Private health mental health waiting period waiver

Generally, private health insurers only cover mental health or psychiatric hospitalisation under Gold hospital coverage or higher. The exemption is that historical policies from some insurers may cover this at lower hospital coverage classifications. This has left the majority of people who have Silver or Bronze hospital cover with limited cover in the private system for mental health and psychiatric hospitalisation.

The Australian Federal Government introduced a waiver in 2019 as part of legislative changes to improve access to mental health and psychiatric hospitalisation under private health insurance. These changes applied specifically to private health insurance and not to coverage available in the public hospital system.

Mental health conditions are subject to a two-month waiting period for pre-existing conditions, which applies when first taking out or upgrading private health insurance coverage for psychiatric or mental health hospitalisation.

Changes introduced by the Federal Government saw the introduction of the Mental Health Waiver, which can be used by an individual only once in their lifetime and removes many of the barriers to seeking immediate coverage. Ordinarily, a person on a Bronze or Silver policy would need to wait the two-month waiting period when upgrading their health covering to Gold to access mental health or psychiatric hospitalisation.

This waiver means that individuals do not need to wait this period when upgrading their cover and can access the coverage for mental health or psychiatric hospitalisation immediately. This is so long as the individual has held their private health insurance at a lower level for at least two months.

What this means is individuals can have assurance that, despite being on a lower private health insurance policy that they can access mental health or psychiatric hospitalisation immediately if needed. This can only be used once in a lifetime.

More information on the Mental Health Waiver can be found on the Government website here. For more information, speak with your private health insurer.

Private health insurer and sub-brands