What does psychiatric or mental health cover refer to on your private medical insurance policy


If you have Private Medical Insurance, many providers offer the option to add cover for psychiatric or mental health claims to your policy. Some insurers include this as part of their core cover and some offer no cover for claims of this type at all but the majority will offer this as an add-on benefit.

Claims for psychiatric conditions can be expensive and as such if you want to have this cover included in your policy it could make a significant difference in the premium you pay. Insurers could offer a specific monetary limit for these claims such as £15,000 or £20,000 per person per policy year where others will provide the limit in days; maybe 28 or 45 days cover there are even insurers who have no yearly limit on specialist fees for psychiatric treatment.

The same rules apply to psychiatric claims as with any other, they must be acute medical conditions and not deemed as chronic. As psychiatric illness is complex to treat, it could be that your insurer agrees to pre-authorise your initial treatment however it could be that eventually the condition becomes chronic and therefore cover would be withdrawn. Your insurance provider would notify you and provide reasonable notice before withdrawing cover.

Conditions such as clinic depression and schizophrenia would be covered under the psychiatric or mental health benefit option.

Is psychiatric cover only available as an in-patient?

No, you will find there may be a requirement for out-patient, day-patient or in-patient treatment depending on the severity of the condition needing treatment.

Can you add psychiatric/ mental health cover mid-term to your policy?

No, you cannot make changes of this type mid-term and if you do want to add psychiatric cover to your existing policy this will be subject to approval from the insurance companies underwriters. They may ask medical questions relating to your health to assess the risk prior to offering cover for claims relating to mental health.

What is not covered?

Even if you have cover for mental illness and psychiatric conditions the general exclusions for your policy would exclude cover for a number of things including:

  • Injuries inflicted on yourself deliberately
  • Attempted suicide
  • Alcohol abuse
  • Drug or substance abuse
  • Conditions that are chronic

For people who are suffering with mild stress related issues, there is normally a 24/7 helpline which can offer counselling assistance. This benefit is predominantly part of the core cover from providers and should not be confused with the optional mental health/ psychiatric benefits available.

If you would like to know whether your current policy has cover for mental illness or psychiatric claims or you would like help in sourcing a private medical insurance policy that can offer cover for this type of condition, please contact us on 01245 929129 or by email enquiries@smphealthcare.com and we will be happy to help you further.