Why mental health coverage is different

• Mental health services often involve allied health (psychologists, counsellors) or specialist psychiatry, which are different from standard GP or hospital services.
• Many mental health services do not carry Medicare items or require specific referrals, which complicates insurer reimbursement.
• There are risk and cost concerns for insurers, so many policies impose waiting periods, limits on number of sessions, or exclude certain therapies.

What Mental Health Services Are Typically Covered (and Not Covered)

Below is a rough guide of what you can expect, but always check your policy’s “policy wording” / “benefit schedule”:

Important caveats / conditions

• Referral / Mental Health Plan from GP: Often insurers require that you see a GP first, get assessed, and obtain a referral or mental health treatment plan before accessing psychology or psychiatry benefits. For some insurers, the use of a GP Mental Health Care Plan (under Medicare) is a required pathway.
• Waiting periods: Many policies impose waiting periods (e.g. 2 months) before you can claim for mental health services (especially outpatient allied health). Some providers treat mental health benefits under “extras” that have waiting times.
• Gap payments: Even when a mental health session is covered, the practitioner might charge more than what the insurer agrees to pay (i.e. MBS benefit). The difference (gap) may need to be paid by you. Allianz OSHC notes that some providers charge above the benefit amount.
• Provider networks: Insurers often maintain a network of mental health providers who agree to accept insurer rates (reducing gap fees). Using an out-of-network provider might reduce your reimbursement.
• Annual limits: Some policies cap the number of sessions or the total dollar value for allied health/psychology per year.

Waiting Periods & Eligibility

• It is common for a 2-month waiting period on mental health / allied health services under OSHC/OVHC before you can make claims.
• Waiting periods may differ for hospital (psychiatric) vs outpatient services - hospital admissions may have shorter or no waiting periods compared to therapy services.
• Some insurers classify mental health support as “extras” or “optional cover,” meaning waiting periods may apply only to those benefits (not core hospital/medical).
• Always check the policy schedule for “service waiting periods,” especially for mental health, psychologist or counselling benefits.

Telehealth, Digital & Alternative Access

• Telehealth mental health consultations (via video or phone) are increasingly included by insurers or as a feature of their mental health network. For example, Allianz OSHC and OVHC support virtual consultations and maintain a network of mental health practitioners nationwide.
• Some OVHC/OSHC providers offer digital mental health tools or wellbeing apps as part of membership (e.g. mood checkers, self-help modules) or 24/7 support lines. nib’s OVHC, for example, mentions a "digital on-demand mental health and wellbeing tool" in its app.
• For students waiting to access therapy or in between sessions, free or low-cost community services, university counselling, or government mental health helplines may be useful as bridging supports.

Claiming, Reimbursement & Out-of-Pocket Costs

• To claim mental health services, you typically submit your invoices/receipts along with claim forms to your insurer (online portals, mobile apps, or by post).
• If the provider is in the insurer’s network and accepts direct billing, the insurer may pay them directly (less your excess / co-payment).
• If the provider is outside the network or charges above the insurer’s rate, you may pay upfront and be reimbursed part of the cost (subject to gap).
• It is vital to check your policy’s “benefits schedule” for the allowed amount per session, any gap, and session limits.
• As many mental health services have variable costs and practitioner rates, the gap can sometimes be substantial.
• Some providers may also require you to obtain a mental health care plan (from your GP) to claim under Medicare items - and that process might overlap with insurer claims.

Comparative Notes: OSHC vs OVHC for Mental Health

• OSHC is generally broader for students: Students’ plans may include more outpatient allied health coverage including psychology/counselling (with limits), whereas OVHC plans often emphasize hospital and emergency cover, with allied health more restricted.
• Flexibility / extras: OSHC providers may offer “extras” or addons for mental health; similarly, OVHC insurers may allow you to select a plan with allied health benefits, but premiums will be higher.
• Policy transparency matters: Because OSHC is a regulated market (via the Deed), there is more oversight. OVHC is more variable across insurers.
• Gap risks higher in OVHC: Because OVHC is more of a private product, gap payments and exclusions are more likely.
• Waiting periods & coverage differences: OVHC may impose stricter waiting periods or exclude certain outpatient mental health services altogether.

What International Students Should Watch Out For / Checklist

• Read the policy wording / benefit schedule
  • Look specifically for terms like “psychology”, “counselling”, “psychiatry”, “mental health / behavioural health”
  • Check session limits, dollar caps, waiting periods, gap amounts
• Check whether the practitioner is in the insurer’s mental health network
  • Using an “in-network” provider may reduce or eliminate gap fees
  • Ask your therapist whether they can bill under your insurer’s mental health scheme
• Obtain referrals / mental health plans via GP
  • Some insurers require that you first see a GP, get assessed, and obtain a mental health treatment plan
  • Having a GP referral can also help you access Medicare-based items (if eligible) which can coordinate with your insurer claim
• Beware waiting periods
  • Don’t assume coverage starts immediately
  • If you expect mental health treatment early (e.g. you have existing conditions), consider plans with shorter waiting periods or higher upfront coverage
• Budget for gap payments
  • Even if sessions are “covered,” you may still pay the difference between what a provider charges and what the insurer reimburses
  • Ask providers in advance about their fees and whether they accept your insurer’s standard rate
• Make use of telehealth / digital supports
  • For convenience, look for insurers offering telehealth or digital mental health tools
  • These may have lower or no gap costs
• Seek community / university supports
  • Many universities offer free or subsidised counselling or mental health services
  • In case of waiting lists or cost barriers, these can act as interim support
• Check mental health history disclosure / “pre-existing condition” clauses
  • Some policies might treat pre-existing mental health conditions differently (e.g. exclusion or waiting period)
  • Always be transparent when applying