Health Insurance (prudential standard) determination No. 8 of 2023

Administered by Department of the Treasury

Legislation au F2023L00691 In force Legislative Instrument

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Health Insurance (prudential standard) determinations No. 8 of 2023

REPLACEMENT 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 power to determine 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 that applies to private health insurers.

On 24 May 2023, APRA made Health Insurance (prudential standard) determination No. 8 of 2023, which revokes Prudential Standard HPS 310 Audit and Related Matters made under Health Insurance determination No. 1 of 2019 and determines a new Prudential Standard HPS 310 Audit and Related Matters (HPS 310).

The instrument commences on 1 July 2023.

1. Background

Capital standards are an important tool to support the objectives of APRA’s prudential framework. They are intended to ensure that an insurer has sufficient financial resources available to meet its financial promises to policy holders despite adverse conditions. APRA’s capital standards determine the minimum regulatory capital requirement for an insurer, taking into account the nature of the risks an insurer is exposed to in its business.

Since assuming prudential regulatory responsibility for the private health insurance industry in 2015, APRA has progressively reviewed and updated the prudential policy framework. APRA’s review of the capital framework represents the third and final phase of that systematic process.

The review of the private health insurance capital framework revealed that, in a number of respects, the former capital framework was less robust than the requirements applied to other Australian insurance sectors and did not appropriately reflect the risks faced by insurers.

The new private health insurance capital framework seeks to address these concerns by ensuring there is an appropriate level of financial resilience and protection for policyholders through:

improved risk sensitivity of the capital standards to better reflect the risks faced by private health insurers;
reduced discretion available to private health insurers to determine their capital requirements, so as to narrow the differences between insurers with similar business models and profiles; and
alignment with the structure of the life and general insurance capital framework, where appropriate. This reflects APRA’s overall approach to capital quality and adequacy and is consistent with international best practice.

The changes to the private health insurance capital framework also incorporate changes to APRA’s insurance capital framework due to the new accounting standard AASB 17 Insurance Contracts (AASB 17). This ensures alignment between he prudential and accounting requirements and reduces cost and complexity for industry from otherwise needing to manage and report on diverging frameworks.

2. Purpose and operation of the instrument

The purpose of this instrument is to revoke HPS 310 and replace it with a new version of HPS 310.

HPS 310 outlines the roles and responsibilities that a private health insurer must require of its Appointed Auditor. This standard has been updated to clarify that quarterly reporting standards require limited assurance. The standard has also been updated to reflect changes in the level of assurance required for auditable returns.

Exercise of discretion by APRA

Under subsection 92(4) of the Act, a prudential standard may provide for APRA to exercise powers and discretions under the standard, including (but not limited to) discretions to approve, impose, adjust or exclude specific prudential requirements in relation to a particular private health insurer.

HPS 310 includes powers to adjust or exclude a provision of the standard, which may be exercised by APRA that involve an element of discretion.

APRA considers a wide range of factors when exercising its discretion under prudential standards, including the considerations set out in the Act and the Australian Prudential Regulation Authority Act 1998. The need to apply discretion is driven by entity specific issues and circumstances which are not adequately addressed by the generally applicable provisions of the prudential standards.

Adjust and exclude powers

Paragraph 26 of HPS 310 provides for APRA to adjust or exclude a specific prudential requirement in relation to a particular private health insurer. APRA will exercise this power if it is satisfied that the exclusion or adjustment of the specific requirement will achieve a better prudential outcome than if it remained in its original form. In other cases, an adjustment or exclusion may be necessary to give APRA comfort that the prudential requirements apply appropriately to protect policy holders (for example when action may need to be taken urgently and with certainty that the insurer will comply with the adjusted requirements). Other considerations include efficiency, competition, contestability, competitive neutrality and regulatory burden, including comparisons with the entity’s peer group.

A decision to exercise the powers under a prudential standard is subject to a robust decision-making framework which is documented in APRA’s internal policies. This framework supports APRA in fulfilling its mandate by limiting decision making to those senior APRA officers with the appropriate experience and skill to exercise prudent judgement. The framework also requires decision makers to seek advice from internal experts.

