1. A Consumer View of Private Health Insurance Presentation to AHIA National Conference Wednesday, 1 st November, 2006 Samantha Gavel, Acting Ombudsman

2. Overview Level of consumer complaint to PHIO not high; A number of reasons for this; Consumers very unhappy when expectations not met; Complex area for consumers; Need for simple, accessible information.

3. Total: 2570 710 893 967

4. PHIO Complaints

5. 2006 PHI Reforms Government announced a number of changes to private health insurance regulation on 26th April 2006; Measures to provide better information to consumers: - standard product information - consumer information website - further encouragement of IFC

6. Consumer Website Aim to improve quality/accessibility of info for consumers about private health insurance; General information on private health insurance; Comparative information on full range of health insurance products available to consumers (some 2,000 products); Website will be operational on 1 April 2007.

7. Website Features and Content Healthcover search: - Key features of current product; - Search for new product or compare products. Check membership eligibility for restricted funds; General fund and phi information; Agreement hospital and gap doctor search; Lifetime Health Cover calculator.

8. Implementation of Website Human Solutions selected by competitive tender; Selection process focussed on consumer and fund usability; PHIO Project Manager Kylie Palmer appointed; Stakeholder liaison and consultation underway.

9. Industry Concerns Focus on price will lead to consumers taking cheaper, restricted products; This will lead to higher complaint levels and dissatisfaction; Product Comparison; Number and range of products to be included.

10. Other Recent Developments Expansion of Ombudsman’s jurisdiction to deal with complaints by and about wider range of providers and professionals; Introduction of compulsory mediation where directed by the PHIO; New object provision makes it clear focus of PHIO activities is on consumer protection. Industry Code of Conduct provides new protections for consumers.

11. Portability Complaints about inter-fund transfers have declined in 2005/06; Transition & Communication Protocols agreed by industry and endorsed by Ombudsman; Mediation power available to Ombudsman from 1 July 2006 in relation to HPPAs.

12. Informed Financial Consent “No patient should be rendered an account, for any amount, that they had not knowingly approved following full financial disclosure prior to their admission to hospital.” Report by Ombudsman October 2002

13. IFC and Doctors 137 complaints about medical gaps in 2004/05. Doctors need to tell the patient what their out of pocket “gap” will be. IFC exceptions and difficulties.

14. Private Patient Election Public Hospitals; AHCAs specify public hospital election requirements; National Standards released in 2001; PHIO can check whether patient made a valid election. Some complaints from hospitals and funds.