Commonwealth Ombudsman Michael Manthorpe PSM today released the State of the Health Funds report detailing comparative information on the performance and service delivery of health funds during 2019–20.

Our Office received 3,706 complaints during 2019–20, an 8.3 per cent decrease on the previous year’s total. Concerns about Benefits, Membership and Service were the major cause of complaints to our Office.

The most significant benefit complaint issues were general treatment (extras/ancillary) benefits, and complaints about unexpected hospital policy exclusions and restrictions. This year there was also a significant increase in the number of complaints about membership suspensions due to COVID-19.

In the February to June 2020 period, the Office received 212 complaints related to COVID-19. ‘The majority of these complaints raised issues related to suspension requests, premium costs and the inability to access hospital and general treatment services as planned,’ Mr Manthorpe said.

Almost all insurers postponed their 1 April 2020 premium increases for at least six months to 1 October 2020. The majority of insurers also introduced provisions to provide financial relief to people who have lost their jobs, are underemployed, in hardship or have contracted the virus: and most insurers covered COVID-19 treatment for existing policyholders.

The Ombudsman encourages consumers to contact their insurer in the first instance if they have any questions or concerns regarding their membership.

The information in this report together with the consumer website assists consumers to choose health insurance policies that better meet their individual needs.