The adjust and exclude power is exercised following discussion with the relevant private health insurer about its appropriateness and the impact it may have on the entity.

Review of decisions

Decisions made by APRA exercising its powers under the Act are not subject to merits review. APRA considers decisions made by APRA exercising discretions under its prudential standards should not be subject to merits review as they are financial decisions with a significant public interest element.

A breach of a prudential standard is also a breach of the Act, as the Act provides that a private health insurer must comply with the prudential standard. However, there are no penalties prescribed for such breaches. Instead, a private health insurer’s breach of a provision in the Act is grounds for APRA to make further, substantive decisions under the Act.

Documents incorporated by reference

Under paragraph 14(1)(a) of the Legislation Act 2003, the prudential standard incorporates by reference as in force from time to time:

Acts of Parliament and associated delegated legislation;
Prudential Standards determined by APRA under subsection 92(1) of the Act; and
Reporting Standards determined by APRA under subsection 13(1) of the Financial Sector (Collection of Data) Act 2001;

which are available on the Federal Register of Legislation at www.legislation.gov.au.

Under subsection 92(7) of the Act, the standard incorporates by reference, as it exists from time to time:

the Australian Accounting Standards determined by the Australian Accounting Standards Board (AASB) under section 334 of the Corporations Act 2001 (the Corporations Act), which are available on the AASB website at https://aasb.gov.au/; and
the Australian Auditing Standards determined by the Auditing and Assurance Standards Board (AUASB) under section 336 of the Corporations, which are available on the AUASB website at https://auasb.gov.au.

3. Consultation

This and other prudential standards, forming the new private health insurance capital framework, are the product of extensive consultation with the industry and other key stakeholders. Submissions were received from, and discussions held with, private health insurers, industry bodies and other government agencies.

Submissions were largely supportive of aligning the private health insurance capital framework with the requirements for life and general insurers. Key areas of feedback from submissions included the treatment of the deferred claims liability within the capital framework, the allowance for management actions, and the design of the insurance risk charge. Insurers also raised the scale of the increase in minimum regulatory capital requirements and the impact this could have on premiums.

A number of public discussion and response papers were released during and following the consultation periods with draft standards accompanying the December 2021 response paper:

November 2018: Letter Roadmap for APRA’s review of the private health insurance capital framework;
December 2019: Discussion Paper Private Health Insurance Capital Standards Review;
December 2021: Response Paper A proposed new capital framework for Private Health Insurance;
December 2021: Quantitative Impact Study;
December 2021: Response Paper Integrating AASB 17 into the capital and reporting framework for insurers and updates to the LAGIC framework;
April 2022: Letter Integrating AASB17 into the Capital and reporting framework for insurers and updates to private health insurer capital framework;
September 2022: Response paper Finalising the review of the Private Health Insurance Capital Framework; and
September 2022: Response Paper Finalisation of the integration of AASB 17 into the capital and reporting frameworks for insurers and updates to the LAGIC framework.

APRA is satisfied the consultation was appropriate and reasonably practicable.

4. Impact Analysis

In making the new prudential standards, including HPS 310, APRA has followed a process which satisfies the requirements of the Office of Impact Analysis (OIA). APRA has followed a similar process to that required for a Regulation Impact Statement which satisfies the OIA’s requirements. APRA’s policy development process is evidenced in Attachment A of the Response Paper Finalising the review of the Private Health Insurance Capital Framework. An extract of Attachment A has been lodged as supporting material.

5. 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 to this Explanatory Statement.

ATTACHMENT

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. 8 of 2023

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

Overview of the legislative instrument

The purpose of the legislative instrument is to revoke Prudential Standard HPS 310 Audit and Related Matters made under Health Insurance determination No. 1 of 2019 and determines a new Prudential Standard HPS 310 Audit and Related Matters.

