We always aim to do the right thing by our customers. If you feel something isn't right or if we’re not meeting your expectations, we’d like the opportunity to resolve it.
If we can’t fix your problem then and there, we’ll refer the issue to our Customer Advocacy Team. They’ll conduct a detailed investigation and do their best to find a solution. If you’re unhappy with the result, you can contact the Private Health Insurance Ombudsman (PHIO) for free independent advice.
When lodging a complaint, it helps to provide us with as much relevant information as possible, including:
- a clear description of your concern, and what you believe caused it
- whether your concern relates to a specific claim or interaction
- your desired outcome
- any special arrangements you’d like us to follow, such as a preferred contact method or support needs.
To protect the security of your personal information, please don’t include details such as your credit card number or password.
Our guiding principles
- People focused – We acknowledge that you have a right to complain, and we will work with you in a mutually respectful way to resolve complaints within a reasonable timeframe.
- Visible and transparent – We’ll make sure that information about how to make complaints (to us, or about us) is made widely available.
- Accessible – We’ll make sure our complaint handling system is accessible to everyone, support customers to make a complaint where needed and enable them to have another person assist or represent them in making a complaint.
- Responsive – We acknowledge customer complaints promptly and will advise if we are unable to deal with all or part of a complaint. We’ll deal with complaints efficiently to the urgency of the issues raised.
- Fair and objective – We’ll deal with complaints in an objective and unbiased manner, and provide for ‘unsatisfactory’ outcomes to be reviewed by an independent person.
- Accountable and preventative – We’ll ensure clear accountability for the operation of our complaint handling system and resolving the root causes of recurrent complaint issues.
- Informative – We’ll draw from complaint data to continuously improve our products and services.
These principals align with our responsibilities under the Private Health Insurance Code of Conduct, and guidelines set out in the Australian/New Zealand Standard 10002:2014 Guidelines for Complaint Management in Organisations.
Process and timeframes
We’ll aim to resolve your complaint when you first contact us.
In more complex cases, where immediate resolution is not possible, we’ll escalate your complaint to our Customer Advocacy Team. This is a specialist team who will investigate your concerns. The Customer Advocacy Team case manager assigned to handle the matter will attempt to contact you within two working days to:
- assign a case manager
- contact you to inform you about your escalation
- conduct an independent review of the matter.
We seek to resolve all complaints within 10 working days. Where it appears this timeframe won’t be met, we’ll contact you to:
- let you know about the expected delay
- explain the reasons for the delay
- provide an alternative timeframe.
We will prioritise any urgent cases such as those involving a threat to life, an upcoming hospital admission or any situation involving financial hardship.
When settling your complaint with you, we’ll explain the reasons for our proposed resolution. If you’re not satisfied with the outcome, we’ll let you know about your right to seek an external review of the matter, see ‘External review’ below.
If we haven’t met the process or timeframes mentioned above, we would like to address this. Please email your complaint details to email@example.com
When deciding how to resolve your complaint, we’ll consider what would be fair and reasonable in the circumstances. Where we have done the wrong thing, we’ll always aim to return you to the circumstances you were in before the problem arose.
Remedies we may apply include:
- apology e.g. a verbal or written apology given in recognition of harm or impact you experienced
- information e.g. verbal or written advice to clarify one of our fund rules or policies
- refunds e.g. returning a premium payment, where appropriate in the circumstances
- financial compensation e.g. by providing you with a benefit payment or reimbursement in recognition of a genuine grievance, where appropriate in the circumstances
- referral e.g. to make sure you’re aware of your right to seek an external review of the matter if you wish (see ‘External review’ below)
- other e.g. any other remedy we consider appropriate in the circumstances.
Please note: We do not charge any fees for handling complaints and we’ll take all reasonable steps to make sure you’re not adversely affected because of a complaint made by you or on your behalf.
If you’re not satisfied with the outcome of your complaint, you can pursue the matter through the independent dispute resolution service offered by the Private Health Insurance Ombudsman (PHIO):
Phone: 1300 362 072 (option 4 for private health insurance)
Mail: GPO Box 442, Canberra ACT 2601