What is the Private Health Insurance Ombudsman?

The Private Health Insurance Ombudsman is an Australian Government agency but acts independently of the Government in dealing with complaints and reporting. The role and functions of the Private Health Insurance Ombudsman are set out in Sections 230- 256 of the Private Health Insurance Act 2007.

The office deals with inquiries and complaints about any aspect of private health insurance.

The Ombudsman provides advice to the health insurance industry, the government and consumers and also publishes independent information about private health insurance and the performance of health funds.

The Private Health Insurance Ombudsman is independent of the private health insurers, private and public hospitals and health service providers.

Who is the The Private Health Insurance Ombudsman?

Ms Samantha Gavel is the Private Health Insurance Ombudsman.

Statements of Expectation and Intent

In January 2013, the Minister for Health & Ageing issued the Ombudsman with a Statement of Expectations. The Ombudsman responded with a Statement of Intent. Both of these documents are available below.

These documents outline the PHIO's role and its relationship with the Minister and Department of Health & Ageing, and explain how the PHIO will be working to protect the interests of people covered by private health insurance.

Statement of Expectations 2013 (PDF)

Statement of Intent 2013 (PDF)