It’s no secret that teaching can be demanding. Long, hectic days can leave you tuckered out. And meeting the needs of students, colleagues and parents can leave you just as mentally and/or emotionally depleted. And that’s only your work life!

If your go-to self-care strategies aren’t cutting it—and you’re concerned about your mental health—you’ve come to the right place.

What’s in scope

Read on to understand when you could access Medicare rebates* and when private health cover may come into play. We can’t be precise about how much you could claim via either, due to the number of variables. Things like your age, income, diagnosis and level of Hospital or Extras cover. But, we’ll point you in the right direction for more detail when possible.

Not what you’re looking for?

If you’re unsure where to begin, or would rather start online, see Should I get help for my mental health?

Shortcuts 

There’s a lot of information here. If you know what you’re looking for, feel free to skip ahead! 

Medicare

GP visits

GPs usually offer longer timeslots for mental health consultations. To give you time to explain your concerns, for your doctor to consider your options, and for you both to agree on next steps. This may be over a single consultation, possibly more.

If you’re diagnosed with a mental health condition (e.g. anxiety or depression) your GP may refer you to a mental health professional for further assessment and/or treatment. They can also give you a mental health treatment plan to subside the costs.

You claim: Medicare rebate (long appointment)
You pay: Balance of the appointment fee (unless bulk-billed)

Mental health professionals

Appointments

A mental health treatment plan details your needs, treatment options and goals. It also enables you to claim Medicare rebates for up to 10 individual (and 10 group) sessions with a mental health professional each calendar year.

These can be with doctors (e.g. psychiatrists or paediatricians) or allied health professionals (e.g. psychologists, social workers or occupational therapists). After the first six sessions, you’ll need to go back to your GP for a review before accessing the remaining four.

If you continue treatment after using all your Medicare-subsidised sessions, you’ll be billed privately. That means you’ll pay the full cost, unless you can use Extras cover (for psychology or counselling).

Practitioner fees

Mental health professional fees can vary a lot, so ensure you understand the costs before starting treatment. The practice should be able to give you a breakdown of the appointment cost and standard Medicare rebate, so you can budget accordingly. You can also ask for the relevant item number(s) and check the Medicare Benefits Schedule (MBS) website yourself.

Medicare Safety Net

You’ll get more back from Medicare if you’ve already reached your Medicare Safety Net threshold. This happens if you spend over a specified amount on doctor visits and/or certain medical tests in a calendar year. If you/your family pass the relevant threshold you’ll get higher rebates for the rest of that year (for services where rebates apply).

You claim: Medicare rebate (for sessions included on your plan)
You pay: Balance of the practitioner’s fee

Medication

Getting a script

Most mental health-related medications (e.g. antidepressants) are prescribed by GPs. That means the costs are limited to repeat prescription charges and periodic review visits.

Some medications (like psychostimulants for ADHD) can only be prescribed by psychiatrists, paediatricians and other specialist doctors. So those costs depend on their prescription charges and the doctor’s fees for review appointments.

Purchasing meds

Some prescribed medications are subsidised by the government’s Pharmaceutical Benefits Scheme (PBS). You may be able to save more still by asking the pharmacist if they can dispense a generic alternative.

You pay: PBS-subsidised fee. Some pharmacies may be cheaper than others though, so it can pay to shop around.

Extras cover

Therapies

All levels of Teachers Health Extras cover provide benefits for psychology and counselling. Here are the current benefits and annual limits.

Check your Extras benefits and limits

We pay: Extras benefit^
You pay: Balance of the fee

Medication

Under the Pharmaceutical benefit, you may be able to claim for medication that’s prescribed by a doctor but isn’t already subsidised by the Pharmaceutical Benefits Scheme (PBS). You can ask your pharmacist if your medicine is or isn’t PBS-subsidised.

The medication needs to be approved by the Therapeutic Goods Administration though. That rules out medication that’s in a clinical trial, for instance. See more on claiming for medication

You pay: The PBS co-payment amount
We pay: Balance of the cost (up to a set maximum based on your cover)^

Hospital cover

Inpatient care

If you need to be admitted to hospital for mental health treatment, Hospital cover can help with the costs.

Top Hospital (Gold)

On Top Hospital (Gold), you’re covered for in-hospital psychiatric services at an agreement hospital. That means you shouldn’t pay anything for your hospital stay other than the excess (if you have one).

If there are any additional out-of-pocket costs, the hospital will detail them (in writing) so you can provide Informed Financial Consent upfront.

Other levels of Hospital cover

On every other Teachers Health Hospital cover, in-hospital psychiatric services are restricted. That can mean significant out-of-pocket expenses if you choose to go to a private hospital.

Mental Health Waiver

If you need immediate inpatient psychiatric treatment, the Mental Health Waiver can help. It enables you to upgrade to Top Hospital (Gold) without serving the usual two-month waiting period.

To use the waiver, you need to have had restricted cover for in-hospital psychiatric services for at least two months. The waiver can be used by each person on a policy, but only once per person in their lifetime.

Want to access the waiver? Please call us on 1300 727 538

Support programs

Provided you’ve served the two-month waiting period, you may be able to access a (fully covered) support program via Healthcare Services. This may include mental health coaching, health professional support after a hospital admission for your mental health or home-based alcohol detox support.

The first step is to get in touch via online contact form or email info@teachershealthcare.com.au. This is followed by a quick phone call with one of the team’s health professionals. They’ll ask a few questions to understand where you’re at, and if one of the programs is likely to be beneficial (and safe) for you.

They’ll also confirm your eligibility^#.

If you do participate in a Healthcare Services program, you’ll get a personal care coordinator who’ll support you along the way.

See more on Healthcare Services

*The information on this page is based on the assumption you’re eligible for Medicare.

^{^}Extras benefits depend on your level of cover and remaining limits – see how to check.

^#To be eligible for a program you must be a member of Teachers Health and have Hospital cover with all relevant waiting periods served. Hospital cover requirements and waiting periods vary for different programs. Additional eligibility criteria may apply.

These programs are brought to members through Teachers Healthcare Services ('Healthcare Services'), an initiative of Teachers Health, to support members’ health and wellbeing through quality, evidence-based health management. Eligible members are connected with a dedicated Healthcare Services care coordinator who supports them along the way.

ⁱ https://www.aihw.gov.au/mental-health/topic-areas/mental-health-prescriptions