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Health insurance reforms: Improved access to mental health services

Making private health insurance benefits for mental health services easier to access and more affordable.

As conversations about mental health finally enter into the mainstream, the Australian government has acted with a series of reforms aimed at improving mental health services in the private health insurance (PHI) industry.

The changes, first announced back in October 2017, are part of a series of changes being made to improve PHI for Australians and are being implemented from October 2017 until February 2020.

What's changing with mental health services?

With psychological ailments now the most common cause for a patient to visit their GP, according to the 2018 report by the Royal Australian College of General Practitioners – the government's reforms are part of a wider campaign to tackle mental health problems in Australia. The changes include:

  • Basic private policies must now include mental health cover as standard.
  • Upgrading your coverage to cover mental health treatment whenever you need it, without facing long waiting periods.
  • Better access to mental health services, including drug and alcohol treatment.
  • Patients with limited cover for psychiatric care are able to upgrade their cover to access higher benefits for in-hospital treatment without a long waiting period. However, you're only able to use this exemption from the existing two-month waiting period once.
  • The reforms will make it harder for insurers to place limits on mental health treatments and therapy sessions, such as group counselling sessions, electroconvulsive therapy or transcranial magnetic stimulation.

How will the 2019 reforms affect you?

Any patient with a health insurance policy with restricted mental health cover can now upgrade to one with full mental health cover without having to serve any waiting periods for mental health treatment. This includes in-hospital psychology, rehabilitation and drug and alcohol treatment. This is a huge step in the right direction, especially for alcohol and drug related problems, as it lets you get the help you need fast and stops you from going down a slippery slope where things simply get worse.

It also goes some way towards providing our youngsters with the help they need. Last year, a Mission Australia report found that mental health was the biggest problem facing today's youngsters. Changes to the current PHI system help prepare our youngsters better for the future.

Improved private mental health and drug and alcohol treatment services will also be a lot more affordable. That's because most basic and medium level hospital products provided limited cover for these services. The improved services will allow providers to enjoy minor upgrades to policies that previously included restrictions or exclusions, at little or no extra cost. It's worth checking if there have been changes to your policy, as you may be entitled to improved services.

In the long run, removing limits on the number of mental health sessions or treatments a patient can access will also save doctors time and insurers money, as you'll get the help you need, when you need it.

Will it impact your wallet?

Patients who require overnight or multi-day care in a private hospital for a serious mental health condition will usually face large out-of-pocket expenses. In the past, long waiting periods have prevented patients from accessing the care they need. However, the new waiting period exemption will make it easier for patients to access care when they need it, without facing a substantial bill at the end of it.

Why are mental health reform services changing?

It's changing because the old system did not meet our mental health needs as a country. Recent studies have shown the need for a comprehensive national response to mental health services. 1 in 5 (20%) Australians aged 16–85 experience a mental illness in any year.

Research has found that the onset of mental illness is typically around mid-to-late adolescence, which is why more needs to be done to tackle the issue earlier. The more research that's done on mental health the clearer it becomes that added services are needed.

While more needs to be done for public services, these changes go some way towards supporting the more vulnerable members of our society, making services more widely available and affordable.

When's it changing?

The enhanced arrangements took effect from 1 April 2018, which means if you do have mental health concerns, you should look into the improved coverage you can receive.

What else is changing?

This isn't the only change being made by the Australian government. The PHI industry is in the middle of a major overhaul, with a new four-tier structure recently coming into effect, which aims to simplify the current system by categorising every policy under one of the following tiers: Gold, Silver, Bronze or Basic. Some insurers are offering these policies now and by 2020, all policies will fit into one of these tiers.

There are also improved discounts for 18- to 29-year-olds, more clarity into out-of-pocket costs and cuts to some natural therapies to help stop rising premiums.

Picture: Unsplash

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