Complaints Policy and Procedure

This complaints policy and procedure is set out in a way which lets you choose if you want to read the whole document or just the parts that interest you. While we recommend that you read the entire document, we acknowledge that you may be interested in some parts only. Below is an index of the contents. The numbers are not paging numbers but numbers of the headings, which you will find in big bold print somewhere on the page.

INDEX

1. Definition of a Complaint
2. What ACA Health believes about complaints
3. If you need help with your complaint
4. How and where to complain
5. What happens with your complaint:
   1. If you choose to complain verbally
   2. If you choose to complain in writing
6. How ACA Health uses complaint information
7. How the Complaints process and procedure is reviewed

Definition of a Complaint

A complaint is when you let us know that you are unhappy with something about our product, product documentation or service, and you want some specific result from your complaint. Because we need to contact you about the result, a complaint cannot be anonymous.

If you want to remain anonymous but want to let us know how you think we could do better, please send us your suggestions.

What ACA Health believes about complaints

• ACA Health is keen to hear from you to be able to improve its service. This could be through feedback you give us or through a complaint you make. A complaint is an opportunity for the staff and management to find out about when you believe we are not doing well and use that information to improve the products and service we provide to our policy holders.

• ACA Health believes it should be accountable to the users of its products and services. We will accept anything as a complaint which policy holders think is unfair or which makes them unhappy with the service provided.

• ACA Health believes in fairness. All complainants will be dealt with fairly, equitably and with respect and dignity.

• Complainants and other people who provide information will not be disadvantaged in any way as a result of making a complaint. If you wish, we will discuss what we can do to make sure you are still comfortable using our products and services after you have made a complaint.

• If your complaint is about the action of a staff member or members, fairness requires that we get their version of what happened as well. The outcome of the compliant and any relevant feedback will be discussed with the staff member or members.

• All information provided will be kept confidential between you and ACA Health. All documentation will be distributed within ACA Health on a “need to know'” basis only. ACA Health will keep a record of your complaint for training, statistical and analytical purposes.

• ACA Health will try to resolve complaints to the satisfaction of the complainant in the shortest time possible. All complaints received in writing either by mail or email will be acknowledged in writing or email within 5 working days. This letter will also tell you how long we believe it will take to investigate your complaint, and what we will do.

• We will tell you the outcome of your complaint in writing, except for verbal complaints, which may be resolved with you immediately. If the complaint has not been resolved to your satisfaction, we will tell you how/ where you can take your complaint further.

• If you have problems writing or formulating your complaint, an advocate can support you. You can choose your own advocate (e.g. a friend or family member).

You can also ask us to help you (see below).

If you need help with your complaint

If you have problems explaining what your complaint is about, completing an ACA Health Benefits Fund Complaint Notification form or writing down your complaint, we can arrange for one of our staff to sit with you and do this. If you want someone outside ACA Health to assist you, we will try to help you find such a person. You can have someone with you to support you in any discussions or meetings with us. If you need an interpreter or translator, please let us know. We will assist you in arranging one at no cost to you.

How and where to complain

You can complain by talking to us (face to face or over the phone), or in writing (by completing an ACA Health Benefits Fund Complaint Notification form, sending a letter or email).

If you want to complain face to face or over the phone (1300 368 390), you can talk to:

• Any of the ACA Health staff
• The Complaints Officer (Fund Manager of ACA Health)
• The Assistant Manager Finance and Operations

If you want to complain in writing, you can request and complete an ACA Health Benefits Fund Complaint Notification form or write to us at: Locked Bag 2014, Wahroonga NSW 2076

And mark it “Attention”

• Fund Manager of ACA Health, or
• ACA Health Benefits Fund Limited Board

To make a complaint, contact the Commonwealth Ombudsman at www.ombudsman.gov.au

For general information about private health insurance, see www.privatehealth.gov.au

The Ombudsman’s office may ask you whether you have attempted to resolve the conflict directly with the Fund.

When you make a complaint please provide a description of your complaint, send in any supporting information or documentation and it would be helpful if you said what you want as a result of your complaint. This could be a review of a decision not to pay a benefit, amending the wording in a document, an apology, training and staff feedback, or a change in the way we do things.

What happens with your complaint?

As soon as you make, or tell us you wish to make a complaint, ACA Health will give you this “complaints procedure and policy” paper, and offer to send you an ACA Health Benefits Fund Complaint Notification form for you to complete. If you would prefer a staff member to complete this form for you can make this request.  We will then record the details of the complaint in a register so we can see what sort of complaints we received and how often. This register will be reported to the ACA Health Board at least once a year. All information about your complaint is confidential to the person(s) who are dealing with the complaint so your identity is removed prior to reporting.

a.If you choose to complain verbally

If you complain to a staff member, there are two possibilities as to what can happen.

The first possibility is that it is a minor complaint, which can be resolved to your satisfaction there and then. If that is the case, the staff member will take a few notes as to what the complaint was. These notes will only be used so we can improve what we are doing.

The second possibility is that your complaint cannot be resolved to your satisfaction there and then. This may be because you and the staff member tried, but you were not happy with the outcome, or because the staff member thought that they could not deal with the complaint. In this case the staff member will tell you what your further options are. The staff member may refer you to talk with the Complaints Officer, or you may want to make a written complaint to any of the options listed under heading 4 previously. A complaint form (ACA Health Benefits Fund Complaint Notification) is available to assist you to make a complaint or if you have problems writing or formulating your complaint, an advocate can support you. You can choose your own advocate (e.g. a friend or family member).

If you are referred to the Complaints Officer (Fund Manager), there are three options as to what can happen.

The first possibility is that your complaint can be resolved to your satisfaction there and then. If that is the case, the Complaints Officer (Fund Manager) will record the details of your complaint by completing an ‘ACA Health Benefits Fund Complaint Notification’ form. These notes will only be used so we can improve what we are doing. Your name does not have to be in the notes if you do not want that. If you do not want your complaint written down at all, you can say so, too.

The second option is that your complaint cannot be resolved immediately. This could be either because you are not happy with the outcome, or it is too complex, and that the Complaints Officer (Fund Manager) needs to investigate something. If you are not happy with the outcome, you can take your complaint to the Board or an outside agency (listed above).

If the Complaints Officer (Fund Manager) needs to investigate something, s/he will get an agreement with you about what s/he will do, and when s/he will get back to you. What has been agreed, and by when the Complaints Officer (Fund Manager) will get back to you will be confirmed in writing within five working days. How long it will take to investigate will depend on how complex the circumstances are, but most complaints can be resolved in 2 to 3 weeks. If it takes longer, you will get regular updates. At the end of this process s/he will tell you the outcome of your complaint in writing.

The third option is that the Complaints Officer (Fund Manager) believes that your complaint needs to go somewhere else, for example the Board, or an outside agency. S/he will tell you why and where you can take your complaint. These complaints usually have to be in writing. If you have problems writing or formulating your complaint, an advocate can support you. You can choose your own advocate (e.g. a friend or family member).

b.If you choose to complain in writing

If you complain in writing to the Fund Manager, there are two options as to what may happen.

How ACA Health uses complaint records

ACA Health wants to continuously improve our service. Getting suggestions and complaints from our policy holders are an important way for us to achieve that. All complaint records are allocated a number and added to a register. This register is reviewed at least annually by the Board.

How the complaints process and procedure is reviewed

It is important that any policy and process achieves its objectives. As such ACA Health may survey complainants in the future about their experience and ACA Health’s Complaints procedure and policy is included in ACA Health’s Internal Audit program. All of the findings and recommendations of this program are reported to the Board as they become available.