Much like the general insurance industry, private health insurers have their own voluntary code called the Private Health Insurance Code of Conduct.
It was developed by the Australian Health Insurance Association (AHIA) in conjunction with industry stakeholders, with the aim of enhancing the relationship between health funds and consumers.
Nearly all of today’s private health insurers are signatories to the Code, which reinforces existing regulations and ensures minimum standards of business practice in the health insurance industry.
While penalties for breaches are relatively minor, a breach of the Code could also mean a breach of a similar regulatory obligation, one that carries heavier penalties, so knowledge of the Code makes good business sense. If you are a private health insurer and your employees are not currently receiving compliance training on the Code, it would be a good idea to introduce it as part of a learning management system.
The Private Health Insurance Code of Conduct requires its signatories to comply with four main obligations:
- Providing correct information to consumers regarding private health insurance policies and the complaints-handling process
- Making information on the complaints-handling process available so customers are aware of the dispute resolution procedures
- Ensuring all policy documentation and communications with customers are clear and contain all the information necessary for them to make an informed decision
- Maintaining the confidentiality of customers’ personal information, in accordance with the requirements of privacy legislation.
Dispute resolution procedures
If a dispute cannot be resolved internally, the Code requires a health fund to make information available on how to engage with the Private Health Insurance Ombudsman complaint handling service.
Clear documents and communication
Signatories to the Code agree to ensure that all policy documentation is clear and in easy-to-understand language and that all communications with customers are conducted in the same way.
Privacy
Health funds are required by the Code to comply with all relevant privacy laws, including the Privacy Act 1988. Private health funds must ensure that policy documentation contains information on how to find out about their Privacy Policy.
Signatories to the Code are also required to ensure that their intermediaries fully disclose their relationship with the fund when presenting health insurance products to their clients.
The creators of the Private Health Insurance Code of Conduct refer to it as a ‘living Code’ that is subject to regular revision. Therefore, a working knowledge of the Code through compliance training is the best way to ensure that your employees and agents are always aware of their current obligations.
