First published January 2021. Updated 17 January 2025.
When accessing private mental health care, it can be difficult to know whether your care will be covered by private health insurance
One thing to know is that as long as you have basic hospital cover, you can contact your insurer to update your cover to include psychiatric care and you won’t have any waiting periods.
This applies to all private hospital mental health care, including perinatal and alcohol and drug treatment.
When do I need to upgrade my cover?
You only need to upgrade your cover immediately before you are admitted to hospital.
However, you can choose to upgrade your cover at any time and you will not have to wait before accessing care.
We recommend you speak to your health insurer as soon as you are referred to mental health care.
How do I upgrade my cover?
To upgrade your cover, you simply call your health insurer and they can action the upgrade immediately while you are on the phone.
If you upgrade your cover you will need to pay a new premium from the day the new cover applied. You should speak to your health insurer to find out the new costs and when the premium is payable.
What if I don’t have private hospital insurance?
If you don’t have private hospital insurance then you will need to wait two months before you can get covered for your mental health care.
It is also possible to self-fund your private hospital care.
Can I upgrade and then downgrade?
Yes, how you manage your health insurance is up to you. However, it is important to note that you can only access this waiting period exemption once in the lifetime of the policy.
What costs are covered by private health insurance?
In general, Medicare and your private health fund will cover the full cost of your care at our hospitals. This is called the no gap arrangement where you don’t have any out of pocket expenses as long as you have private health insurance.
If you are seeing one of our psychiatrists as an outpatient, you will have a gap fee to pay at your first appointment. Some of your costs are covered by Medicare but most doctors charge an out of pocket fee. The amount is set by the individual doctor – similar to your family doctor.
You can call your psychiatrist’s office before you see them to ask for their fees and charges.
Need more information?
The Department of Health has more information about private health insurance which can help you understand this further.
We recommend speaking to your private health insurer to check what your current policy includes and excludes.
