The following publications are often referenced by our office in dealing with health insurers and industry when resolving complaints.
PHIO Referral to Fund Guidelines
Overview of PHIO's complaint handling processes where a consumer makes a complaint against a health fund. The Guidelines were last updated in November 2010.
Pre-Existing Conditions - Best Practice Guidelines
The Best Practice Guidelines were released by the Department of Health & Ageing in September 2001. For more information please refer to Circular HBF 736 PH 470.
Hospital Agreements: Transition and Communication Protocols
The following protocols are arrangements agreed within the private health industry to ensure
adequate consumer protection and minimise undue disruption and risk to the industry when
contractual agreements between health funds and hospitals are terminated.
The protocols have been developed by the Private Health Insurance Ombudsman, in
consultation with the Australian Health Insurance Association, the Health Insurance Restricted
Membership Association of Australia, the Australian Health Services Alliance, the Australian
Private Hospitals Association and the Department of Health and Ageing.