Ombudsman Act 1976

After exercising powers under section 20SA, the Private Health Insurance Ombudsman may make recommendations under this section.

The Private Health Insurance Ombudsman may recommend either or both of the following:

to a private health insurer, that the insurer take a specific course of action or make changes to its rules, or both;

to a health care provider or private health insurance broker, that the provider or broker take a specific course of action.

The Private Health Insurance Ombudsman may, by written notice given to the person to whom the recommendation was made, or an officer of that person, require the person to report to the Private Health Insurance Ombudsman, before action is taken to give effect to the recommendation, on the action proposed to be taken. The notice must specify the period within which the report is to be given.

After exercising powers under section 20SA, the Private Health Insurance Ombudsman may:

report to the Health Minister on any recommendations made to a private health insurer or private health insurance broker and any responses to those recommendations; or

report to the Health Minister on any recommendations to general changes in regulatory practice or industry practices relating to the kind of issues raised as a result of the exercise of those powers.

If the Private Health Insurance Ombudsman provides a report to the Health Minister, as mentioned in subsection (4):

the report must refer to the Private Health Insurance Ombudsman’s exercise of powers under section 20SA; and

the Private Health Insurance Ombudsman must notify any private health insurer or private health insurance broker named in a report provided to the Health Minister of that fact, unless doing so would, or could be reasonably expected to, prejudice the conduct of a current or pending investigation.