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Customer Service
Introduction and Relevant Legislation
PHIAC has a strong commitment to excellence in customer service for its stakeholders – members of the general public, Government departments and other agencies, and private health insurers. All PHIAC employees strive for high standards in business behaviour in accordance with the PHIAC Staff Policy and the Australian Public Service Code of Conduct.
Who is PHIAC and what is it here for?
PHIAC is an independent Statutory Authority established in 1989, to regulate the private health insurance industry. The Council’s functions and powers are set out in section 264-10 of the Private Health Insurance Act 2007:
General
(1) The functions of the Council are:
(a) to administer the Risk Equalisation Trust Fund; and
(b) to administer the registration of private health insurers under Part 4-3 of the Act; and
(c) the information collection function under subsection (2); and
(d) the compliance functions under subsection (3); and
(e) the enforcement functions under subsection (4); and
(f) the public information functions under subsection (5); and
(g) the agency cooperation functions under subsection (6); and
(h) to advise the Minister about the financial operations and affairs of private health insurers; and
(i) functions incidental to any other functions of the Council; and
(j) any other functions conferred on the Council by this, or any other, Act
Information collection function
(2) The information collection function of the Council is to obtain from each private health insurer regular reports about the insurer’s operations, including reports supported by actuarial certification.
Compliance functions
(3) The compliance functions of the Council are:
(a) to establish a solvency standard and a capital adequacy standard to be complied with by private health insurers, and to give solvency directions and capital adequacy directions to private health insurers; and
Note: The solvency standard and the capital adequacy standard are established by the Private Health Insurance (Health Benefits Administration) Rules.
(b) to exercise powers and discretions under the prudential standards, and to give directions to private health insurers relating to compliance with the prudential standards; and
Note: The prudential standards are established by the Private Health Insurance (Insurer Obligations) Rules.
(c) to consider, in accordance with Division 160, whether persons should, or should not, be appointed actuaries; and
(d) to consider, in accordance with Division 166, whether persons should, or should not, be disqualified persons; and
(e) to examine, from time to time, the financial affairs of private health insurers, by the inspection and analysis of the records, books and accounts of the insurers and any other relevant information; and
(f) to review, by carrying out independent actuarial assessment, the value of the assets and liabilities of each health benefits fund; and
(g) if it is necessary, for the purpose of making a proper examination of the financial affairs of a private health insurer, for the Council to incur unusually high costs—to impose an appropriate fee on the private health insurer concerned.
Enforcement functions
(4) The enforcement functions of the Council are:
(a) to take action under Part 5 2 to monitor compliance with, and to encourage or compel compliance with, Council supervised obligations; and
(b) to appoint, under section 214-1, inspectors for the purpose of investigating the affairs of private health insurers under Division 214, and to exercise other related powers and functions of the Council under that Division; and
(c) to appoint, under Subdivision 217-B, persons as external managers of health benefits funds, and to exercise other related powers and functions of the Council under Division 217 and 220.
Public information functions
(5) The public information functions of the Council are:
(a) to make statistics, and other financial information, relating to a private health insurer or private health insurers, publicly available in accordance with the Private Health Insurance (Council) Rules; and
(b) to collect and disseminate information about private health insurance, for the purpose of enabling people to make informed choices about private health insurance.
Agency cooperation functions
(6) The agency cooperation functions of the Council are:
(a) to cooperate with other regulatory agencies on matters affecting private health insurers and the private health insurance industry generally; and
(b) to provide the Private Health Insurance Ombudsman, from time to time, with information in the Council’s possession that the Council considers likely to be of use in production of the State of the Health Funds Reports referred to in paragraph 238-5(c).
Responsibility for the setting of private health insurance policy remains with the Minister and the Department of Health and Ageing.
Who the Customer Service Charter is for:
The Charter is designed for those who come into contact with the Private Health Insurance Administration Council (PHIAC), including:
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private health insurers
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the Department of Health and Ageing
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members of the public, and other agencies, who receive publications or seek information from PHIAC
PHIAC also produces Insure? Not Sure? - - a booklet to assist consumers in making choices in relation to their health insurance. Copies are available on request from the PHIAC office and can also be downloaded from the PHIAC website.
