What is a Mental Health Care Plan?

The Australian government has implemented a rebate program for people seeking treatment from a Clinical Psychologist or General Psychologist under Medicare. The ‘Better Access’ program has helped Australians access affordable mental health care.:

If you are experiencing a mental health disorder, you and your GP may be able to create a Mental Health Care Plan or Mental Health Treatment Plan. A Mental Health Care Plan will outline the support you need from mental health professionals when treatment is required. It should also have the goals you and your GP agreed upon and the treatment options. Additionally, your Mental Health Care Plan should include a safety plan for you to follow in a crisis or prevent relapse.

Your health information and treatment plan will be private. GPs can’t share your information unless you agree to it; for instance, if you both agree for your Mental Health Care Plan to be sent to a mental health professional such as a Clinical Psychologist.

How can I get a Mental Health Care Plan?

You don’t need a Mental Health Care Plan and GP referral to see a psychologist. However, you need them if you wish to claim Medicare rebates.

To know whether you are eligible to get a Mental Health Care Plan and claim Medicare rebates, you need to make a long appointment with your GP or see your psychiatrist. They will assess your eligibility and may refer you to a Psychologist under a Mental Health Care Plan. As part of the process, they may ask you to complete some psychometrics, such as the K10 Anxiety and Depression test.

Eligible clients with a GP referral and Mental Health Care Plan can claim Medicare rebates for up to 10 individual sessions per calendar year.

How much is the Psychologist Medicare Rebate?

The Medicare rebate covers a portion of the cost of sessions with a General Psychologist and Clinical Psychologist. The out-of-pocket or gap fee will depend on the psychologist’s session fee.

As of the 1st July 2023, the Medicare rebates are as follows:

• $136.35 rebate per 50+ minute session with a Clinical Psychologist
• $92.90 rebate per 50+ minute session with a General Psychologist.

How does it work? After a session with a psychologist, they will invoice you the full session fee. After the invoice has been paid in full, they will be allowed to submit it to Medicare on your behalf (or you can submit it yourself if you wish). The corresponding rebate amount is then deposited into your nominated bank account by Medicare, generally within 24 hours.

Medicare rebates are only available for individual therapy. Better Access does not cover the cost of psychological reports, non-attendance fees, and couples counselling.

What treatment is covered under a Mental Health Care Plan?

The Medicare program covers the treatment of some of the most commonly presenting psychological conditions, such as:

• Alcohol use disorder
• Adjustment disorder
• Attention deficit disorder
• Bereavement disorder
• Bipolar disorder
• Chronic fatigue
• Conduct disorder
• Co-occurring anxiety and depression
• Depression
• Dissociative disorder
• Drug use disorder
• Eating disorders
• Enuresis
• Generalised anxiety disorder
• Mental disorder not otherwise specified
• OCD Obsessive-compulsive disorder
• Panic disorder
• Phobic disorder
• PTSD Posttraumatic stress disorder
• Psychotic disorders
• Schizophrenia
• Sexual disorders
• Sleep problems
• Unexplained somatic complaints.

Psychologist Private Health Insurance

Private Health Insurance options are available to both Australian residents and overseas students.

If you have private health insurance, you may be eligible to claim rebates for sessions with a psychologist.

Private health typically covers both in-person and online therapy sessions. These include individual therapy sessions, couples counselling and family therapy.

The level of cover and applicable waiting periods vary between insurance companies and depend on your extras cover policy.

Don’t hesitate to contact your private health insurance to determine eligibility and how much funding you can claim for psychological sessions. Your private health insurance may ask for the item code that will show on your invoice. Please see below the psychological session item codes:

100 – Initial Individual Therapy Session with a Psychologist

200 – Follow-up Individual Therapy Session with a Psychologist

300 – Online Couples Counselling / Family Therapy session with a Psychologist

701 – Initial Online Therapy Session with a Psychologist

801 – Follow-up Online Therapy Session with a Psychologist.

It is best to call your Private Health Insurance fund and find out if you are eligible, how many appointments you can claim and the exact amount of your rebates.

How does Private Health Insurance cover sessions with a psychologist?

Suppose you can claim private health insurance rebates for appointments with a psychologist. In that case, your psychologist should be able to process your claim at the end of your appointment, and you then pay the ‘gap’ fee. Alternatively, you can claim rebates directly with your provider after the session with your psychologist, via an online portal or by completing one of their forms. You will need a copy of the invoice and receipt provided by your psychologist.

Overseas Student Health Cover

If you are an overseas student with Overseas Student Health Cover (OSHC) you may be entitled to private health insurance rebates from the following insurance companies:

• Bupa
• Allianz Global Assistance (Peoplecare Health)
• Medibank Private
• AHM by Medibank OSHC
• nib.

Most of the health funds listed above provide students with a rebate similar to watch Medicare offers under a Mental Health Care Plan. You may need to get a referral or Mental HEalth Care Plan from a GP to be able to access a rebate that equals the Medicare rebate.

For more information about OSCH, visit PrivateHealth.org.au.

NDIS Funding Options

The NDIS scheme provides funding to eligible NDIS participants with psychological therapy and/or assessment included in their NDIS Plan. Most psychologists can work with NDIS participants that are either self-managed or plan-managed.

The NDIS sets price limits for psychological services provided to NDIS participants. These limits specify the maximum amount that a psychologist can charge for services to NDIS participants. These limits must be followed when a psychologist delivers services to patients using plan-managed or NDIA-managed funds. Check the NDIS website for the most up-to-date information on psychology services fees.