How Will the Coverage of Mental Health Change in April 2019

Mental health services are an essential healthcare component, given that one in five Aussies will experience a mental illness and the majority of us will experience a mental health issue at some point in our lives. Mental illnesses or disorders are health problems that affect how individuals feel, think, behave, and interact. Healthcare professionals use objective criteria to diagnose and assess these conditions, which can range from depression and anxiety to personality disorders and schizophrenia. If you have a mental illness or disorder, it’s important to get the right advice and treatment.

We look at Aussies who are currently covered under private health insurance, and what the April 1st 2019 changes that have taken effect are.

What you’re currently covered for in mental health insurance

Depending on the policy, you could becovered in two ways through your private health insurance. First, inpatient psychiatric care covers you for in-hospital treatments like therapy, psychological evaluation, addiction treatment, and other in-patient mental health services. This will can be found under the hospital component of your cover, and it’s usually on top-tier policies.

Outpatient mental health cover could include things like therapy and counselling sessions with a psychologist. This type of cover is offered in most extras policies. Typically your health fund pays a specific benefit amount or a percentage of the cost of the service while you cover the rest. Keep in mind your provider needs to be registered with the fund.

Please note however, Medicare will cover you for certain free or subsidised treatments as long as you have a mental health care plan. For example, if you qualify for the Better Access Initiative, you could get Medicare rebates for certain mental health services by GPs, psychiatrists, psychologists, and some social workers and occupational therapists. This is for up to 10 individual and 10 group allied mental health services per calendar year. Additionally, you might also be able to obtain psychological services through your local Primary Health Networks.

At a policy level, each state and territory has mental health legislation – usually the Mental Health Act – designed to improve mental health treatment and protect the rights and dignity of mental health patients. They typically also emphasise the central role of you, the patient, in making decisions about your own care.

The April 2019 Changes

In April 2018, the federal government introduced some changes to how private health insurance covers mental health services. These changes were aimed at making it easier for people to get in-hospital mental treatment, whether it’s for things like anxiety, depression, and drug/alcohol addiction or some other mental health concern. Some additional changes will happen in April 2019.

  • Waiting period exemption – In April 2018, the government introduced waiting period exemptions for higher benefits. Before the changes, if you were on a hospital policy with restricted benefits for psychiatric care, you needed to upgrade your plan and serve a two-month waiting period before accessing the benefits. From April 2018, however, policy holders could upgrade to a higher benefit level without the two-month waiting period. This would then allow them to access higher benefits for psychiatric care in a private hospital immediately, but only once per lifetime so long as you had already completed two months of membership on any level of hospital cover. The exemption applies to hospital or hospital substitute treatment, and to mental health services and drug and alcohol treatment. You can even upgrade your cover within five business days of admission to hospital and receive retrospective cover for these mental health services. If you wait more than five business days after admission to upgrade, you can still skip the waiting period but you will only be covered under the higher tier policy from the date of upgrade.
  • Treatment limits – In April 2018, limits on the number of sessions or treatments were also removed. Before the reforms, these usually applied to day programs, electroconvulsive therapy, and transcranial magnetic stimulation.
  • Easier identification of policies – With the introduction of the new four-tier system for hospital cover starting in April 2019 (Basic, Bronze, Silver and Gold), it’ll be easier for consumers to work out which policies offer certain levels of coverage. For example, all top-tier (Gold) hospital policies need to offer unrestricted cover for hospital psychiatric services at a minimum. Insurers will start adopting the changes in April 2019 and must do so by April 2020.

Will the changes affect pricing?

The April 2018 and 2019 changes might not necessarily affect pricing for health insurance policies, though it would depend on the specific insurer. The latest annual premium changes due to take effect from April 2019 have beenthe lowest in nearly two decades, so it’s likely the updates to mental health coverage regulations haven’t significantly driven up prices.

Additionally, requiring top-tier policies to have unrestricted cover for hospital psychiatric services might not have impacted premiums as most top-tier policies likely already offered this level of coverage. However, the change does make it easier to identify, understand, and compare policies.

Considering your mental health in future

This year the private health insurance reforms that have been introduced for mental health are seemingly designed to improve access to mental health services as well as drug and alcohol treatment when policy holders need them most. It’s a good idea to upgrade your cover (if you need to) as soon as you know you require mental health coverage, so you can minimise your out-of-pocket costs for treatment.

At Itsmyhealth, we’re passionate about health insurance and keeping things simple, as we help you find the right cover. For further help selecting a health insurance policy that benefits you, Itsmyhealth can help you find a plan that meets all your needs.

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Stephen Vickery

Stephen Vickery

Baker, chef and wanderer, Stephen Vickery brings over 10 years experience within the Private Health Insurance industry and has developed extensive knowledge within all aspects of Private Health Insurance, customer relationship management and sales management. He is a creative and thoughtful individual who enjoys the freedom of creating something from nothing. Living in Victoria, Stephen relish's married life and while children might be on the agenda over the next few years, he is quite content with his two naughty puppies.