Health Insurance (prudential standard) determination No. 1 of 2017

Administered by Department of the Treasury

Legislation au F2017L00984 Not in force Legislative Instrument

Legislation content

Health Insurance (prudential standards) determination

 No. 1 of 2017

EXPLANATORY STATEMENT

Prepared by the Australian Prudential Regulation Authority (APRA)

Private Health Insurance (Prudential Supervision) Act 2015, section 92

Under subsection 92(1) of the Private Health Insurance (Prudential Supervision) Act 2015 (the Act), APRA has the power to determine standards (prudential standards), in writing, in relation to prudential matters to be complied with by private health insurers.  Under subsection 92(5) of the Act, APRA may, in writing, vary or revoke a prudential standard.

On 26 July 2017, APRA made Health Insurance (prudential standard) determination No. 1 of 2017, which revokes Prudential Standard HPS 001 Definitions made under Health Insurance (prudential standard) determination No. 1 of 2015, and replaces it with Prudential Standard HPS 001 Definitions (HPS 001).

The instrument commences on 1 April 2018.  

  1. Background

APRA’s mandate is to ensure the safety and soundness of prudentially regulated financial institutions so that they can meet their financial promises to depositors, policyholders and fund members within a stable, efficient and competitive financial system.

APRA carries out this mandate through a multi-layered prudential framework that encompasses licensing and supervision of institutions. In the case of the private health insurance industry, APRA is empowered under the Act to issue legally binding prudential standards that set out specific prudential requirements with which private health insurers must comply. These standards are supported by prudential practice guides, which clarify APRA’s expectations with regard to prudential requirements.

APRA regularly reviews its regulatory regime and amends its prudential requirements as a result of a number of factors including:

  • international developments;
  • changes in financial market conditions or changes in risk management practices, in response to identified weaknesses in the prudential framework; and
  • to reduce potential negative impacts of emerging industry issues.

 

2.      Purpose of the instrument

The purpose of the instrument is to revoke HPS 001 and to replace it with a new version of HPS 001.

 

HPS 001 incorporates common definitions used in private health insurance prudential standards in a single standard. Generally, only definitions that are unique to a particular prudential standard will be retained in that prudential standard, otherwise, definitions common to two or more prudential standards are consolidated in HPS 001.

3.      Operation of the instrument

The instrument makes changes to HPS 001 to insert a number of definitions from cross-industry Prudential Standard CPS 220 Risk Management (CPS 220), which will come into effect for private health insurers on 1 April 2018. A number of minor amendments were also made to existing definitions to harmonise language and to resolve minor typographical errors in the prudential standard.

4.      Consultation

In December 2016 APRA released for public consultation a discussion paper proposing to apply CPS 220 to the private health insurance industry. The consultation package included a draft of CPS 220, a prudential practice guide to facilitate private health insurers’ understanding of the prudential standard and an amended version of HPS 001 to facilitate the industry’s understanding of terminology used in CPS 220.

Stakeholders were given four months to provide comment on the proposed amendments to HPS 001. 

APRA also consulted the Department of Health.

Submissions were supportive of the proposed changes to HPS 001 subject to a number of minor changes which have been incorporated into the new version of HPS 001.

5.      Regulation Impact Statement

The Office of Best Practice Regulation advised that a Regulation Impact Statement was not required for this determination.

6.      Statement of compatibility prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

A Statement of compatibility prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011 is provided at Attachment A to this Explanatory Statement.


 

ATTACHMENT A

Statement of Compatibility with Human Rights

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

Prudential Standard HPS 001 Definitions (HPS 001)

This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011 (HRPS Act).

Overview of the Legislative Instrument

Prudential Standard HPS 001 Definitions sets out key definitions used in other prudential standards made by the Australian Prudential Regulation Authority (APRA) to which private health insurers must comply. The purpose of the instrument, is to improve private health insurers’ understanding of prudential requirements contained in prudential standards made by APRA under section 92(1) of the Private Health Insurance (Prudential Supervision) Act 2015.

