Private Medical Insurance and Mental Health — What You Need To Know

4th March 2024
 minute read

Table of contents


Private Medical Insurance (PMI) provides swift access to private GP services, diagnostic tests and medical treatment. However, mental health coverage in health insurance often excludes chronic or pre-existing conditions, limiting support for many employees. These restrictions can leave employees without much-needed support, facing costly private therapy. 

Navigating mental health care through insurance can also be complex and costly, sometimes involving additional fees. Specialist workplace mental health solutions like Lumo offer complimentary access to private counselling, including for chronic and pre-existing mental health issues.

PMI cover explained

In the evolving landscape of workplace well-being, understanding the intersection of health insurance and mental health support is essential. While traditional PMI offers various medical benefits, its limitations in addressing mental health needs are significant. This is where specialist mental health solutions step in, offering a more inclusive and effective approach to mental health care in the workplace (take a look at additional advice from Lumo’s Dr. Kate Robinson on 4 Ways to Make Mental Wellbeing Support More Accessible at Work).

Typically, PMI is designed to provide employees with prompt access to medical care for acute conditions. This includes access to private medical consultations, diagnostic tests and treatment options. However, when it comes to mental health, insurance policies often come with notable limitations.

Unless an enhanced cover is purchased by the employer – which typically enables access to specialists such as clinical psychologists – employees will usually only have access to a basic EAP counselling service. Here’s a quick summary of why EAPs have limited impact:

  • Call centres and triage systems make it difficult for employees to get access to the care they need.
  • Waiting times for an initial appointment are typically six weeks, during which time issues may escalate and they may be unable to work.
  • Counselling is only one approach and whilst suitable for some individuals, it may not be appropriate for an employee’s particular needs. As a result, it won’t help them to successfully deal with the issue.

Benefits of PMI

Immediate access to care

One of the most significant benefits PMI tries to provide is the speed at which individuals can access care. Unlike public health services, which typically have long waiting lists, private insurance allows for quicker referrals to specialist mental health professionals. This timely access can be crucial for individuals in need of immediate support, plus it offers support to  employers in managing individuals who are struggling.

Confidentiality and convenience

For many, the appeal of private medical insurance lies in the confidentiality and convenience it provides. Accessing mental health services privately can alleviate concerns about stigma and confidentiality, encouraging more employees to seek the help they need without fear of judgement. 

However, PMI services tend to be very separate from the organisation, meaning that there’s often no data or feedback regarding cultural or systemic issues that are affecting employee’s mental health. This makes it hard for workplaces to address these issues, causing HR departments and leaders to be in the dark about how their people are doing. They also have no data or information to guide them on organisational changes that they could implement to promote greater psychological safety and better wellbeing for all.

Physical and mental health cover combined

PMI might appeal to employers as they are able to offer a benefit that covers physical and mental health, including access to GP appointments. This might feel neat and easy to have everything in one place – the health box is ticked and employers might feel reassured that they’re doing what they need to be for their people. Yet this is not always the case.

The shortcomings of PMI in mental health care

Treatment rather than prevention

A significant drawback of private medical insurance is the necessity for an individual to have a diagnosable mental health condition to access services. This requirement medicalises mental health issues, yet not everybody wants to conceptualise their difficulties in this way or be given a mental health label. This can put people off from accessing support. It’s also against the tide in terms of trends in mental health developments, which are increasingly moving away from medical explanations. Instead, a more contemporary perspective is to recognise the impact of life experiences — and our environments — on our mental health. Many workplaces are trying to normalise taking care of mental health and wellbeing but having to have a clinical diagnosis in order to get support can be an obstacle to this. 

Clinical diagnosis also has another pitfall — it prioritises treatment over prevention. This means that it excludes those who may benefit from therapeutic support to manage stress or improve their wellbeing but who do not meet the criteria for a clinical diagnosis yet. However, without an early intervention approach, those individuals may go on to experience more significant difficulties that could impact their ability to perform their job.

Coverage limitations

Mental health exclusions are a common issue, with many policies excluding certain conditions or imposing caps on the number of therapy sessions available. Moreover, not all treatments or therapeutic approaches may be covered, which could limit the effectiveness of the support provided.

One major limitation is the exclusion of chronic and pre-existing conditions, which encompasses a wide range of mental health issues. This gap in coverage means that employees suffering from long-term mental health conditions often find themselves without the necessary support, leading to increased personal and financial burdens.

Chronic conditions 

These are long-term health issues that require ongoing management and are deemed unlikely to be cured. Examples include conditions like diabetes, asthma and certain mental health disorders, such as eating disorders. For many mental health conditions, this is an outdated view that does not take into account advances in treatment – there are many issues that were previously thought to be ‘incurable’ that have been shown to respond well to specialised treatments.

Pre-existing conditions

These are health issues that have been diagnosed or treated within a certain time frame before joining the PMI plan. In mental health, this often includes conditions that an employee has been managing for years, such as such as anxiety or depression. If an employer switches PMI provider, any treatment that was received under the previous plan may now be counted as a ‘pre-existing condition’, meaning that the employee is now no longer able to access therapy for it.

Not everyone will have access

In some companies, individuals need to opt in and/or part pay to be included on their employer’s PMI scheme – yet not everyone will do so, for various reasons. So there is then the question of how their mental health and wellbeing is being supported. At other companies, only employees in certain roles or levels of seniority will receive this perk. Again, what’s the solution for everybody else?

