Least-favored health insurance providers in Australia singled out for continuous complaints
Article Title: Defence Health and AIA Top List of Worst Performing Health Funds in Australia
In a recent analysis by CHOICE, an independent Australian consumer advocacy group, Defence Health and AIA have been identified as the private health insurance funds with the worst complaint ratings in Australia as of 30 September 2025 [1].
These funds have been highlighted due to a higher than average number of complaints relative to their size in the 12 months leading up to the date. The most common issues consumers have complained about to these funds include pre-existing condition waiting periods, membership cancellation, hospital exclusions and restrictions, general treatment benefits, and verbal advice problems.
The complaint rating, assigned by CHOICE health insurance experts, is indicative of the quality of a fund's internal complaints-handling processes. It is considered the best available metric of fund performance in this area, though detailed complaint reasons and outcomes are not publicly disclosed [1].
Defence Health has acknowledged letting down its members and has apologized, promising to do better. The high complaint rating for Defence Health is primarily due to an IT failure in the second half of 2023 that caused problems with automatic payments, claims, and long call center wait times.
It is worth noting that complaint/dispute rates for each fund are compared with the overall industry rates to allow for fair comparisons. When calculating complaint ratings, greater weight is given to referrals because only a small number of complaints reach the investigations stage.
CHOICE health insurance experts have analyzed complaints data for all health insurance funds on the market. However, they do not have detailed data on the reason for the complaints for each fund, nor the outcomes of these complaints.
To make a complaint to the Ombudsman about your private health fund, follow these steps:
- Ensure the complaint is about private health insurance, not the quality of care.
- Complain directly to the insurer, hospital, or doctor.
- Gather information such as key details, dates, membership number, correspondence, and relevant contacts.
- Send the complaint to the ombudsman, keeping it brief, listing key dates and contacts, and providing your contact details. For more information, visit ombudsman.gov.au
The Private Health Insurance Ombudsman's industry updates can be found here.
[1] Data used for calculating complaint ratings comes from quarterly complaints bulletins published by the Commonwealth Private Health Insurance Ombudsman.
- The quality of some health insurance funds' internal complaints-handling processes is questionable, with Defence Health and AIA identified as the worst performers by CHOICE as of 30 September 2025.
- Pre-existing condition waiting periods, membership cancellation, hospital exclusions and restrictions, general treatment benefits, and verbal advice problems are common complaints lodged against Defence Health and AIA.
- The complaint rating assigned by CHOICE health insurance experts indicates the quality of a fund's internal complaints-handling processes.
- The high complaint rating for Defence Health is primarily due to an IT failure in the second half of 2023 that caused problems with automatic payments, claims, and long call center wait times.
- Complaint/dispute rates for each fund are compared with the overall industry rates to allow for fair comparisons.
- Greater weight is given to referrals when calculating complaint ratings, as only a small number of complaints reach the investigations stage.
- CHOICE health insurance experts have analyzed complaints data for all health insurance funds on the market.
- Detailed data on the reason for complaints for each fund, nor the outcomes of these complaints, are not publicly disclosed by CHOICE.
- To make a complaint to the Ombudsman about your private health fund, follow the steps outlined.
- Ensure the complaint is about private health insurance, not the quality of care.
- Complain directly to the insurer, hospital, or doctor before contacting the Ombudsman.
- Gather information such as key details, dates, membership number, correspondence, and relevant contacts.
- Send the complaint to the ombudsman, keeping it brief, listing key dates and contacts, and providing your contact details.
- For more information, visit ombudsman.gov.au.
- The Private Health Insurance Ombudsman's industry updates can be found here.
- Data used for calculating complaint ratings comes from quarterly complaints bulletins published by the Commonwealth Private Health Insurance Ombudsman.
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