Need to know
- CHOICE health insurance experts analyse complaints data for all the health insurance funds on the market
- We give each health fund a rating of low, medium or high – low is better than high
- Some funds seem to have some unhappy members, earning themselves a high complaint rating in our comparison
There's more to finding the right health insurance than just assessing the monthly hit to your pocket.
Aside from getting the coverage you need (which can be complicated enough in itself) for a good price, you'll also want to find a health insurance fund with good customer service, including how it handles complaints.
To help you find the best insurer for your needs, our health insurance experts have trawled through the data and scored each private health fund on its member complaints, so you know which ones have a great track record for this (and which don't).
Funds with the worst complaint ratings in the 12 months to 30 June 2024
AIA and Defence Health
Our health insurance experts have analysed data about health insurance fund complaints and given AIA and Defence Health a complaint rating of high. We explain how we rank funds below in "How we calculate funds' complaint ratings".
Defence Health still feeling the fallout from IT failure
Although complaints about Defence Health have been trending downwards from their peak in the December 2023 quarter, the fund still accounts for a large number of complaints to the Ombudsman – well beyond its 2% market share.
One of the reasons is an IT upgrade that resulted in the failure of automatic payments, which in turn resulted in problems with claims and very long call centre wait times. Defence Health has acknowledged that it let down its members and has apologised, promising to do better.
The Ombudsman says: "While the overall volume of contacts was significant, this event emphasises the need for a robust and scalable complaints resolution system for any insurer undertaking a large systems transformation."
Want all the details? Here are the Private Health Insurance Ombudsman's industry updates.
How we calculate funds' complaint ratings
We assign each fund a complaint rating of low, medium or high.
Our health insurance experts take a look at the number of complaints and disputes a fund has received in the last four financial quarters.
They then standardise them for fund size, so a large fund isn't penalised for receiving many complaints just because it has lots of members. (For instance, Medibank and Bupa receive the highest number of complaints overall, but they're also the two biggest insurers on the market.)
The data we use comes from quarterly complaints bulletins published by the Commonwealth Private Health Insurance Ombudsman.
Some funds may be subsidiaries of another fund – for example, Nurses & Midwives Health and Teachers Health. For these funds we score them together, since they share the same claims-handling departments.
What's the difference between a 'referral' and an 'investigation'?
If a referral (complaint) is taken up by the Private Health Insurance Ombudsman (PHIO) for intervention, it's then considered an 'investigation' (dispute). When we calculate complaint ratings, we give greater weight to referrals because only a small number of complaints reach the investigations stage.
How does your fund compare with the rest of the industry?
For each fund, we compare their complaint/dispute rates with the overall industry rates, so you can compare apples with apples.
If a fund consistently has the same rate of complaints, but the industry overall experiences a fall in complaints, then the fund's complaint rating is likely to change for the worse.
To see how your health insurer stacks up, check our health fund information pages. We compare thousands of policies from more than 40 insurers, including:
What do most people complain about?
These are the most complained-about issues:
- pre-existing condition waiting periods
- membership cancellation
- hospital exclusions and restrictions
- general treatment benefits
- verbal advice.
"Unfortunately, we don't have much detailed data on the reason for the complaints for each fund, nor the outcomes of these complaints," says CHOICE health insurance expert Daniel Graham. "If we did, we'd take these into account."
"But the complaint rating is indicative of the quality of a fund's internal complaints-handling processes, so we think it's the most useful metric we have to measure a fund's performance in this area."
Stock images: Getty, unless otherwise stated.
