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11 Apr 2012 | Press Release

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Ombudsman Launches Health Insurance Insider

Private Health Insurance

The Private Health Insurance Ombudsman (PHIO) today launched its new consumer bulletin, Health Insurance Insider, as part of its ongoing consumer awareness campaign.


Private Health Insurance Ombudsman, Samantha Gavel said Health Insurance Insider was another one of the consumer information tools provided by her office to demystify the complexity of private health insurance.

"Consumers can only make the best decisions about private health insurance through access to the best quality information.

"The whole purpose of Health Insurance Insider is to provide consumers with regular updates on private health insurance issues so they can make the best choices for themselves and their families. This first edition focuses on the importance of consumers regularly reviewing their policy and keeping it up-to-date."

Ms Gavel said there were four things every Australian with private health insurance could do straight away to ensure they had right cover to meet their needs:

  • keep their personal details up-to-date;
  • review their policy;
  • keep premium payments up-to-date; and
  • be aware of fund rule changes and notifications.

"As with all things in life, circumstances may change from time to time, so it's important that consumers are diligent on their own behalf and review their health insurance policy regularly to make sure it still meets their health needs.

"My office recommends consumers review their policy at least once a year. A good time to do this is in April when the annual premium increases are notified. The notification often includes a Standard Information Statement (SIS), which outlines policy details. Consumers should use the SIS to review their policy benefits and make sure their cover still meets their needs.

"Consumers should check their policy details to confirm all their personal details are correct and up-to-date. This not only includes address and contact number information, but also ensuring that the correct people are covered under the policy, such as children and partner or spouse.

"Consumers should remember that it is their responsibility to make sure their premium payments are up-to-date. As long as a policy is in arrears, consumers cannot claim any benefits and they risk having their membership cancelled.

Consumers may then have to rejoin as a new member and complete their waiting periods again.

"Consumers should also be aware that private health insurance differs from other forms of insurance in that health funds may make changes to policies during the term of an existing membership - while this is not common, it does occur from time to time.

"By law, any important information about policy or level of cover changes must be confirmed in writing, so consumers should always take the time to read the letters and notifications sent by their health fund.

"If consumers have any questions about changes to their policy or want to upgrade their policy, they should contact their fund as soon as possible.

"If consumers believe they have not been properly notified of a change in their policy, they should first contact their fund for clarification. If the fund isn't able to provide an explanation or solution, consumers can contact my office for advice and assistance on 1800-640-695 or through the www.phio.org.au website."

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