This complaints procedure and policy 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.
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.
You can also ask us to help you (see below)
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.
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 or sending a letter).
If you want to complain face to face or over the phone (1300 368 390 or 02 9847 3390), you can talk to:
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 to"
If you want to complain to someone outside ACA Health, you can talk or write to
The Ombudsman's office may ask you whether you have attempted to resolve the conflict directly with the Fund.
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.
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.
If you are referred to the Complaints Officer (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 (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 (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 (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 (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 (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).
If you complain in writing to the Manager, there are two options as to what may happen.
The first option is that the Complaints Officer (Manager) is able to deal with your complaint. S/he will send you a letter within 5 working days acknowledging your complaint and letting you know when s/he will get back to you. Most complaints can be resolved within 2 to 3 weeks, but if it takes longer you will receive regular updates. At the end of this process we will tell you the outcome of your complaint in writing and where appropriate the general reasons for this outcome. If you are not happy with the outcome of your complaint, you can request the Board review the decision or refer the matter to the outside agency listed above.
The second option is that s/he cannot deal with your complaint. If that is the case s/he writes to you with the reasons why s/he cannot deal with your complaint and tell you where you can take it (usually the Board or one of the agencies listed above).
If you complain in writing to the Board, there are two options as to what could happen.
The first option is that the Board is able to deal with your complaint. It will send you a letter within 5 working days acknowledging your complaint and letting you know when they will get back to you. Most complaints referred to the Board can be resolved within 3 to 5 weeks, but if it takes longer you will receive regular updates. If you are not happy with the outcome of your complaint, you can take it to the outside agency listed above.
The second option is that the Board cannot deal with your complaint. If that is the case they will write to you with the reasons why they cannot deal with your complaint and tell you where you can take it. (Usually the agency listed above).
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.
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.