Does private health insurance cover mental health?
Statistics show that in England, one in four people experience a mental health issue each year. However, lengthy NHS waiting lists can mean people are having to wait more than three months for treatment to start, but could private health insurance help instead?
1-minute read about health insurance and mental health
Most health insurance policies will provide you with some telephone-based "mental health support"; however, you'll usually have to pay more for additional "mental health cover" if you'd like access to a broader field of specialists and services.
Bear in mind that health insurance policies exclude anything you've suffered from in the past five years, so if you currently have mental health issues and are wondering if health insurance will cover the cost of treatment, it's unlikely it will. If you take out a health insurance policy and go for two years without having symptoms or needing treatment or advice, it'll be covered in year three and beyond.
The World Health Organisation (WHO) describes mental health as a 'state of mental wellbeing that enables people to cope with the stresses of life'.
Having good mental health can help us carry out activities and interact with others in a positive or effective way. In contrast, poor mental health can make us feel anxious and negatively affect the way we think, feel and behave around others.
In some cases, poor mental and emotional health can manifest itself into certain behaviours – 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).
Some health insurance policies include mental health support as a standard, although it's typically limited to a set number of telephone counselling or therapist calls.
Before we go much further, we need to explain that for most insurers, the definition of "support" isn't treatment as such, and it's usually limited to telephone-based counselling or access to other specialists remotely.
Mental health cover, often an additional extra you pay for each month, will give you access to various mental health specialists for many conditions and treatments.
What's offered by each provider varies, but as a guide, by paying for mental health cover (on top of your private health insurance) you'll get access to:
- Specialist treatments as a day or inpatient (often time limited to around 28 days)
- Outpatient consultations with psychologists and cognitive behavioural therapists.
- Outpatient consultations with psychiatrists
- Outpatient mental health and wellbeing therapists
Bupa includes mental health cover in its base Bupa By You Comprehensive product, unlike most other providers who only offer mental health support.
While most insurers will allow you to add full mental health cover to your policy, it will increase your monthly premiums.
What mental health conditions does private health insurance cover?
Policies cover a broad range of mental health conditions, including (but not limited to):
- Depression
- Anxiety
- Eating disorders
- PTSD
- Addiction
- Phobias
- OCD (obsessive-compulsive disorder)
What mental health conditions aren't covered by private health insurance?
Your policy should specify what isn't covered but as a rule, health insurance won't cover long-term (chronic) mental health conditions. This typically includes dementia, learning disabilities, behavioural or developmental conditions.
Also, bear 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 benefits of private health insurance is the ability to access help quickly – regardless of whether it's for your physical or mental health.
When it comes to mental health cover specifically, being able to get help as soon as you need it, can make a huge difference. Depending on your policy, you may not even need a GP referral in order to access counselling services or talking therapies.
Read our latest reviews on Mental Health Cover by provider (November 2024): Bupa, Vitality and Aviva. Coming next Axa and WPA.
If you've 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 one you've previously experienced.
In most cases, insurers will also exclude anything you've experienced symptoms of, and you won't even need an official diagnosis. The good news is that after a certain length of time (usually two years), your insurer may reinstate cover for any exclusions, but only if you've not had symptoms, sought advice or required treatment for it during that time.
It's important to know that having a pre-existing mental health condition should not stop you from getting cover altogether, but you could face some challenges, for example:
- Your pre-existing condition is unlikely to 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 a mental health condition?
Insurers cannot discriminate against you if you have a mental health condition, and if you opt for moratorium underwriting, they won't even ask you if you have one, as it's only when you claim they'll ask about your medical history. Bear in mind, though, if you take out a policy and opt for mental health cover but have a pre-existing condition, when you claim, your insurer may reject it.
What can I do if I disagree with a decision or feel unfairly treated?
If you think you've been unfairly treated – for instance, if the insurer can't or won't tell you why you've had exclusions added to your policy you should complain to them in the first instance. Check your policy documents or the insurer's website; there should be a clear complaints procedure.
If you want help drafting a letter to your insurer, you can find templates at MoneyHelper.org.
If you don't hear back after eight weeks (or the answer is not satisfactory), you can take your complaint to the Financial Ombudsman Service. They will investigate your complaint and take evidence from you and the insurer to try and reach a resolution. You don't have to agree with their final decision, but it does mean they won't be able to help you any further.
If you wanted to pursue your complaint, you could consider taking legal action against the insurer.
Additional help is available from Citizens Advice.
Cost will depend on your circumstances and insurers will look at numerous factors alongside your mental health, including your age, where you live and your overall health and lifestyle.
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As with any sort of insurance policy, you should take the time to find out:
- What's included – check what treatment or support your policy covers.
- Whether there are any limits to claiming – for example, are sessions limited or is there a cap on how much you can claim?
- Will you need a GP referral – some policies will need a referral; others will let you access mental health professionals directly.
- What treatment plans entail – if this is offered, check how are they managed and progressed.
- What the claims process is – will you need every appointment signed-off by your insurer or are you free to choose the support you need and then make a claim?
- Who pays first – does the health professional submit invoices to your insurer directly or do you pay first and then claim the money back?
If you want to find out more about private medical insurance and mental health support, contact us and we can put you in touch with a regulated broker. With their expertise and market knowledge, they'll be able to take you through what's available and discuss your options. You can also compare policies with us online.
If you need support now and want to speak 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 aid website that can help you work through 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 messaging support line) – text 85258
Related reading: Understanding the increase in children's mental health referrals.
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Disclaimer: This information is general and what is best for you will depend on your personal circumstances. Please speak with a financial adviser or do your own research before making a decision.