Does private health insurance cover mental health treatment?

What does mental health mean?

The World Health Organization (WHO) describes mental health as ‘a state of mental well-being that enables people to cope with the stresses of life’.

Good mental health can help us perform activities and interact with others in a positive or effective way. Conversely, poor mental health can make us feel anxious and negatively affect the way we think, feel and behave with others.

In some cases, poor mental and emotional health can manifest in certain behaviors – for example, eating disorders. Other examples of mental health conditions include:

• Anxiety and depression.
• Post-traumatic stress disorder (PTSD).
• Phobias.
• Psychosis (including schizophrenia and bipolar disorder).

Does private health insurance cover mental health support?

Some health insurance policies include mental health support as standard, although it is usually limited to a certain number of telephone consultations or therapist calls.

Before we go any further, we must explain that for most insurers the definition of “support” is not treatment as such, and is usually limited to telephone counseling or access to other professionals at a distance.

What is mental health cover and what does it include?

Mental health cover, often an extra you pay each month, will give you access to a variety of mental health professionals for many conditions and treatments.

Each provider’s offer varies, but as a guide, paying for mental health cover (on top of your private health insurance) will give you access to:

• Specialist treatments such as day or hospital (often time-limited to around 28 days)
• Outpatient consultations with psychologists and cognitive behavioral therapists.
• Outpatient consultations with psychiatrists
• Outpatient mental health and wellness therapists

Bupa includes mental health cover in its core Bupa By You Comprehensive product, unlike most other providers who only offer mental health support.

Although most insurers will allow you to add full mental health cover to your policy, this will increase your monthly premiums.

What mental health conditions does private health insurance cover?

Policies cover a wide range of mental health conditions, including (but not limited to):

• Depression
• Anxiety
• Eating disorders
• PTSD
• Addiction
• Phobias
• OCD (obsessive-compulsive disorder)

Which mental health conditions are not covered by private health insurance?

Your policy should state what is not covered, but generally health insurance will not cover long-term (chronic) mental health conditions. These usually include dementia, learning difficulties, behavioral or developmental conditions.

Also, keep in mind that private health insurance doesn’t cover pre-existing conditions, so if you’ve already been diagnosed with a mental health condition, it probably won’t be covered.

What are the benefits of private health insurance with mental health cover?

One of the main advantages of private health insurance is the ability to quickly access help – whether it’s about your physical or mental health.

When it comes to mental health coverage specifically, being able to get help as soon as you need it can make all the difference. Depending on your policy, you may not even need a GP referral to access counseling services or talking therapies.

Read our latest mental health cover reviews by provider (November 2024): Bupa, Vitality and Aviva. Next Axa and WPA.

Can I get private health insurance if I have mental health problems?

If you have been diagnosed with a mental health condition, it will usually be excluded from your policy as it will be considered a pre-existing condition (so you won’t be able to claim for it). You can still be covered for other mental health conditions, just not for those you’ve previously experienced.

In most cases, insurers will also rule out whatever caused your symptoms, and you won’t even need a formal diagnosis. The good news is that after a certain time (usually two years), your insurer can reinstate cover for any exclusion, but only if you have had no symptoms, sought advice or needed treatment during that time.

It’s important to know that a pre-existing mental health condition should not prevent you from getting full cover, but you may face some challenges, for example:

• Your pre-existing condition probably won’t be covered.
• Answering questions about your mental health can feel intrusive and could be triggering.
• Searching for a policy can be frustrating and overwhelming if you can’t find the support you need.

Can I be denied private health insurance because of my mental condition?

Insurers cannot discriminate against you if you have a mental disorder, and if you opt for moratorium insurance, they will not even ask you if you have one, because they will only ask you about your medical history when you claim. However, be aware that if you take out a policy and opt for mental health cover but have a pre-existing condition, when you make a claim, your insurer may refuse it.

What can I do if I do not agree with the decision or feel it is unfair?

If you think you’ve been treated unfairly – for example, if your insurer can’t or won’t tell you why they’ve added exclusions to your policy, you should complain to them first. Check your policy documents or the insurer’s website; there should be a clear procedure for complaints.

If you want help writing a letter to your insurance provider, you can find templates at MoneyHelper.org.

If you do not hear back after eight weeks (or the answer is unsatisfactory), you can submit your complaint to the Financial Ombudsman Service. They will investigate your complaint and take evidence from you and the insurer to try to reach a resolution. You don’t have to agree with their final decision, but it means they won’t be able to help you anymore.

If you wish to pursue your complaint, you may consider taking legal action against the insurer.

You can get additional help at the Citizens Advice Bureau.

How much does health insurance with mental health coverage cost?

The cost will depend on your circumstances and insurers will take into account a number of factors in addition to your mental health, including your age, where you live and your overall health and lifestyle.

What should I consider before getting health insurance with mental health coverage?

As with any type of insurance policy, you should take the time to find out:

• What is included – check what treatment or support is covered by your policy.
• Are there any limits to the claim – for example, are sessions limited or is there a limit to how much you can request?
• Will you need a referral to a general practitioner? – some policies will require a recommendation; others will give you direct access to mental health professionals.
• What the treatment plans include – if offered, check how they are managed and how they are progressing.
• What is the claim procedure – will each term need to be signed by the insurer or can you freely choose the support you need and then submit a claim?
• Whoever pays first – does the health care provider invoice your insurer directly or do you pay first and then request a refund?

If you would like to find out more about private health insurance and mental health support, please contact us and we can put you in touch with a regulated broker. With their expertise and knowledge of the market, they will be able to walk you through what’s available and discuss your options. You can also compare policies with us online.

Who can I turn to now for mental health support?

If you need support now and want to talk to someone, you can find free advice and help at:

• Mind
• NHS
• Young Minds – support for children and young people, the site also has links and advice for parents.
• Love Respect – This is a women’s help website that can help you overcome the signs of an unhealthy relationship.

Free listening services include:

• Samaritans – call 116 123 or email
• Childline (for under 19s) – call 0800 1111
• Shout (text message support line) – text 85258