Private Health Insurance (Data Provision) Rules 2018 (Cth)

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Private Health Insurance (Data Provision) Rules 2018

made under item 9 of the table in subsection 333‑20(1) of the

Private Health Insurance Act 2007

Compilation No. 8

Compilation date:1 November 2025

Includes amendments:F2025L01255

About this compilation

This compilation

This is a compilation of the Private Health Insurance (Data Provision) Rules 2018 that shows the text of the law as amended and in force on 1 November 2025 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. Any uncommenced amendments affecting the law are accessible on the Register ( saving and transitional provisions

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Presentational changes

The Legislation Act 2003 provides for First Parliamentary Counsel to make presentational changes to a compilation. Presentational changes are applied to give a more consistent look and feel to legislation published on the Register, and enable the user to more easily navigate those documents.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. Any modifications affecting the law are accessible on the Register.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Contents

Part 1Preliminary

1Name of Rules

These Rules are the Private Health Insurance (Data Provision) Rules 2018.

4Definitions

In these Rules:

Act means the Private Health Insurance Act 2007.

GT‑Dental Data from Insurers to the Department means the protocol set out in the document approved by the Assistant Secretary of the Private Hospitals Branch of the Department of Health and Aged Care on 14 April 2025 which consists of “Data Specifications (GT‑Dental)” and “Explanatory Notes (GT‑Dental)”.

HCP1 Data from Insurers to the Departmentmeans the protocol set out in the document Supplementary – HCP Data Specifications HCP1 Insurer to Department 2025‑26 approved by the Assistant Secretary of the Private Hospitals Branch of the Department of Health, Disability and Ageing on 17 October 2025 and which consists of:

  1. (a)

    Explanatory Notes;

  2. (b)

    Data Specifications – Episode;

  3. (c)

    Data Specifications – Medical;

  4. (d)

    Data Specifications – MDHT; and

  5. (e)

    Data Specification – AN‑SNAP.

HCP1 Data from Insurers to the Department 2024‑25means the protocol set out in the document Supplementary – HCP Data Specifications HCP1 Insurer to Department 2024‑25 approved by the Assistant Secretary of the Data and Analytics Branch of the Department of Health, Disability and Ageing on 17 October 2025 and which consists of:

  1. (a)

    Explanatory Notes;

  2. (b)

    Data Specifications – Episode;

  3. (c)

    Data Specifications – Medical;

  4. (d)

    Data Specifications – MDHT; and

  5. (e)

    Data Specification – AN‑SNAP.

HCP2Data from Insurers to the Departmentmeans the protocol set out in the document approved by the Assistant Secretary of the Private Hospitals Branch of the Department of Health and Aged Care on 14 April 2025 which consists of “Data Specifications (HCP2)” and “Explanatory Notes (HCP2)”.

Note: Terms used in these Rules have the same meaning as in the Act―see section 13 of the Legislation Act 2003. These terms include:

health benefits fund

private health insurer

complying health insurance products

5Information to be provided

  1. (1)

    For the purpose of section 172‑10(1) of the Act, in relation to the treatment of insured persons under complying health insurance products that are referable to health benefits funds, private health insurers must give to the Secretary of the Department the information specified in:

    1. (a)

      GT‑Dental Data from Insurers to the Department; and

    2. (b)

      HCP1 Data from Insurers to the Department; and

    3. (ba)

      HCP1 Data from Insurers to the Department 2024‑25; and

    4. (c)

      HCP2 Data from Insurers to the Department.

Endnotes

Endnote 1About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.

If a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to the amendment history.

Endnote 2Abbreviation key

ad = added or inserted

orig = original

am = amended

p = page(s)

amdt = amendment

para = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

/sub‑subparagraph(s)

ch = Chapter(s)

pres = present

cl = clause(s)

prev = previous

cont. = continued

(prev…) = previously

def = definition(s)

pt = Part(s)

Dict = Dictionary

r = regulation(s)/Court rule(s)

disallowed = disallowed by Parliament

reloc = relocated

div = Division(s)

renum = renumbered

ed = editorial change

rep = repealed

exp = expires/expired or ceases/ceased to have

rs = repealed and substituted

effect

s = section(s)/subsection(s)

gaz = gazette

/rule(s)/subrule(s)/order(s)/suborder(s)

LA = Legislation Act 2003

sch = Schedule(s)

LIA = Legislative Instruments Act 2003

SLI = Select Legislative Instrument

(md) = misdescribed amendment can be given

SR = Statutory Rules

effect

sub ch = Sub‑Chapter(s)

(md not incorp) = misdescribed amendment

sub div = Subdivision(s)

cannot be given effect

sub pt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

commenced or to be commenced

Ord = Ordinance

Endnote 3Legislation history

Name

Registration

Commencement

Application, saving and transitional provisions

Private Health Insurance (Data Provision) Rules 2018

6 June 2018 (F2018L00717)

1 July 2018 (s 2)

Private Health Insurance (Data Provision) Amendment Rules 2019

13 June 2019 (F2019L00817)

1 July 2019 (s 2)

Private Health Insurance (Data Provision) Amendment Rules 2020

15 May 2020 (F2020L00577)

1 July 2020 (s 2(1) item 1)

Private Health Insurance (Data Provision) Amendment Rules 2021

10 Feb 2021 (F2021L00110)

1 July 2021 (s 2(1) item 1)

Private Health Insurance (Data Provision) Amendment Rules 2022

13 May 2022 (F2022L00698)

1 July 2022 (s 2(1) item 1)

Private Health Insurance (Data Provision) Amendment Rules 2023

27 June 2023 (F2023L00879)

1 July 2023 (s 2(1) item 1)

Private Health Insurance (Data Provision) Amendment Rules 2024

17 Apr 2024 (F2024L00459)

1 July 2024 (s 2(1) item 1)

Private Health Insurance (Data Provision) Amendment Rules 2025

22 Apr 2025 (F2025L00512)

1 July 2025 (s 2(1) item 1)

Private Health Insurance (Data Provision) Amendment Rules (No. 2) 2025

21 Oct 2025 (F2025L01255)

1 Nov 2025 (s 2(1) item 1)

Endnote 4Amendment history

Provision affected

How affected

Part 1

s 2.............................................

rep LA s 48D

s 3.............................................

rep LA s 48C

s 4.............................................

am F2019L00817; F2020L00577; F2021L00110; F2022L00698; F2023L00879; F2024L00459; F2025L00512; F2025L01255

s 5.............................................

am F2025L01255

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