Consumer Charter

Introduction

The Health Insurance Authority (“The Authority”) regularly receives queries and complaints from consumers relating to their health insurance. We also receive enquiries from insurers, the media, public bodies, professional associations and private companies. You are all customers of the Authority and we are committed to delivering the highest standard and service to you.

Our Commitment to You

We aim to provide a high quality, effective and efficient service in a polite, courteous and fair manner.  We will aim to provide you with clear and correct information about private health insurance.  Any query or complaint received by the Authority will be investigated by a staff member with the necessary knowledge and experience to deal with the matter promptly and fairly and who has access to more senior staff for guidance if required.


If your query or complaint is more appropriately dealt with by another body, we will advise you and provide you with the contact details of that body.

If you wish to escalate a complaint the Authority will advise you of the options available for further action e.g. reference to Financial Services Ombudsman or the Courts.

We are committed to the Government’s Twelve Principles of Quality Customer Service for Customers and Clients of the Public Service.  The twelve principles are listed in the associated Customer Action Plan which also details The Authority’s services and intended objectives by reference to each of these Principles.

 

Courtesy and Consideration

You are at all times entitled to be served:

  • Promptly and in a courteous manner
  • With due regard to privacy and confidentiality
  • By friendly and helpful staff
  • You can help us by also being respectful and courteous in your dealings with our staff

 

Independence, Openness and Impartiality

The Authority is committed to providing an independent and impartial consumer information service in a fair and open manner. The aim is to give full and accurate information in a manner that suits you.

We will provide this information through our website, advertisements, information booklets or other publications, or by contacting the Authority directly.

 

Our Performance

We undertake to:

  • Monitor and evaluate our performance;
  • Examine the development and delivery of our services in order to meet your needs; and
  • Train our staff to meet your needs on an ongoing basis.

 

Equality / Discrimination

The Authority is committed to ensuring that, in dealings with staff, your rights relating to the use of the Irish language and the nine grounds on which discrimination is unlawful are fully respected.

Our publications will be clearly written, simple and easy to understand and we will promptly provide you with copies of our publications by the method preferred by you.

 

Access

The Authority will endeavour to provide clean, accessible offices that ensure an appropriate level of privacy, comply with occupational and safety standards and, as part of this, facilitate access for people with disabilities and others with specific needs.

 

Complaints

The Authority will maintain an open, accessible, and responsive system of dealing with queries and complaints and to facilitate comments and suggestions from customers on the quality of service provided. Details of how a complaint/comment can be made are set out in the Authority’s Customer Action Plan which is available at www.hia.ie

 

 

CUSTOMER ACTION PLAN

 

 

Introduction

The Health Insurance Authority (“The Authority”) is a statutory regulatory body that was established by ministerial order under the Health Insurance Act, 1994, as amended. 

 

The Authority is independent in the exercise of its functions.  The principal functions of the Authority as provided for in the Health Insurance Acts include the following:

  1. To monitor the health insurance market and to advise the Minister (either at his or her request or on its own initiative) on matters relating to health insurance;

 

  1. To monitor the operation of the Health Insurance Acts and, where appropriate, to issue enforcement notices to enforce compliance with the Acts;

 

  1. To carry out certain functions in relation to health insurance stamp duty and risk equalisation credits and in relation to the risk equalisation scheme;

 

  1. To take such action as it considers appropriate to increase the awareness of members of the public of their rights as consumers of health insurance and of health insurance services available to them; and

 

  1. To maintain “The Register of Health Benefits Undertakings” and “The Register of Health Insurance Contracts”.

 

The Authority shall exercise such powers as are necessary for the performance of its functions. The Minister for Health may assign further responsibilities to the Authority as provided for in the Acts.

The Authority is audited by the Comptroller and Auditor General and subject to the requirements thereof. The Authority is also subject to the corporate governance procedures of the revised “Code of Practice for the Governance of State Bodies 2016” issued by the Department of Public Expenditure and Reform and effective from 1st September 2016. The Authority is a public body to which the provisions of the Freedom of Information Acts and the Data Protection Acts apply.

 

 

 

What is the aim of this Customer Action Plan?

Two of the Authority’s primary functions generate the majority of customer interaction, whether they are from members of the public seeking to purchase, or having purchased health insurance products, or from insurers, the media, public bodies, professional associations and private companies.  These two functions are:

 

  • To take such action as it considers appropriate to increase the awareness of members of the public of their rights as consumers of health insurance and of health insurance services available to them; and

 

  • To monitor the operation of the Health Insurance Acts and, where appropriate, to issue enforcement notices to enforce compliance with the Acts.

