Ombudsman Complaint Letter Templates
The following letters are templates that you can modify and send to the Private Health Insurance Ombudsman (PHIO).
How they work:
Download the template letter that meets your requirements and open it with your word processor. Then input your personal information about your compliant within the brackets. Delete the brackets and instructions, and change the font colour from red to black to match the rest of the document. Important: Please remember to personalise your letter and provide enough detail about your specific situation so the insurance ombudsman can determine if you have a valid claim.
Misleading Communications – This letter provides a template if your health fund has provided misleading information to you in written or oral communications. Businesses, including health funds, are prohibited by law from making false claims or misleading statements either intentionally or unintentionally.
If your health fund has provided incorrect oral advice, failed to keep promises kept in a benefits quote, or provided incorrect information on brochures, websites and notification letters, this letter helps you complaint compliant with the insurance ombudsman.
Benefits / Level of Cover – This template letter is provided as a sample complaint letter for use when contacting the Private Health Insurance Ombudsman regarding a benefits dispute.
Membership Issues – This letter provides a template if you have experienced membership issues with your health fund including improper cancellation of a policy or difficulty obtaining clearance certificates.
Service Issues – This letter provides a template if you have experienced service issues with your health fund provider including administrative delays, customer service issues, or administrative delays.
If you experience service issues with your health fund, this letter makes it easier to file a complaint with the insurance ombudsman.
Disclaimer: The above information is correct and current at the time of publication.
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