Overview

Australia's Private Health Insurance Ombudsman

The role of the Private Health Insurance Ombudsman (PHIO) is to protect the interests of private health insurance consumers. PHIO carries out this role in a number of ways, including:

  • assisting health fund members to resolve disputes through our independent complaints handling service; 
  • identifying underlying problems in the practices of private health funds or health care providers in relation to the administration of private health insurance;
  • providing advice to Government and industry about issues affecting consumers in relation to private health insurance; and
  • providing advice and recommendations to government and industry about private health insurance, specifically the performance of the sector and the nature of complaints.

PHIO also has an important consumer information and advice role regarding private health insurance. In support of this role, we produce and publish a range of tools for consumers, including the consumer website PrivateHealth.gov.au, the annual State of the Health Funds Report, consumer e-bulletin Health Insurance InsiderQuarterly Bulletin and a range of brochures and factsheets.

The role and functions of PHIO are set out in Part 6-2 of the Private Health Insurance Act 2007 (Cth). PHIO is prescribed as an agency under the Financial Management and Accountability Act 1997 (Cth). PHIO is funded by a levy collected from private health insurers under the Private Health Insurance Complaints Levy Act 1995 (Cth), which fully recovers the cost of its funding.
 
The Private Health Insurance Ombudsman is independent of the private health insurers, private and public hospitals and health service providers.