 

The legislative instrument revokes HPS 001 determined by APRA in 2015 and replaces it with a new HPS 001 which includes additional definitions relating to risk management.

 

The instrument does not impose new prudential requirements on the industry.

Human rights implications

APRA has assessed this Legislative Instrument and is of the view that it does not engage any of the applicable rights or freedoms recognised or declared in the international instruments listed in section 3 of the HRPS Act. Accordingly, in APRA’s assessment, the instrument is compatible with human rights.

Conclusion

Prudential Standard HPS 001 Definitions is compatible with human rights as it does not raise any human rights issues.

 

Overview

The Private Health Insurance (Prudential Supervision) Act 2015, enacted by the Parliament of Australia, empowers the Australian Prudential Regulation Authority (APRA) to issue legally binding prudential standards to ensure the safety and soundness of private health insurers. The Act addresses a gap by providing a structured framework for prudential regulation in the private health insurance industry. APRA, in exercising its powers under section 92 of the Act, issued the Health Insurance (prudential standard) determination No. 1 of 2017 on 26 July 2017, which took effect on 1 April 2018. This determination revokes the previous Prudential Standard HPS 001 Definitions and replaces it with a revised version, consolidating common definitions used in private health insurance prudential standards. The revised standard incorporates definitions from cross-industry Prudential Standard CPS 220 Risk Management, aiming to enhance the industry's understanding of prudential requirements, particularly in relation to risk management. This legislative instrument does not introduce new prudential requirements but seeks to clarify and harmonise existing standards to better support the stability of the private health insurance sector.

Scope and Application

The Health Insurance (prudential standards) determination No. 1 of 2017 applies to private health insurers operating within Australia, who must comply with the prudential standards set by the Australian Prudential Regulation Authority (APRA) under the Private Health Insurance (Prudential Supervision) Act 2015. These standards aim to ensure the financial stability and soundness of private health insurers, enabling them to fulfil their commitments to policyholders. The instrument primarily affects entities engaged in the private health insurance industry across the Commonwealth. While the Act and its subordinate instruments do not specify particular exclusions, exemptions, or thresholds, they generally govern the operations of all private health insurers. The instrument revokes the previous Prudential Standard HPS 001 Definitions from 2015 and replaces it with an updated version, incorporating definitions from cross-industry Prudential Standard CPS 220 Risk Management, effective from 1 April 2018. This change aims to enhance the clarity and understanding of the prudential requirements for the industry. APRA periodically reviews and amends these standards in response to international developments, changes in market conditions, and emerging industry issues to maintain an effective prudential framework.

Key Provisions

The main operative sections of the Health Insurance (prudential standards) determination No. 1 of 2017 (HPS 001) are those that revoke the previous Prudential Standard HPS 001 and replace it with a new version. This determination, under section 92 of the Private Health Insurance (Prudential Supervision) Act 2015, empowers the Australian Prudential Regulation Authority (APRA) to set prudential standards that private health insurers must comply with. The new HPS 001 consolidates common definitions used across private health insurance prudential standards into a single standard, with specific definitions being unique to particular prudential standards. This consolidation aims to enhance clarity and reduce redundancy in regulatory terminology. APRA imposes specific obligations on private health insurers through this determination. Insurers must ensure that their operations and compliance frameworks align with the updated definitions provided in HPS 001. This includes integrating the new definitions into their policies, procedures, and documentation to maintain consistency and accuracy in their interpretation and application of prudential standards. Insurers are also required to update their internal systems and training programs to reflect these changes, ensuring that all staff are adequately informed about the revised definitions. Failure to comply with the prudential standards set out in HPS 001 can result in significant consequences for private health insurers. Although the determination itself does not introduce new prudential requirements, non-compliance with the definitions and standards it incorporates could lead to regulatory action by APRA. APRA has the authority to take enforcement measures against insurers who do not adhere to the prudential standards, which may include fines, public reprimands, or more severe penalties depending on the nature and severity of the breach. The maximum penalties for such breaches are not explicitly stated in the determination but are generally outlined in the overarching regulatory framework under which APRA operates.

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Insurance Law
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Regulation
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Definitions & Interpretation
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