25 February 2020: State of the Health Funds Report 2019

Commonwealth Ombudsman Michael Manthorpe PSM today released the State of the Health Funds report detailing comparative information on the performance and service delivery of health funds during 2018–19.

Our Office received 4,042 complaints during 2018–19, an 11 per cent decrease on the previous year’s 4,553. Concerns about Benefits, Membership and Service were the major cause of complaints to our Office.

One of the significant complaint issues was a Benefit issue—unexpected hospital policy exclusions and restrictions. ‘Some basic and budget levels of hospital cover exclude or restrict services that many consumers assume are routine treatments or standard items’ Mr Manthorpe said.

‘However, with the continued implementation of the private health insurance reforms during 2019–20, which were introduced to standardise clinical categories and give consumers more certainty about their benefits, we anticipate that the number of complaints about Benefits will continue to reduce in future years’.

Overall, the number of complaints to the Office about almost all issues reduced compared to the previous year, showing a general improvement across the industry.

The State of the Health Funds Report makes note of the new private health insurance reforms which took effect from 1 April 2019 and are mandatory from 1 April 2020. More information about these changes is available at privatehealth.gov.au and health.gov.au/private-health-reforms.

The information in this report together with the consumer website privatehealth.gov.au assists consumers to choose health insurance policies that better meet their individual needs.