 

Within this remit, the Authority aims to increase consumer awareness of their rights and assist them in understanding health insurance products. The Authority also monitors the provision of information to consumers by insurers as well as monitoring compliance with the Health Insurance Acts.

The Authority’s aim is to provide the highest quality of service to all customers. The Authority continues to encourage feedback from customers, to evaluate and, where possible, improve on the quality of service offered.

 

How will we develop these services?

We will make our services better by:

  • developing new ways to deliver services;
  • making greater use of technology;
  • training, developing and listening to our staff;
  • operating effective complaints and appeal procedures; and
  • responding to feedback from customers and employees.

 

Delivery

The Authority has adopted and published the Customer Charter included as part of this document. The Customer Charter and Action Plan are available on the HIA’s website (www.hia.ie) and in hard copy by contacting the Authority directly.

 

The Government has set out twelve guiding principles of quality customer service for public sector organisations and this Action Plan details the Authority’s services and objectives by reference to each of these Principles.

 

1)  Quality service standards

We will publish a statement that describes the kind of service you can expect from us and display it prominently at the point of service.

 

The Authority’s Customer Charter sets out the service customers can expect from the Authority in terms of its commitment to quality customer service, courtesy and consideration, independence, openness and impartiality, performance, equality / discrimination, access and complaints.

 

2)  Equality and diversity

We are committed to delivering a quality service to all of our customers. We are committed to ensuring that:

  • no one is discriminated against because of their gender, family status, marital status, religion, age, race, membership of the Traveller community, sexual orientation or disability, as laid down in the Employment Equality Act 1998 and the Equal Status Act 2000; and
  • the service we deliver is accessible to customers within the nine grounds of the Equality legislation.

 

3)  Physical access

We will endeavour to provide clean, accessible public offices that meet occupational and safety standards and allow you to conduct your business with us in private.

 

4)  Information

We will aim to provide clear, timely and accurate information which will be available at various points of contact and we will work, where practicable, to meet the requirements of people with specific needs.

We will use a variety of channels to deliver information to our customers. We will make sure that information on our websites follows the government’s guidelines for web publication.

We will aim to simplify where possible rules, regulations, forms, information leaflets and procedures.

If your query or complaint is more appropriately dealt with by another body, we will advise you and provide you with the contact details of that body.

 

5)  Timeliness and courtesy

We will deliver our services with courtesy, sensitivity and as little delay as possible.

We will give you the name of the person dealing with your request so that you can communicate easily with us.

 

6)  Complaints

We know there will be times when our systems will not work as well as we would wish. For this reason, we will maintain a clear, simple and easy-to-access system to handle complaints. You’ll find more information about our complaints and appeals system in Appendix A of this document.

 

7)  Appeals

We will maintain a formal, transparent and easy-to-use appeals process so that you can appeal a decision or request a review.

 

8)  Consultation and evaluation

We will take on board the views of customers about the development, delivery and evaluation of services.

 

The Authority will record and analyse queries, complaints and customer feedback to ensure that they are being dealt with effectively, and to improve the service given to customers.

 

9)  Choice

Where we can, we will provide choice in service delivery including points and means of contact, opening hours and contact details using existing and new technologies.

 

10)  Official languages equality

The Authority recognises our customer’s rights to access our services through one or other of the official languages and is committed to providing this service.

 

11)  Better co-ordination

We will foster a co-ordinated and integrated approach to the delivery of public services.  

The Authority has agreed a memo of understanding with the Financial Regulator, now incorporated into the Central Bank of Ireland, and a Competition Agreement with the Competition Authority, now incorporated into the Competition and Consumer Protection Commission.

 

12)  Internal customers

We view staff as internal customers and will support and consult with them through a partnership model and internal communication channels.

 

Access to Services

 

Contact Details

 

Telephone:      +353 1 406 00 80 

 

Contact Details

 

Telephone:      +353 1 406 00 80                    

Fax:                  +353 1 406 00 81

Email:              info@hia.ie

Website:          www.hia.ie

 

Address: The Health Insurance Authority

Canal House

Canal Road,

Dublin 6

D06 E7F6

 

 

Members of the public contacting the Authority by telephone

We are available to take your calls between 9.30am and 12.45pm and between 2.00 pm and 5.00p.m. Monday to Friday, excluding weekends and public holidays.
 

 

Standards of Service

  • We will answer phones quickly and courteously.
  • We will give the information you ask for in a helpful way.
  • As far as possible, we will deal with your query at your first phone call.
  • If we cannot give you an answer immediately, we will take your details and either write or phone back.
  • We will tell you when you can expect to hear from us or arrange to call at a time which is convenient for you.
  • We will give you the name of the person dealing with your query in case you need to phone again

 

Visitors to our public offices

The Health Insurance Authority’s offices are located at: Canal House, Canal Road, Dublin 6, D06 E7F6.

