PRIVATE HEALTH INSURANCE INTERMEDIARIES

CODE OF CONDUCT


 

The Board of PHIIA has developed a new Private Health Insurance Intermediaries Code of Conduct (Code). This summary provides an overview of the Code.


 

1. INTRODUCTION


 

The Private Health Insurance Intermediaries Code of Conduct (“Code”) is a self-regulatory code to promote honest, informed and transparent relationships between Private Health Insurance Intermediaries and consumers.


 

Our objective is that the Code will, together with other industry codes, assist to maintain and enhance regulatory compliance and service standards across the private health insurance industry. The provisions in this Code are for the purpose of clarification or are in addition to the existing regulatory obligations on Intermediaries.


 

For this purpose the Code is to be a “living Code” which will be progressively reviewed from time to time. We welcome the input of the industry into the Code and its operation. We may also seek the input of consumers from time to time, including through consulting with the Private Health Insurance Ombudsman (“PHIO”).


 

2. OUR COMMITMENT UNDER THE CODE


 

We will:

(a) continuously work towards improving the standards of practice and service in the private health insurance industry;

(b) work in the best interests of our clients;

(c) put consumers' interests before our own;

(d) provide information to consumers and organisations in plain language

(e) promote better informed decisions about the private health insurance products and services we offer by:

(i) ensuring that our proposals contain all required information;

(ii) providing an effective explanation of the contents of the policy documentation in plain English and in the form requested by a consumer;

(iii) ensuring that our staff and other persons providing information on our behalf are appropriately trained;

(f) provide information to consumers on their rights and obligations under their relationship with their health fund or general insurer, including information on this PHI Intermediaries Code of Conduct;

(g) disclose to consumers or our principal our relationship with the Private Health Insurers we are recommending to them;

(h) provide consumers with easy access to our internal dispute resolution procedures, which will be undertaken in a fair and reasonable manner; and

(i) where internal dispute resolution procedures do not reach a satisfactory outcome for the consumer, or if a consumer wishes to deal directly with an external body, advise the consumer of the right to take the issue to a health fund that may be the subject of the dispute or an external body, such as the PHIO;

but apart from the provisions for enforcement and sanctions in the Private Health Insurance Intermediaries Codes of Practice, a breach of the Code shall not give rise to any legal right or liability.


 

3. PRIVATE HEALTH INSURANCE ENVIRONMENT


 

In meeting our commitments, we will have regard to:

(a) the provisions of the Private Health Insurance Act 2007 which govern private health insurance policies and arrangements between consumers, Private Health Insurers and government;

(b) our requirement to comply with the provisions of the Trade Practices Act 1974 and the state Fair Trading Acts; and

(c) the need for effective competition and cost efficiency being promoted in the private health insurance industry.