Mental Health and Private Cover
Unlike other pre-existing conditions, which normally require you to complete 12 months of membership before you can be covered for a hospital admission, psychiatric services and rehabilitation only require a 2 month waiting period, even if the condition is pre-existing.
This means you can be covered 2 months after commencing a policy.
Restrictions and Exclusions
As not all hospital policies will give you full cover for psychiatric services and rehabilitation, take care to select a policy that does not restrict (only partially cover) these services. If you purchase a policy that restricts psychiatric services, then you will not be covered for all or most of the cost of hospital treatment as a private patient. If you aren't covered for these services on your current policy and do require hospital treatment, then you can upgrade your policy and complete the 2 month waiting period to be covered.
Going to hospital
Private hospital insurance will cover you as a private patient for the cost of accommodation and a portion of the medical fees. However, it won't cover all the costs associated with your admission. If you're expecting a hospital admission, you should contact your health fund, Beleura Private Hospital and your doctor to find out how much will be covered, how much you will have to pay, and any other expenses.
Some of the out-of-pocket expenses you may incur include:
Medical services incurred outside of hospital including private psychiatric consultations and check-ups. These costs, like your visits to your GP, can only be claimed on Medicare.
The 'gap' on medical services incurred while admitted to hospital. Your health fund and Medicare will cover the equivalent of the Medicare Benefits Schedule fee, but the remainder is your own expense. Discuss the situation with your doctor – ask if he or she has a "no gap" or "known gap" agreement with your health fund and request a written quote of expenses at the start of your treatment.
Excesses and co-payments. Some health insurance policies require you to pay an excess or co-payment for admissions to hospital, which you will need to pay directly to the hospital.
General treatment (extras) insurance for psychology and counselling
Some general treatment or extras policies you can purchase will also provide benefits towards psychology services and counselling. Your health fund will pay a set benefit or percentage of the cost of the service, and you pay the rest. Your provider needs to be registered with your health fund, so you should check this with your fund before sending in a claim.
The waiting periods, benefits and limits to claiming vary from fund to fund. For more information, you can review policies on www.privatehealth.gov.au or contact health funds directly.
For information on services, check the Community Help and Welfare Services and 24-hour emergency numbers in your local telephone directory. For immediate counselling assistance, contact Lifeline on 13 11 14 or www.lifeline.org.au. Lifeline can also supply you with contacts, further information and help.
To check and upgrade your private health cover, contact your health fund. For general information about private health insurance and to compare health insurance policies, visit www.privatehealth.gov.au or phone on 1300 737 299.
If you have a complaint about your health fund, you can contact the Private Health Insurance Ombudsman on 1800 640 695 or www.phio.org.au for assistance.
This information is issued by the Private Health Insurance Ombudsman. For more information visit www.phio.org.au