reforms put in place:

  • Mild mental health problems. More help to be provided through online counselling services.
  • Moderate mental health problems. Medicare subsidies will be provided for visits to a psychologist.
  • Severe mental health problems. A care plan will be organised by the patient’s Primary Health Care Network and will include psychological services, mental health nursing, drug & alcohol services, vocational assistance and peer support.

A new Mental Health Hotline will also be set up to direct people to the appropriate services and to co-ordinate the existing government-supported mental health phone services.

Frequently asked questions about mental illness and health insurance

No, but you will need a Mental Health Treatment Plan from a GP to claim a Medicare rebate.

Yes, many health funds cover psychiatric visits, but you will need to be referred by a GP.

Psychologists can set their own fees, but the Medicare rebate is a set amount.

The government sets the Medicare schedule fees and indexes them on 1 November each year. Rebates for psychology services are set at 85% of the schedule fee.

No, only a psychologist registered with the Psychology Board of Australia is eligible to provide services under Medicare.

Yes, social workers and occupational therapists with the appropriate mental health expertise can provide some of these services.

They can, but to qualify for a Medicare rebate, they must be provided face to face.

You can receive up to 10 individual psychological services a year including services by psychologists and eligible social workers, occupational therapists and GPs.

No, you must decide if you will use Medicare or your ancillary cover to pay for the psychological services you receive.

If they are not an eligible psychologist (i.e. have no Medicare Provider Number), if you were not referred to them by a psychiatrist or GP or if you have exceeded the number of services per year you are entitled to.

Useful contacts

There are a range of useful mental health contacts and resources including:

  • beyondblue. beyondblue provides information and support to help Australians achieve their best possible mental health, regardless of their age or where they live.
    Website: beyondblue.org.au
    Phone: 1300 22 4636
  • headspace. headspace offers early intervention mental health services for 12 to 25 year olds.
    Website: headspace.org.au
    Phone: 1800 650 890
  • The Mental Health Services in Rural and Remote Areas  (MHSRRA). The MHSRRA program provides funding to non-government health organisations to deliver mental health services to those in rural and remote areas.
    Website: health.gov.au
  • MindSpot Clinic. The MindSpot Clinic is a national clinic providing free online and telephone assessment and treatment for Australian adults suffering from stress, anxiety and depression.
    Website: mindspot.org.au
    Phone: 1800 61 44 34
  • SANE Australia. SANE Australia helps Australians affected by mental illness lead better lives.
    Website: https://www.sane.org/
    Phone: 1800 18 7263
  • Australia Counselling. Allows Australians to find counsellors and therapists in their local area.
    Website: https://www.australiacounselling.com.au
    Phone: 1300 855 148
  • mindhealthconnect. mindhealthconnect provides information for carers about mental health conditions.
    Website: mindhealthconnect.org.au
  • Black Dog Institute. The Black Dog Institute carers how to help someone with depression or anxiety.
    Website: blackdoginstitute.org.au
  • National Eating Disorders Collaboration (NEDC). The NEDC provides advice to carers on how to help someone with an eating disorder.
    Website: nedc.com.au
    Phone: 1800 33 4673
  • My Aged Care. My Aged Care provides help and advice for those caring for older people with a mental health condition
    Website: myagedcare.gov.au
    Phone: 1800 200 422
  • Carers Australia. Carers Australia offers support for carers of those with a range of health issues, including mental illness.
    Website: carersaustralia.com.au
    Phone: 1800 242 636

Compare health insurance that covers mental illness from over 30 health funds

Picture: Shutterstock

Richard Laycock

Richard is the senior insurance writer at finder.com.au and is on a mission to make insurance easier to understand.

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