Health Insurance (prudential standard) determination No. 2 of 2018

Administered by Department of the Treasury

Legislation au F2018L01401 Not in force Legislative Instrument

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Health Insurance (prudential standard) determination No. 2 of 2018

 

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 PHIPS 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 14 September 2018, APRA made Health Insurance (prudential standard) determination No. 2 of 2018, which revokes Prudential Standard HPS 001 Definitions made under Health Insurance (prudential standard) determination No. 1 of 2017, and determines a new Prudential Standard HPS 001 Definitions (HPS 001).

The instrument commences on 1 July 2019.

  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 include new terminology that can usefully be defined in this Legislative Instrument.

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, defining the terms associated with the new governance, fit and proper and audit requirements.

 

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 Standards CPS 510 Governance (CPS 510) and CPS 520 Fit and Proper (CPS 520) and a new Prudential Standard HPS 310 Audit and related matters (HPS 310), which will come into effect for private health insurers on 1 July 2019. These include references to the new Appointed Auditor position arising from HPS 310; the Board Risk and Remuneration Committees required by CPS 510 and the meaning of a responsible person for the purposes of CPS 520.

4.      Consultation

In February 2018 APRA released for public consultation a discussion paper proposing to apply CPS 510 and CPS 520, and introduce HPS 310, to the private health insurance industry. The consultation package included drafts of CPS 510 and CPS 520 and their associated prudential practice guides to facilitate private health insurers’ understanding of the prudential standard and a draft HPS 310 and an amended version of HPS 001 to facilitate the industry’s understanding of terminology used in these Prudential Standards.

Stakeholders were given three months to provide comment on the proposed amendments to HPS 001. Submissions were supportive of the proposed changes to 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

Health Insurance (prudential standard) determination No. 2 of 2018

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

The Legislative Instrument revokes Prudential Standard HPS 001 Definitions made under Health Insurance (prudential standard) determination No. 1 of 2017, and determines a new Prudential Standard HPS 001 Definitions (HPS 001) which includes additional definitions relating to the new governance, fit and proper and audit requirements.

 

HPS 001 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 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

This Legislative Instrument is compatible with human rights as it does not raise any human rights issues.

 

Overview

The Health Insurance (prudential standard) determination No. 2 of 2018 was enacted to address the need for a consolidated and updated set of definitions for terms used in the prudential standards for the private health insurance industry. This determination was made by the Australian Prudential Regulation Authority (APRA) under the authority granted by section 92 of the Private Health Insurance (Prudential Supervision) Act 2015. The policy objective of this legislative instrument is to enhance the clarity and consistency of prudential requirements by replacing the existing Prudential Standard HPS 001 Definitions with a new version that incorporates definitions from cross-industry standards such as CPS 510 Governance and CPS 520 Fit and Proper, as well as a new standard HPS 310 Audit and related matters. The determination aims to facilitate better understanding and compliance by private health insurers without imposing additional prudential requirements.

Scope and Application

The Health Insurance (prudential standard) determination No. 2 of 2018, made by the Australian Prudential Regulation Authority (APRA), applies to private health insurers regulated under the Private Health Insurance (Prudential Supervision) Act 2015. This legislation sets out prudential standards that private health insurers must comply with to ensure their safety and soundness, thereby protecting the interests of policyholders and the broader financial system. The instrument revokes the previous Prudential Standard HPS 001 Definitions and introduces a new version, effective from 1 July 2019, to incorporate definitions relevant to new governance, fit and proper, and audit requirements. These definitions aim to provide clarity and uniformity across various prudential standards, ensuring that private health insurers understand the terminology and requirements they must adhere to. The instrument does not impose new prudential requirements but rather seeks to enhance the industry's understanding of existing standards. The instrument's scope is national, applying across the Commonwealth of Australia, and it does not contain any stated exclusions or exemptions. APRA's authority to determine and modify prudential standards extends through subordinate instruments as specified in the Act.

Key Provisions

The Health Insurance (prudential standard) determination No. 2 of 2018, issued by the Australian Prudential Regulation Authority (APRA), primarily focuses on revising the definitions outlined in Prudential Standard HPS 001 (HPS 001). Specifically, the determination revokes the previous HPS 001 Definitions from the 2017 determination and introduces a new HPS 001, which consolidates definitions related to governance, fit and proper, and audit requirements (paragraphs 2 and 3). This revision aims to streamline and enhance the clarity of definitions used across various prudential standards applicable to private health insurers. The changes are set to take effect on 1 July 2019, ensuring that insurers have ample time to adapt to the new definitions, which include terms such as the Appointed Auditor position, Board Risk and Remuneration Committees, and the meaning of a responsible person (paragraph 3). In terms of obligations, private health insurers must comply with the definitions and requirements set forth in HPS 001 as these definitions underpin other prudential standards issued by APRA under the Private Health Insurance (Prudential Supervision) Act 2015 (PHIPS Act). These definitions are crucial for the consistent application of prudential standards, ensuring that all stakeholders have a uniform understanding of the terminology. Insurers must ensure their practices and internal documentation align with these definitions to maintain compliance with APRA's regulatory framework (paragraph 2). There are no direct offences or penalties outlined in this determination itself. However, non-compliance with the prudential standards that rely on these definitions could result in enforcement actions by APRA. These actions may include fines, corrective actions, or other regulatory measures to ensure the safety and soundness of the private health insurance industry. The overarching aim is to maintain a stable and efficient financial system by ensuring insurers meet their obligations as defined by APRA (paragraphs 2 and 6).

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