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Spike in health insurance complaints

Posted: 6 March 2018 5:54 am
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Group of unhappy people

The largest year-on-year rise in a decade.

The number of complaints to the Private Health Insurance Ombudsman (PHIO) went up by 30% in 2016-17, according to the annual State of the Health Funds Report (SOHFR) 2017.

The report found that the number of complaints dealt with by the PHIO has risen dramatically over the last four years. In 2016–17, the PHIO received 5,750 private health insurance complaints, an increase of over 1,300 complaints from the previous year (4,416 in 2015–16).

The PHIO didn't cite any single issue for the rise in complaints but rather said it was the culmination of a range of issues including increased problems associated with benefits, membership administration, service, verbal advice and written information.

While Medibank makes up 26.9% of the private health insurance market in Australia, it accounted for almost half (46.3%) of all the 5,750 complaints to the PHIO. The next closest fund was Bupa, which has the same market share as Medibank but only accounted for 17.6% of all complaints. This was followed by the two other funds from the big four, HCF (9.7%) and nib (6.1%).

Not only was HCF the only fund out of the big four to record a higher percentage of complaints than their market share, it was only one of six other health funds that had a higher percentage of complaints compared to their market share. The other funds were Australian Unity, CUA Health, Health.com.au, GU Corporate and Transport Health.

Probably not surprisingly, all six funds (save GU Corporate) saw a reduction in their member base over the last year, with Medibank shedding -1.3% (24,201) of its members. Australian Unity saw a -1.7% (3,362) reduction, CUA Health -1.3% (525), Health.com.au -4.0% (1,583), and Transport Health-13.5% (1,277).

The SOHFR compares how health funds perform across a range of areas including extras benefits, financial management, fund operations, hospital benefits, medical gap schemes and service performance. The annual report is designed to help consumers make better decisions when it comes to getting cover or choosing to switch funds.

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