 

Where consumers wish to visit our offices to avail of our services we would recommend booking an appointment:

  • We will be courteous and fair in our dealings with you.
  • We will deal with enquiries as quickly as possible.
  • We will respect your privacy and provide private interview room where possible.
  • We will keep our offices safe, clean and accessible, particularly for people with disabilities.

 

Contact by email or post

  • The Authority will acknowledge your letter/email within 3 working days of the query/complaint being received.  If this reply is an acknowledgement rather than a full reply it will indicate the name and contact details of the person dealing with the query/complaint and the estimated time scale for a full reply.
  • All communications with you will be in 'plain English' as much as possible and avoid the use of jargon.
  • You will be kept informed if the original time scale changes.

 

Contacting us by social media

Queries we receive through Facebook and Twitter are responded to as soon as possible, usually within 3 working days.

 

Publications

We publish a variety of booklets, periodicals and leaflets covering all aspects of our services. In addition, we publish regular newsletters as part of the consultation process for major developments and for community liaison.

 

Our publications will be clearly written, simple and easy to understand and we will promptly provide you with copies of our publications by the method preferred by you.

 

Services in Irish

You have the right to do business with us through Irish or English in accordance with the Official Languages Act 2003.

 

With a total staff of eleven, the availability of Irish language services in all areas of operation at all times cannot be provided. However, the Authority is committed to improving the provision of services through Irish in accordance with the provisions of the Act.

 

Freedom of Information

Under the Freedom of Information Act 2014, public bodies are obliged to release records held, subject to some exemptions. The Freedom of Information Act provides that every person has a right to access to any record (other than an exempt record) held by a public body. General principles/procedures and any fee requirements for making a request under the Freedom of Information Act are available at www.hia.ie

 

The Authority is a public body to which the provisions of the Freedom of Information Acts, 2014 as amended and the Data Protection Act, 1988 as amended apply.

 

We will continue to meet all of our obligations under these Acts.

 

 

 

Appendix A – Complaints Procedure

 

 

Consumer Complaints/Queries Relating to their Health Insurance

 

Any query or complaint relating to a consumers health insurance should firstly be addressed to their insurer using their insurer’s internal complaints procedure.

If the complainant has exhausted their insurer’s complaint procedure, any query or complaint received by the Authority will be investigated by a staff member with the necessary knowledge and experience to deal with the matter promptly and fairly and who has access to more senior staff for guidance if required.

We will get back to you within an agreed timeframe if we can’t respond to your query or complaint immediately.

If you wish to escalate your complaint, the Authority will advise you of the options available for further action e.g. reference to Financial Services Ombudsman or the Courts.

If your query or complaint is more appropriately dealt with by another body, we will advise you and provide you with the contact details of that body.

 

 

Consumer Service Complaints

 

The Authority is committed to dealing with complaints about the quality of the service provided.

Complaints about customer service should be made in accordance with the following protocols:

  • In the first instance where a customer feels that the service being provided via a staff member is deficient the matter should be raised directly with the staff member concerned.
  • If the customer is still unhappy following the staff member’s response, the matter can be referred to the staff member’s Head of Department. In this regard, the staff member will give the customer the name and contact details of the Head of Department and will inform the Head of Department as soon as possible of the nature of the issue concerned.
  • The Head of Department will contact or be put in contact with the customer as soon as practicable but at least no later than 3 working days from the date the issue has been raised.
  • Following contact with the Head of Department and if the customer is still unhappy and wishes to sustain the complaint then a formal written complaint should be made to the respective Head of Department, The Health Insurance Authority, Canal House, Canal Road, Dublin 6, D06 E7F6.
  • We will acknowledge all written & email complaints within 3 working days.
  • We will investigate all complaints and issue a reply to your complaint within 15 working days or, where this is not possible, an interim reply will issue explaining the position and advising when a substantive response will issue.
  • All complaints will be treated promptly, fairly, impartially and in confidence.
  • We will keep records of complaints separate from other records.
  • We will ensure that no complaint you have made in good faith will be used to your disadvantage in the future.
  • We will endeavour to learn from mistakes to ensure that errors are not repeated.

 

Can you appeal?

 

In respect of decisions relating to health insurance or our consumer service, if you are not satisfied with the outcome of the investigation by the Head of Department, the matter may be appealed to the Chief Executive/Registrar at the address supplied above.

Should you wish to escalate your complaint, the Authority will advise you of the options available for further action e.g. reference to Financial Services Ombudsman or the Courts.

The deadlines for responding to appeals will be the same as those for formal complaints (outlined above).