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 complaint 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 a 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 to make a complaint to 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 a health fund, including improper cancellation of a policy, inability to obtain a refund you are due, or difficulty obtaining clearance certificates.
Service Issues – This letter provides a template if you have experienced service issues with a health fund, including administrative delays and customer service issues.
Disclaimer: The above information is correct and current at the time of publication.