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) is a party to 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 our fund?

Adopting the Code signals to members and prospective members 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.

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 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 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?

  • Click here to download a copy of the Private Health Insurance Code of Conduct.
  • Click here to download a copy of the Private Health Insurance Code of Conduct Compliance Policy.

Who will adopt the standards of the Code?

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

How will the Code be adopted?

A health fund that is seeking to adopt the Private Health Insurance Code of Conduct (Code) must complete a detailed self-audit and be approved to participate in the Code processes by the Code of Conduct Compliance Committee (Committee).

A signatory health fund that has been admitted to participate in the Code and that has satisfied the Committee that it continues to be compliant with the Code requirements, is able (once authorised by the Committee) to certify compliance using a triennial cycle of:

  1. Annual certification for years one and two, in which the fund certifies that, subject to any changes identified in the certification, the policies and processes identified in the self-audit continue to be followed.
  2. Where changes to policies or processes or changes to the Code have been implemented since the last certification, the fund will also certify that those changes are compliant.
  3. A detailed self-audit in year three.


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