For Health Funds

This secured section has been developed by Private Healthcare Australia (PHA) to assist health funds in implementing the Private Health Insurance Code of Conduct.

Private Health Insurance Code of Conduct

The Private Health Insurance Code of Conduct (Code) is a self-regulatory and voluntary code to promote informed relationships between health funds and consumers.

The Code’s objective is to maintain and enhance regulatory compliance and service standards across the private health insurance industry.

The Code is a ‘living document’ and as such is reviewed on an annual basis. This review was last conducted in October 2023.

As part of the review process the input of stakeholders may be sought from time to time as well as through consultation with the Commonwealth Ombudsman .
Private Health Funds who are signatories to the Code agree to:

  • work towards improving the standards of practice and service in the private health insurance industry;
  • provide information to consumers in plain language;
  • ensure information between consumers and the fund is protected in accordance with privacy principles;
  • provide information to consumers on their rights and obligations under their relationship with the consumer, including information regarding the PHI Code of Conduct;
  • provide consumers with easy access to the fund’s internal dispute resolution procedures, which will be undertaken in a fair and reasonable manner and to advise them of their rights to take an issue to an external body such as the Commonwealth Ombudsman.
  • promote better informed decisions about their private health insurance products and services by:
    • ensuring that policy documentation is full and complete.
    • providing clear explanations of the contents of their policy documentation when asked by a consumer.
    • ensuring that persons providing information on health insurance are appropriately trained.