Just before the health insurance premium increase came into effect yesterday (April 1) the Private Health Insurance Ombudsman (PHIO) published its annual State of the Health Funds Report (the Report) on March 28.
Funds are compared against various measures including financial management, performance and service delivery, and health fund operation.
The Report is designed to give consumers more information to help them make decisions about their health insurance.
PHIO Samantha Gavel said that the Report gives existing members information that will help them to compare the performance of their fund with all other funds; as well as assisting consumers who are considering taking out private health cover.
"Pleasingly, there was a decline in the number of higher level complaints requiring investigation (630 in 2011-12 compared with 716 in 2010-11), which showed that funds were successfully dealing with referrals from the Ombudsman without further action being required," Ms Gavel said.
"Private health insurance was very much ‘front of mind’ for consumers during the reporting period, due to the introduction of income testing of the Australian Government Rebate on private health insurance from 1 July 2012 and the associated publicity campaign to inform members about the changes."
Ms Gavel said this increased the demand for PHIO's information and advice services, with the consumer website receiving its "highest number of unique visits" in July 2012, since it went live in April 2007.
The issues that caused higher levels of complaints to the PHIO during this period were restrictions and exclusions on hospital policies, oral information (advice given to members in retail branches or over the phone) and pre-existing condition waiting periods.
Ms Gavel noted that there was a decline in complaints about premium increases, fund rule changes and payment delays.
Funds that focused on providing "good communication and advice to members" through material such as letters, brochures and advice from branch staff and call centres were noted by Ms Gavel to have fewer complaints about these issues.
There has also been positive health fund membership growth and retention figures for the period, Ms Gavel said, with a 3.7 per cent growth in membership, and fund membership retention figures ranging from 70 to over 90 per cent.
The PHIO urged consumers who have health insurance – and those considering health cover – to read the Report and assess information on the performance of funds.
"We know from dealing with complaints that the best private health insurance outcomes result from access to the best information. This Report is the most comprehensive body of information available to consumers for all the private health insurance funds in Australia," Ms Gavel said.
"By using this Report, consumers can gain valuable insights into how their current or potential fund performs on measures such as membership retention, complaints, the effectiveness of its Gap Scheme in reducing out-of-pocket medical costs and the percentage of Hospital and General Treatment related charges covered."
Ms Gavel concluded that as consumers, "we owe it to ourselves" to be diligent on our behalf when it comes to private health insurance.
A number of Australian health funds have increased their health insurance premiums, with the average rise 5.6 per cent.
If you are considering taking out individual health cover or family health insurance then make sure to compare health insurance policies to find the plan that best suits your health and financial requirements.
Your health consultant can help you with a private health insurance comparison to find the most appropriate plan for your needs.