Bupa HI Pty Ltd

The Australian Competition and Consumer Commission (ACCC) has accepted a court enforceable undertaking (Undertaking) from Bupa HI Pty Ltd (Bupa HI), in relation to admitted contraventions of sections 18, 21 and 29(1)(m) of the Australian Consumer Law (ACL) in Schedule 2 of the Competition and Consumer Act 2010 (Cth).

Bupa HI admits that between May 2018 to August 2023 it engaged in misleading or deceptive conduct and made false or misleading representations regarding members’ entitlements to private health insurance benefits for certain claims (Mixed Coverage Claims and Uncategorised Item Claims as defined in the Undertaking). Further, Bupa HI admits that, between June 2020 and February 2021, it engaged in unconscionable conduct by incorrectly assessing certain claims of Bupa HI members after it failed to generate and manually review a report which had previously been generated to identify incorrectly automatically assessed claims. It has admitted that this was unconscionable in certain circumstances, including where it knew that manual review was necessary to ensure it identified and paid benefits for those claims.

The ACCC has instituted proceedings in the Federal Court of Australia against Bupa HI (Proceedings) in connection with Bupa HI’s admitted conduct. Bupa HI and the ACCC will jointly seek relief orders in the Proceedings, including declarations, an injunction, a compliance program order and a pecuniary penalty of $35 million. The Federal Court will consider whether to make the orders sought on a date to be fixed.

The Undertaking includes commitments from Bupa HI that it will:

• implement and administer a remediation program and provide remediation to affected parties, including:
  • attempting to remediate affected parties identified by Bupa HI before the Commencement Date within 90 days of the Commencement Date;  
  • providing avenues for further potentially affected parties to be able to contact Bupa HI to request remediation in accordance with the remediation program, including publishing a form accessible on Bupa HI’s website;
  • assessing any inquiry submitted during the term of the undertaking and, if deemed eligible, attempt within 30 days to pay the affected party;
• in the event of a dispute about Bupa HI’s assessment of a party’s entitlement to payment, refer the dispute to an Independent Arbitrator to make a determination in respect of the dispute; and
• provide reports to the ACCC about the remediation program, including the number of affected parties who contacted Bupa HI, the number of affected parties assessed by Bupa HI, and the total payments made to affected parties.