Money

Your insurer may have cut benefits without you knowing

May 31, 2017

NIB told several of its members certain eye procedures would be covered - turns out they weren't.

The ACCC has got your back – especially when it comes to protecting you from a health fund trying to pool the wool over your eyes.

The consumer watchdog has begun proceedings in the Federal Court against NIB Health Funds Limited (NIB) alleging NIB failed to notify members prior to its decision to remove certain eye procedures from its “MediGap Sheme” in 2015.

The ACCC claims NIB violated Australian Consumer Law by engaging in misleading or deceptive conduct, unconscionable conduct and making false or misleading representations.

Under NIB’s previous MediGap Scheme, members were able to receive the eye procedures without facing out-of-pocket expenses if their doctor participated in the scheme.

Between June 2011 and October 2016, the ACCC maintains NIB represented to members that several of its policies covered eye procedures and members would not pay any out-of-pocket expenses.

However, members could indeed incur out-of-pocket costs.

The ACCC alleges NIB made this representation by paying gap amounts on behalf of members for these eye procedures prior to August 2015.

“Consumers have a right to be informed of important changes to their insurance cover in advance, as these changes can result in very large financial consequences at a time when consumers are at their most vulnerable,” ACCC chairman Rod Sims said.

“Private health insurers must ensure their disclosure practices are in line with the Australian Consumer Law.

“Insurers should not expect consumers to bear the responsibility of making independent enquiries to find out about important changes made unilaterally by insurers.”