Frequently Asked Questions (FAQ)

What is a Code of Conduct?

A Code of Conduct sets out agreed standards and responsibilities for companies and organisations, or for whole industries.

Why do we need a Private Health Insurance Code of Conduct?

The code has been introduced to complement the existing regulations funds work under and to enhance the relationship between consumers and health funds by adopting voluntary industry self-regulation.

What's in it for consumers?

For consumers, knowing their fund (or a fund they are thinking of joining) is a party to the Code will give them certainty that the fund has a formal policy of:
o providing information in plain language;
o training and instructing their staff to ensure they are competent to deal with enquiries from consumers;
o Ensuring privacy of information between the fund and the consumer; and
o Providing the consumer with a reliable and free system to redress any complaint between the fund and the consumer.

What's in it for your fund?

Adopting the Private Health Insurance Code of Conduct makes good sense from your fund's perspective because the fund can signal to you and potential members that it has thought about you and how it does business with you. Adopting the Code also signals to your health fund's staff that it is sincere in its commitment to its members, and the adoption of the Code is a formal recognition of its efforts in this regard. The process of adopting the Code will also be beneficial for the fund as your fund will have a clearer path for dealing with you with less chance of misunderstanding and potential conflict.

Where did the Code come from?

The Code is a voluntary industry Code and has been developed and adopted by the two industry associations covering private health funds in Australia:
*   the Australian Health Insurance Association (AHIA)
*   the Health Insurance Restricted & Regional Membership Association of Australia (HIRMAA)

How will the code be monitored?

AHIA has established a Code Compliance Committee that monitors, investigates (in the event of a complaint) and audits compliance with the Code. The Code Compliance Committee will only look at breaches of the Code reported to it by a fund or external body such as the Private Health Insurance Ombudsman (PHIO).

Who was involved in developing the Code?

The Australian Health Insurance Association (AHIA) established a Code of Conduct Committee made up of representatives from AHIA and the Health Insurance Restricted & Regional Membership Association of Australia (HIRMAA) to develop the Code.

Does the Code change?

This is a 'living Code' and as such is reviewed from time to time. This review was last conducted in October 2009.

Will I understand the Code?

The Code is written in plain language and has been divided into sections that reflect the way in which consumers interact with funds.

Where can I find a copy of the Code?

• Click here to download a copy of the Private Health Insurance Code of Conduct 2009   (119.63 KB PDF)

Who will adopt the standards of the Code?

All registered private health insurance funds in Australia are encouraged to adopt the standards.

How will the Code be adopted?

Funds are encouraged to adopt the standards of the Code as soon as possible. Once a fund has satisfied the compliance obligations, the Code Compliance Committee will issue the necessary authority for the fund to use the new Private Heath Insurance Code of Conduct logo.