What is the Charter for?
The Charter is to assist in understanding PHIAC’s role and what can be expected when dealing with PHIAC, what information can be provided by PHIAC, and the required standards of the services provided.
Some of the services PHIAC provides are:
Quarterly
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Quarterly Statistics on contributors and coverage - printed editions are available by request and can be downloaded from the PHIAC website
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PHIAC A Report - provides details about membership and benefits on a state and aggregate basis, and
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PHIAC B Report - available only to private health insurers
Annually
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PHIAC Annual Reports to Parliament, including Operations of Private Health Insurers
Other
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General information about PHIAC and statistics - available from the PHIAC website
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Managing Supervision and Intervention, PHIAC Reporting Requirements, and Risk Management Practises in the Private Health Insurance Industry - documents designed to provide guidance to the private health insurance industry
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The publication and distribution of Insure? Not Sure? - available from the PHIAC office and the PHIAC website
Providing feedback on the Charter’s contents and the quality of PHIAC’s services
To provide feedback on this Charter and the quality of services provided by PHIAC, please contact the Chief Executive Officer at the PHIAC office.
Referral Information
If you have a complaint about any aspect of your private health insurance, you should contact the:
Private Health Insurance Ombudsman
Complaints Hotline (toll free)
1800 640 695
Preparation of this Charter
This Charter was developed via a Customer Service Survey first circulated in September 1997. Prior to finalising the Charter, a draft was forwarded to customers for further comment.
Customers were again surveyed for reviews of the Charter in August 2000, February 2005 and May 2007.
Review of this Charter
PHIAC will monitor and review the terms of this Charter and its effectiveness, on a regular basis. It will invite comments from customers and stakeholders as part of its monitoring and review process, and include details in the Annual Report to Parliament, on the effectiveness and progress of the Charter.
Customer Service Standards and Customer Rights and Responsibilities
What can you expect from PHIAC?
Customers can expect:
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to be treated courteously and professionally
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to be provided with a high quality of service
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responses to written enquiries within ten working days of receipt by PHIAC. If PHIAC is unable to provide a complete response within that timeframe, you will be contacted and advised when a response will be provided
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telephone calls returned by the close of business on the following day
- the Quarterly Statistics are published promptly after the risk equalisation arrangements are finalised, and
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information provided is current and accurate
Private health insurers specifically, can expect:
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to be contacted promptly in relation to any errors or omissions in data provided to PHIAC
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that every attempt is made to finalise and advise the results of the risk equalisation arrangements within three weeks after the due date for PHIAC 1 returns
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the release of financial statistics within three weeks after the due date for PHIAC 2 returns
- the release of statistics within three weeks after the due date for PHIAC 3 and 4 returns, and
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information about financial affairs and membership status will be treated in the strictest confidence by PHIAC personnel
What Does PHIAC Expect From You?
PHIAC expects that customers generally:
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will treat PHIAC staff with courtesy, and
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will notify us promptly of any change in fund information, management, or of contact details
PHIAC expects that private health insurers will:
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provide all returns (PHIAC 1-4) by no later than twenty-eight days after the end of the quarter to which the return relates
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submit Financial Condition Reports, Annual Financial Statements together with Audit Reports on the Financial Statements and PHIAC 1 information, by no later than 30 September of each year, and
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provide prompt and complete responses to PHIAC’s enquiries
Customer Feedback and Complaints
Should PHIAC fail to meet these standards:
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try to resolve your issue directly with the staff member with whom you have been dealing
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talk to the Chief Executive Officer if this does not resolve the matter
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if you are still not satisfied, contact the PHIAC Commissioner, and
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as a final recourse, or if you feel as though you have not been treated fairly, write to or telephone the Commonwealth Ombudsman
Communication with Customers
How to contact PHIAC:
By writing to PHIAC at:
PO Box 4549
KINGSTON, ACT, 2604, AUSTRALIA
Or visiting our office at:
Level 2, 10-12 Brisbane Avenue
BARTON, ACT, 2600, AUSTRALIA
By telephone: (02) 6215 7900
By facsimile: (02) 6215 7977
By email: phiac@phiac.gov.au