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Member Insider - Government Mental Health Reforms

03 April, 2018
Mental Health Reform

Changing approach to mental health

In October 2017 the Australian Government announced it would introduce changes to make it easier for insured people to access higher benefits for psychiatric care. These changes commence on 1 April 2018.

What does this mean?

Members with limited mental health cover on their hospital policy will be able to upgrade their cover to access private in-hospital mental health services without serving the upgrade waiting period. If a member with limited mental health cover is hospitalised they will have a one-off opportunity to upgrade their cover, and have their hospital stay fully covered without a waiting period on higher benefits.

Why is this important?

Most basic and medium level hospital products provide limited cover for private in-hospital mental health services. Members with these products who require overnight or multi-day care in a private hospital for a serious mental health condition will usually face large out-of-pocket costs.

The waiting period exemption will make it easier for members to access care when they most need it, without facing substantial out-of-pocket costs.

What are waiting periods?

A waiting period is an initial period of health fund membership where you are unable to claim a benefit for certain procedures and services after joining or upgrading.

What is the normal waiting period to access mental health services?

2 months under Private Health Insurance Act 2007

How often can I use this waiting period exemption?

Once - this opportunity to upgrade to access private in-patient mental health services is only available once in a lifetime.

The use of the upgrade exemption will be captured on transfer certificates in the same way other membership details are captured for portability between funds.

Can I use this waiting period exemption to avoid waiting periods for other services?

No - The Government has legislated the change for in patient mental health services only.

Does the waiting period exemption apply to all members on the upgraded membership?

No - The waiting period exemption only applies to the member requiring in-patient mental health services. All normal waiting periods will apply to all other members on the upgraded membership.

Are there any other conditions?

The waiver is only granted if the member has had any level of hospital cover for 2 or more months. Otherwise the member still needs to complete 2 months of hospital cover before the waiver is applied

The waiver is only applicable when a member has upgraded the cover and a claim is made for private in-patient mental health services under the new cover.

How can I access the waiting period exemption?

Contact CBHS on 1300 654 123 or email help@cbhs.com.au

When does the change happen?

This change will take place from 1 April 2018, and will be reflected in our Product Brochure in the near future.

Sources

http://www.health.gov.au

http://www.ombudsman.gov.au

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