The Private Health Insurance Ombudsman has been given the power to raid insurers and insurance brokers to resolve complaints, under a package of reforms introduced by Health Minister Greg Hunt.
Documents obtained by The Australian show the ombudsman’s office has already held meetings with industry representatives to explain its new powers.
As insurance premiums continue to increase and more Australians drop private hospital policies, there are concerns about affordability, and complaints from health fund members who find themselves without cover when they need it.
Health funds have been warned that investigators will raid their offices if there is a suspicion they have tried to cover up cases of members being misled or having their claims unfairly denied.
Insurers need to provide members with sufficient notice of planned policy changes. In some cases, more than 60 days’ notice is required, and the wide-ranging reforms — intended to help stabilise the industry — only add to the need for insurers to keep members informed.
A spokesman for the ombudsman said it would work with stakeholders on a framework and protocols to support the use of the powers.
The ombudsman’s office expects to commence inspections this year.