Code of conduct

This Code was developed by the Australian Health Insurance Association (AHIA) and the Health Insurance Restricted Membership Association of Australia (HIRMAA). As well as promoting improved standards in clarity of information given to contributors, it aims to solve problems between contributors and onemedifund through internal dispute resolution. The Code also ensures that your fund must tell its members of their entitlement to seek assistance from an external dispute resolution body, such as the Private Health Insurance Ombudsman (PHIO).

Board resolution regarding “Detrimental Changes” and “Cooling Off” Periods

The Board of Directors of National Health Benefits Australia Pty Ltd (“onemedifund”) endorses the establishment of the Private Health Insurance Industry Code of Conduct and commits to ensuring that contributors of the fund are treated fairly at all times and in particular where “detrimental” or “significant detrimental changes” are introduced.

The Board also recognises that in some instances persons who join the fund or those contributors that change their cover may change their mind shortly after the transaction is effected and in these circumstances (subject to no claims having been made) a cooling off period will be provided.

At onemedifund, we will:

1. Recognise that a “significant detrimental change” to hospital benefits includes:

  • Removal of material benefits or restrictions to default benefits for any identified condition;
  • Addition of material excesses / co-payments; and
  • Increases in excess / co-payments greater than 50%

Where there is a “significant detrimental change” to hospital benefits we will:

  • Provide the affected consumer with at least 60 days’ notice;
  • Not apply the changes to pre-booked admissions;
  • Put in place transitional measures for patients in a course of treatment for a period of not less than 6 months

Where there is a “detrimental change” (other than a significant detrimental change) to hospital benefits we will:

  • Provide the affected consumer with at least 30 days’ notice;
  • Not apply the changes to pre-booked admissions;
  • Put in place transitional measures for patients in a course of treatment for a period of not less than 3 months

2. Recognise that a “significant detrimental change” to ancillary benefits will includes:

  • Introduction of a new limit or sub limit; and
  • A greater than 50% reduction in any limit

Where there is a “significant detrimental change” to ancillary benefits we will:

  • Provide the affected consumer with at least 30 days’ notice;
  • Put in place transitional measures for patients affected by rollover type benefits accumulated in the previous year

3. Allow any consumer who has not yet made a claim, to cancel their policy and receive a full refund of any premiums paid within a period of 30 days from the commencement date of their policy.  For clarity this equally applies to new members joining the fund or existing members who decide to change their level of cover.

Date of Effect:  1 June 2009