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.
One of the primary principles of the code concerns adequate training for staff and this also applies to knowledge of the code itself. 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.
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.
The Private Health Insurance Code of Conduct requires its signatories to comply with four main areas of conduct:
- Providing correct information via suitably trained staff
- Making customers aware of the internal and external dispute resolutionprocedures that are available to them
- Ensuring all 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.
Suitable employee training
Signatories to the code agree to train their employees and agents according to their particular roles and responsibilities, so that only those qualified to give health insurance advice do so. They agree to train them to be able to clearly explain consumer choices, to provide adequate information and to keep records of any advice they give.
Dispute resolution procedures
If a dispute cannot be resolved internally, the code requires a health fund to make the consumer aware of any available external resolution options, including how to contact the Private Health Insurance Ombudsman.
Clear documents and communication
Signatories to the code agree to ensure all documents and policies are in easy to understand language and that all oral communications with customers are conducted in the same way.
They are further required to provide a 30 day cooling-off period with their products and to provide a refund for cancellations, as long as no claims have been made.
Signatories to the code are also required to ensure that their agents 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.