What insurers must tell policy holders

Private health insurers must tell policy holders certain things, including what their policy covers, out-of-pocket costs that apply to them, and changes to their cover or premiums.

What the policy covers and its features

You must give private health information statements to policy holders. The statements must explain what the policy covers and its features.

Learn more from the Commonwealth Ombudsman about private health information statements.

Changes to cover or premiums

You must tell policy holders in writing about any changes to their premiums or cover.

You must give them enough time to find a different policy if they wish.

Find out more about:

If you discontinue a policy

If you discontinue a policy and move people to a new policy, you must explain how this will affect them.

You must let them know if:

  • any services that were covered under the discontinued policy will not be covered under the new policy
  • any excess or co-payments will change
  • any waiting periods will apply under the new policy.

You must also tell policy holders what their new premiums will be.

Policy holders don’t have to transfer to the new policy you offer them. They can transfer to a new policy of their own choice if they wish.

Learn more about the consumer's right to choose (PDF, 278 KB).

Out of pocket costs

You must tell policy holders if they have to pay any out of pocket costs for a treatment or service they are covered for.

This allows them to give informed financial consent to treatment.

Last updated: 
21 October 2020

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