Concerns over growing private health cover exclusions

For the first time, the majority of hospital treatment policies held by Australians now contain exclusions, according to the Australian Competition and Consumer Commission’s (ACCC) annual report into the private health insurance industry.

More than 57 per cent of policies held by Australians contain exclusions, up from about 44 per cent in the previous year.

“Many people may not be aware their policies may have exclusions and don’t realise they would not be covered at all for treatment as a private patient for those conditions,” ACCC deputy chair Delia Rickard said.

“We’ve been working with private health insurers about how they can better communicate such detrimental policy changes to consumers.

“Insurers need to make sure these changes are communicated clearly, prominently and in a timely manner, to avoid misleading consumers,” Ms Rickard said.

The report found that, while the rate of increase in average annual premiums has slowed over the past five years, average premiums have increased by more than inflation and wage growth over the year, while consumers continue to drop their private health insurance.

The ACCC’s annual report into the private health insurance industry identified a number of other key industry developments and trends in 2018-19, including:

  • In 2018-19, consumers paid over $24.5 billion in private health insurance premiums, an increase of more than $661 million or 2.8 per cent from 2017-18.
  • The amount of hospital benefits paid to consumers by health insurers was around $15.4 billion and the amount of extras treatment benefits paid was around $5.3 billion.
  • The number of hospital policies with an excess or co-payment continued to increase slightly from 84 per cent to 85 per cent.
  • 86.8 per cent of in-hospital treatments are delivered without requiring any gap payments from patients, a slight reduction from the 2017-18 figure of 87.8 per cent.
  • Complaints to the private health insurance ombudsman (PHIO) have decreased by more than 11 per cent since June 2018. Over the same period, contacts to the ACCC relating to private health insurance decreased by 17 per cent – the same percentage decrease as from 2016-17 to 2017-18.

The ACCC has also identified an emerging and potential risk of consumer harm from the collection and use of consumer data by health insurers and other businesses in the health sector.

“Several health insurers offer rewards schemes for their members, some of which include the use of tracking apps to record physical activity. Such information may in some cases be combined with other external data sources to profile consumers for targeted marketing,” Ms Rickard said.

“While Australian consumers can benefit from these programs, we are concerned that few consumers may be fully informed or fully understand the scope of data collected when they sign up for, or use, such services.”

The ACCC is undertaking current enforcement action in relation to alleged misleading and deceptive conduct regarding consumer data in the health sector. 

Have you reached a tipping point with your private health cover? Do you believe the annual prices rises are justified?

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