It’s not always quick to access

In theory it should be easy to get started quickly in therapy using a corporate PMI policy but in practice, it can be more burdensome. Firstly, employees have to call up to obtain authorisation to claim on their policy. They’ll then often speak to a generic mental health professional who may not even be trained in therapy, yet that person will be responsible for recommending what type of treatment they should have. 

Next,  they may be given a list of counsellors or therapists (depending on the level of company cover) and left to make contact and book in themselves. Often these providers are very booked up so there can be a wait to start or the employee has to contact multiple professionals, which can be disheartening.

The complexities of PMI cover

Insurance providers are typically hesitant to cover mental health conditions due to their complex nature and fears that treatment will be long-term. People and their mental health are complicated – care is not always linear and can involve multiple treatment approaches over an extended period. Outcomes can be difficult to predict, making it a high-risk area for insurance providers. 

For instance, someone may have successful therapy to overcome anxiety difficulties they’re experiencing but then go through a bereavement and start feeling anxious again,  requiring more sessions. Additionally, many policies for ‘enhanced mental health cover’ will provide access to specialists such as clinical psychologists, but will also cover in-patient admissions which a very, very few number of employees will need – increasing the premium for the employer.

Specialist mental health solutions

Specialist mental health solutions, such as Lumo, offer a streamlined and inclusive approach to mental health support. It addresses the gaps left by traditional PMIs, ensuring that all employees, regardless of their condition's nature, have access to the support they need.

Our cover

Simplified access

We make it easy for employees to book therapy sessions without navigating the complexities of traditional insurance claims.

Comprehensive coverage

Unlike PMI, we cover both chronic and pre-existing mental health conditions.

Proactive support

Through regular surveys and monitoring, we identify employees who are struggling and in need of additional support. 

Therapy options

Lumo provides diverse therapy options, including different therapy styles and therapists, to suit individual employee needs.

Quick appointment availability

We offer same and next day appointments, reducing wait times for critical support.

Privacy and convenience

Booking a session is straightforward and private, ensuring employee confidentiality and convenience.


Intervening early can mean that fewer sessions are needed to address an issue. Sometimes we’re able to help an employee deal with their issue in a single session, which means that they’re back to being their best and most productive selves in as little as a week or two.

Our process

A preventative approach

We all have mental health, which will fluctuate depending on what’s going on in our lives. Our stepped care model provides appropriate support and care for all employees no matter where they are on the mental health continuum — for instance, whether they’re in crisis, starting to struggle or thriving. 

Easy access to support

We make it easy for employees to recognise signs that their mental health is beginning to slip. This means that they will be more aware of the need to book a session with one of our therapists.

Same day and next day access to therapy

Employees can quickly book sessions through an intuitive booking platform, choose therapists based on personal preferences and get an appointment within 24 hours.

Flexible scheduling

Employees can schedule therapy sessions at convenient times, including evenings and weekends, accommodating different work schedules and lifestyles.

Diversity in therapy

Lumo offers therapy in multiple languages with therapists representing a wide range of ethnic backgrounds. This caters to a diverse workforce and makes therapy more accessible to everyone.

Wide range of therapy

Lumo provides access to every evidence-based therapy in the UK, ensuring that employees receive care tailored to their specific needs.

Continuity in care

Employees have the option to continue with the same therapist, building a consistent and trusting therapeutic relationship.

Empowering employees

Lumo empowers employees by giving them control over their mental health journey. They can choose their therapist, the type of therapy that works for them, and the appointment schedule. This makes the process more person-centred and effective.

Benefits for employers and employees

Employers who partner with Lumo benefit from a workforce that is better supported in terms of mental health. This support can lead to increased productivity, lower absenteeism and a more positive workplace culture. Employees will also receive accessible, personalised and immediate care, fostering a sense of being valued and supported by their employer.

Actionable data

Lumo provides organisations with the data they need to make informed decisions about their mental health care packages. For instance, we provide detailed usage reports and the ability to set budgets for therapy sessions. This transparency and control over expenses make Lumo a cost-effective solution for corporate mental health support.

Impact on workplace wellbeing

The proactive approach of Lumo in identifying and supporting employees with mental health challenges leads to a more resilient workforce.This includes employees who are happier, more productive and better able to collaborate with others. 

Impact on organisational identity

Offering effective and inclusive mental health support also demonstrates a company's commitment to the holistic wellbeing of its employees. This can enhance brand identity, attract new talent and improve employee retention.

Integration with workplace culture

Lumo seamlessly integrates into the existing workplace culture, reinforcing the organisation's commitment to mental health and wellbeing. This integration is vital for creating an environment where mental health is openly discussed and supported.

Training and workshops

Lumo also offers workshops and training sessions for individuals or teams. These sessions are designed to educate both employees and management about mental health, reduce stigma and foster a supportive environment.

The future of workplace mental health

As awareness around the importance of mental health in the workplace grows, solutions like Lumo are becoming increasingly essential. They represent a shift towards more inclusive, proactive and supportive workplace mental health strategies that benefit everyone.

Private Medical Insurance and Mental Health — What You Need To Know
You may also like
No items found.

Boost your teams’ mental wellbeing today

Ready to find out more? Let’s talk