What is a Code of Conduct?

A Code of Conduct sets out agreed standards and responsibilities for companies and organisations, or for whole industries.

Why do we need a Private Health Insurance Code of Conduct?

The Code has been introduced to complement the existing regulations funds work under and to enhance the relationship between consumers and health funds by adopting voluntary industry self-regulation.

What’s in it for consumers?

For consumers, knowing their fund (or a fund they are thinking of joining) has adopted the Code will give them certainty that the fund has a formal policy of:

  • providing information in plain language;
  • training and instructing their staff to ensure they are competent to deal with enquiries from consumers;
  • ensuring privacy of information between the fund and the consumer; and
  • providing the consumer with a reliable and free system to redress any complaint between the fund and the consumer.

What’s in it for your fund?

Adopting the Code signals that the health fund is sincere in its commitment to its members, and the adoption of the Code is a formal recognition of its efforts in this regard. The process of adopting the Code will also be beneficial for the fund as your fund will have a clearer path for dealing with you with less chance of misunderstanding and potential conflict.

Where did the Code come from?

The Code is a voluntary industry Code that has been developed by Private Healthcare Australia and the Members Health Fund Alliance as the bodies which represent private health funds.

How will the Code be monitored?

To ensure the Code is adhered to by participating health funds and is as effective as possible, Private Healthcare Australia has established a Code of Conduct Compliance Committee (Committee), comprising of independent consumer and industry representatives.

The Committee is responsible for approving the compliance audits which have been submitted by the signatory health funds and reviewed and assessed by independent auditors.

Does the Code change?

This is a ‘living Code’ and as such is reviewed from time to time. This review was last conducted in October 2023.

The Code is a living document and will be reviewed on an annual basis to ensure it reflects current legislation.

Will I understand the Code?

The Code is written in plain language and has been divided into sections that reflect the way in which consumers interact with funds.

Where can I find a copy of the Code?

You can find a copy of the Code here.

Who will adopt the standards of the Code?

All registered private health insurance funds in Australia are encouraged to adopt the standards.

How is the Code adopted?

Once a fund has satisfied the compliance obligations, the Code of Conduct Compliance Committee will issue the necessary authority for the fund to use the Private Health Insurance Code of Conduct logo.


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