Private Health Insurance

The role of the Private Health Insurance Ombudsman (PHIO) is to protect the interests of private health insurance consumers. PHIO carries out this role in a number of ways, including:

  • assisting health fund members to resolve disputes through our independent complaints handling service;
  • identifying underlying problems in the practices of private health funds or health care providers in relation to the administration of private health insurance;
  • providing advice to Government and industry about issues affecting consumers in relation to private health insurance; and
  • providing advice and recommendations to government and industry about private health insurance, specifically the performance of the sector and the nature of complaints.

The Ombudsman can deal with complaints from health fund members, health funds, private hospitals or medical practitioners. Complaints must be about a health insurance arrangement.

PHIO also has an important consumer information and advice role regarding private health insurance. In support of this role, we produce and publish a range of tools for consumers, including the consumer website, the annual State of the Health Funds Report, consumer e-bulletin Health Insurance InsiderQuarterly Bulletin and a range of brochures and factsheets.

In addition to the data available in the Commonwealth Ombudsman Annual Report, PHIO has published further information for the 2015-16 year – see Publications.

The Private Health Insurance Ombudsman is independent of the private health insurers, private and public hospitals and health service providers.

The Ombudsman ACT 1976 has been changed to include an inspection function for the Private Health Insurance Ombudsman. Protocols for the Inspection Function describe requirements for inspections

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