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The most complained about health insurance funds

We reveal the six funds with the worst overall complaints ratings.

woman worrying about health insurance bill
Last updated: 26 April 2021
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Fact-checked

Checked for accuracy by our qualified fact-checkers and verifiers. Find out more about fact-checking at CHOICE.

Need to know

  • CHOICE's health insurance experts analyse complaints data for all the health insurance funds on the market
  • We give each fund a rating of low, medium or high. Low is better than high
  • Six funds seem to have some unhappy members, earning themselves a high complaints rating in our review

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 complaints handling.  

To help you find the best insurer for your needs, our health insurance experts have trawled through the data and scored each health insurance fund on its complaints – so you know which ones don't have a great track record when it comes to complaints. 

Funds with the worst complaints ratings in the 12 months to 30 September 2020

Our health insurance experts have analysed data about health insurance fund complaints and given these six funds a complaint rating of high. (We explain how we rank funds below.)

Want all the details? Here's the private health insurance ombudsman's State of the Health Funds Report

How we calculate funds' complaints ratings 

We assign each fund a complaint rating of low, medium or high. Here's how we do it. 

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 'complaint' and a 'dispute'? 

If a complaint is taken up by the private health insurance ombudsman (PHIO) for intervention, it's then considered a 'dispute'. When we calculate complaints ratings, we give greater weight to disputes because they tend to be more egregious cases. 

How does my 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 36 funds, including:

What do most people complain about?

These are the most complained-about issues:

  • Pre-existing conditions' waiting period
  • 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."

Correction 26/04/21: We changed the subheading that now reads 'Funds with the worst complaints ratings in the 12 months to 30 September 2020'. The original version was 'Funds with the worst complaints ratings 2020–21'. 

We care about accuracy. See something that's not quite right in this article? Let us know or read more about fact-checking at CHOICE
We care about accuracy. See something that's not quite right in this article? Let us know or read more about fact-checking at CHOICE