Industry Resources
The Office of the Commonwealth Ombudsman (the Office) is also the Private Health Insurance Ombudsman (PHIO).
PHIO protect’s the interests of people covered by private health insurance by:
- - taking complaints about health insurance matters
- - providing information and advice
- - helping health insurers and health care providers resolve contract disputes so consumers are not impacted.
PHIO’s complaints handling service is independent. We listen and do not take sides .
Industry Resources
These publications can help health insurers and health care providers to resolve complaints.
PHIO: How we deal with complaints (Information for insurers)
This document focuses on the process of handling complaints made about private health insurers and provides information for insurers about engaging with the Office. This document applies to our public reports for the 2021-22 financial year onwards.
Pre-Existing Conditions – Best Practice Guidelines
The Best Practice Guidelines were released by the Department of Health in September 2001.
- Best Practice Guidelines for Health Funds (September 2001)
- Best Practice Guidelines for Hospitals (September 2001)
A Quick Guide to the Private Health Insurance Ombudsman’s New Inspection Powers
This document summarises the Office's powers to conduct inspections of private health insurance insurers and health insurance brokers. These powers came into effect in September 2018 following amendments to the Ombudsman Act 1976.
This document was developed in consultation with private health insurance industry stakeholders in 2019. It includes answers to frequently asked questions regarding how and when the new powers are likely to be used, and how this may affect insurers and brokers.
PHIO Mediation Guidelines
The Private Health Insurance Ombudsman (PHIO) has legislative power to require health insurers and healthcare providers to attend formal mediation, in order to resolve disputes that may affect consumers’ rights and entitlements under their private health insurance cover. These disputes usually occur when there is disagreement between parties about the renewal of a Hospital Agreement.
- PHIO Mediation Guidelines (May 2020)
Hospital Agreements: Termination and Transition Guidelines for Hospitals and Insurers
The following guidelines have been developed in consultation with the private health industry to support consumer protection and minimise undue disruption and risk to the industry when contractual agreements between health insurers and hospitals are terminated.
Detrimental Changes to Health Fund Policies
PHIO's recommendations for insurers in relation to advising members of detrimental policy changes:
- Quarterly Bulletin 45 (December 2007)
- Quarterly Bulletin 69 (December 2013)