Human rights implications

APRA has assessed the 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 legislative 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. 8 of 2023, issued under the Private Health Insurance (Prudential Supervision) Act 2015 by the Australian Prudential Regulation Authority (APRA), seeks to address gaps in the previous capital framework for private health insurers. The Act empowers APRA to set and revise prudential standards for private health insurers to ensure they maintain sufficient financial resources to meet policyholder obligations during adverse conditions. The new Prudential Standard HPS 310 Audit and Related Matters, which replaces the earlier version, aims to enhance the robustness of the capital framework, aligning it more closely with the standards applied to other insurance sectors and international best practices. This update focuses on improving the risk sensitivity of capital standards, reducing insurer discretion in determining capital requirements, and ensuring alignment with the life and general insurance capital frameworks. The changes also incorporate updates from the new accounting standard AASB 17, reducing industry complexity and cost by harmonising prudential and accounting requirements.

Scope and Application

The Health Insurance (prudential standard) determination No. 8 of 2023 applies to private health insurers operating within Australia. This legislation, enacted by the Australian Prudential Regulation Authority (APRA) under the authority granted by the Private Health Insurance (Prudential Supervision) Act 2015, is designed to establish and update prudential standards that these insurers must comply with. Specifically, the instrument revokes the previous Prudential Standard HPS 310 Audit and Related Matters and introduces a new version of the same standard, effective from 1 July 2023. The new standard outlines the roles and responsibilities of Appointed Auditors for private health insurers, updating requirements for quarterly reporting and the level of assurance needed for auditable returns. APRA retains discretion to adjust or exclude specific prudential requirements for individual insurers, subject to a robust decision-making process that considers various factors including entity-specific issues and the overall prudential outcome. This instrument incorporates by reference other legislative instruments, including Australian Accounting Standards and Australian Auditing Standards. APRA has ensured the development of these standards through extensive consultation with industry stakeholders and has assessed the compatibility of the legislative instrument with human rights, concluding that it does not engage any of the applicable rights or freedoms as recognised by relevant international instruments.

Key Provisions

The main operative sections of the Health Insurance (prudential standard) determination No. 8 of 2023 include the revocation of Prudential Standard HPS 310 Audit and Related Matters made under Health Insurance determination No. 1 of 2019, and the establishment of a new version of HPS 310 (section 1). The revised HPS 310 details the roles and responsibilities that a private health insurer must impose on its Appointed Auditor, clarifying that quarterly reporting standards require limited assurance and updating the level of assurance required for auditable returns (section 2). Under subsection 92(4) of the Private Health Insurance (Prudential Supervision) Act 2015 (the Act), the prudential standard allows the Australian Prudential Regulation Authority (APRA) to exercise discretions, including approving, imposing, adjusting, or excluding specific prudential requirements for particular private health insurers (section 2). The obligations and requirements imposed by the Act on the parties it governs include the necessity for private health insurers to comply with the prudential standards set forth by APRA. These standards are designed to ensure that insurers maintain sufficient financial resources to meet their obligations to policyholders, even under adverse conditions. Private health insurers must adhere to the new HPS 310, which specifies the responsibilities of Appointed Auditors, including the assurance level required for different types of reports. Additionally, APRA retains the discretion to adjust or exclude certain prudential requirements based on entity-specific circumstances, aiming to achieve a better prudential outcome. This discretion must be exercised with consideration of factors such as efficiency, competition, and regulatory burden, and it is subject to a documented decision-making framework within APRA (section 2). The determination does not prescribe specific penalties for breaches of prudential standards. However, any breach of a prudential standard constitutes a breach of the Act, and APRA has the authority to make further substantive decisions under the Act in response to such breaches. The determination incorporates by reference various Acts of Parliament, delegated legislation, Prudential Standards, Reporting Standards, Australian Accounting Standards, and Australian Auditing Standards, ensuring alignment with broader regulatory frameworks (section 2). Decisions made by APRA exercising its powers under the Act are not subject to merits review, as they are considered financial decisions with significant public interest elements (section 2). The consequences of breaching the prudential standards revolve around the potential for APRA to take further action under the Act. Although specific penalties are not detailed in the determination, the Act allows APRA to address non-compliance through various measures, such as imposing additional requirements or sanctions on the offending insurer. This approach ensures that breaches are managed in a manner consistent with the public interest and the objectives of the prudential supervision framework (section 2).

Area of Law: Financial Regulation; Insurance Law
Instrument: Regulation
Concepts: Definitions & Interpretation; Regulatory Standards; Enforcement Powers; Consultation Requirements

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.

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