Private health insurance reforms: Strengthening the powers of the Private Health Insurance Ombudsman

The Private Health Insurance Ombudsman’s role will be expanded in 2019, strengthening its ability to protect consumers

Page last updated: 09 January 2019

Private health insurance reforms: Strengthening the powers of the Private Health Insurance Ombudsman (PDF 201 KB)

  • The Private Health Insurance Ombudsman will be able to conduct inspections and audits of private health insurers to address consumer complaints.
  • Investigators will focus on verifying customer activity records and addressing complaints by consumers regarding private health insurer and private hospital contractual arrangements, including prostheses.
  • Under this measure additional staff will be employed by the Private Health Insurance Ombudsman in investigatory roles.

Why is this important?

  • The Private Health Insurance Ombudsman takes an active role in working with consumers and private health insurers to address consumer concerns.
  • Over 13 million Australians hold private health insurance and annual complaints to the Ombudsman represent less than 0.03% of Australians with private health insurance.
  • Health insurers have a good track record in voluntarily providing full records to the Ombudsman during complaint investigations. However, there are some instances where further investigation reveals additional records like phone calls, letters or emails have been overlooked by insurers in their response to the Ombudsman.
  • By accessing a health insurer’s records directly within their premises, investigation officers will be able to assure themselves that an insurer is not overlooking records.
  • The Ombudsman will also be able to assure complainants about the accuracy of the information provided by insurers to the Ombudsman, and not rely solely on the health insurer to respond without error.
  • As an overarching principle, the government will seek to work in cooperation and partnership with the sector. The Ombudsman will give 48 hours written notice of their intention to access premises.

Who will benefit?

  • This will benefit all private health insurance consumers.
  • The Ombudsman’s expanded role strengthens its ability to protect consumer interests.

What impact will this change have on private health insurance?

This change will strengthen the Ombudsman’s ability to protect consumer interests.