Private Health Insurance (Data Provision) Amendment Rules 2020

Administered by Department of Health, Disability and Ageing

Legislation au F2020L00577 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

Private Health Insurance Act 2007

 

Private Health Insurance (Data Provision) Amendment Rules 2020  

 

Authority

 

Subsection 333-20(1) of the Private Health Insurance Act 2007 (the Act) authorises the Minister of Health to, by legislative instrument, make Private Health Insurance Rules. The types of rules are specified in the second column of the table provided in subsection 333-20. In particular, the Minister is authorised to make Private Health Insurance (Data Provision) Rules as specified in item 9 of the table at subsection 333-20. The rules provide for matters required or permitted by Part 4-5 of the Act, or necessary or convenient in order to carry out or give effect to Part 4-5 of the Act. Part 4-5 of the Act imposes miscellaneous notification and other obligations on private health insurers.

 

Subsection 33(3) of the Acts Interpretation Act 1901 provides that where an Act confers a power to make, grant or issue any instrument of a legislative or administrative character (including rules, regulations or by-laws), the power shall be construed as including a power exercisable in the like manner and subject to the like conditions (if any) to repeal, rescind, revoke, amend, or vary any such instrument.

 

Purpose

 

The Private Health Insurance (Data Provision) Amendment Rules 2020 (the Amendment Rules) amend the Private Health Insurance (Data Provision) Rules 2018 (the Rules) to update the information, relating to the treatment received by insured persons, that private health insurers must give to the Secretary of the Department of Health (the Department) under subsection 172‑10(1) of the Act. 

 

Background

 

The Rules apply and incorporate the following instruments without modifications:

  • the matters contained in the document titled “GT-Dental Data from Insurers to the Department”, (approved by the Assistant Secretary of the Data and Analytics Branch of the Department on 6 May 2020);
  • the matters contained in the document titled “HCP1 Data from Insurers to the Department”, (approved by the Assistant Secretary of the Data and Analytics Branch of the Department on 6 May 2020); and
  • the matters contained in the document titled “HCP2 Data from Insurers to the Department”, (approved by the Assistant Secretary of the Data and Analytics Branch of the Department on 6 May 2020),

 

from the time the Amendment Rules commence.

 

The documents referred to above can be accessed on the Department’s website using the following link: https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-casemix-data-collections-about-HCP (Hospital Casemix Protocol (HCP)).

 

Data specifications are reviewed routinely every year by the Department. Following consultation with external stakeholders changes are generally introduced effective 1 July in each financial year.

Changes to the 2020/21 data specifications are designed to align with national metadata standards published in METeOR, the Australian Institute of Health and Welfare’s Metadata online registry, and to improve data quality.

Supply of the GT-Dental Data, HCP1 Data and HCP2 Data involves private health insurers disclosing to the Department de-identified information about the treatment received by insured patients. Subsection 323-1(1) of the Act makes it an offence for a person to disclose protected information to another person that the first person obtains in the course of performing a duty, function or power under the Act, unless the disclosure is an authorised disclosure. The Act allows for a limited set of circumstances to be considered as authorised disclosures, one of which is to enable a person to perform functions in connection with a Medicare program. The collective effect of these provisions limit the way in which the Department deals with information about individuals.

Consultation

 

The Department has consulted with the private health insurance and private hospital industry about the Amendment Rules through existing working group arrangements. The working groups are comprised of representatives from the Department and industry stakeholders. Private health insurance and private hospital stakeholder representatives interested in developing the amendments also participated in the process. Feedback received from industry is that it is appropriate for amendments to be managed by the existing working group arrangements. Previous amendments to the data specifications have also been managed in this way. The amended data specifications are distributed to industry via a Private Health Insurance Circular published by the Department. Private Health Insurance Circulars can be accessed at the following link: https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-phicirculars2020-index1

 

The Amendment Rules are a legislative instrument for the purposes of the Legislation Act 2003.

 

The Amendment Rules commence on 1 July 2020.


Statement of Compatibility with Human Rights

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

 

Private Health Insurance (Data Provision) Amendment Rules 2020

This Disallowable 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.

 

Overview of the Disallowable Legislative Instrument

Private Health Insurance (Data Provision) Rules provide for matters required or permitted by Part 4‑5 of the Private Health Insurance Act 2007 (the Act), or necessary or convenient in order to carry out of give effect to Part 4-5 of the Act.

The Private Health Insurance (Data Provision) Rules 2018 (the Rules) specify the information, relating to the treatment received by insured persons, that private health insurers must give to the Secretary of the Department of Health (the Department) under subsection 172-10(1) of the Act.

The Private Health Insurance (Data Provision) Amendment Rules 2020 (the Amendment Rules) amend the Rules to update the information, relating to the treatment received by insured persons, that private health insurers must give to the Secretary of the Department under subsection 172-10(1) of the Act.

The Rules apply and incorporate the following instruments without modifications:

  • the matters contained in the document titled “GT-Dental Data from Insurers to the Department”, (approved by the Assistant Secretary of the Data and Analytics Branch of the Department) on 6 May 2020;
  • the matters contained in the document titled “HCP1 Data from Insurers to the Department”, (approved by the Assistant Secretary of the Data and Analytics Branch of the Department on 6 May 2020); and
  • the matters contained in the document titled “HCP2 Data from Insurers to the Department”, (approved by the Assistant Secretary of the Data and Analytics Branch of the Department on 6 May 2020),

 

from the time the Amendment Rules commence.

 

The amendments to the Rules requiring that the information requirements set out in those documents to be provided to the Department commence on 1 July 2020.

 

These documents can be found on the Department’s website using the following link: https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-casemix-data-collections-about-HCP (Hospital Casemix Protocol (HCP)).

 

Human rights implications

This Disallowable Legislative Instrument will engage the human right of privacy but will not result in any limitation of that right.

Supply of the GT-Dental Data, HCP1 Data and HCP2 Data involves private health insurers disclosing to the Department de-identified information about the treatment received by insured patients. Further, Part 6- 8 of the Act makes it an offence for a person to disclose protected information to another person that the first person obtains in the course of performing a duty, function or power under the Act, unless the disclosure is an authorised disclosure for the purposes of the Act. The effect of this provision is to limit the way in which the Department deals with information about individuals.

 

Conclusion

This Disallowable Legislative Instrument is compatible with human rights as, although it engages the right of privacy in relation to personal information, it will not derogate from that right.

 

Joanne Groube

A/g Assistant Secretary

Data and Analytics Branch

Department of Health

 

 

Overview

The Private Health Insurance (Data Provision) Amendment Rules 2020 were enacted to amend the Private Health Insurance (Data Provision) Rules 2018. These amendments were introduced to update the information regarding treatment received by insured persons, which private health insurers must provide to the Secretary of the Department of Health under subsection 172-10(1) of the Private Health Insurance Act 2007. Authorised by the Minister of Health under subsection 333-20(1) of the Act, the rules were formulated to ensure alignment with national metadata standards and to enhance data quality. This legislative instrument, which is a disallowable one, was developed following consultations with stakeholders from the private health insurance and private hospital industry through existing working group arrangements. The changes were designed to improve the quality and consistency of the data provided, without infringing upon the privacy rights of individuals, as outlined in the Statement of Compatibility with Human Rights. The Amendment Rules came into effect on 1 July 2020.

Scope and Application

The Private Health Insurance (Data Provision) Amendment Rules 2020 applies to private health insurers who must provide specific information to the Secretary of the Department of Health under subsection 172-10(1) of the Private Health Insurance Act 2007. These rules are amendments to the Private Health Insurance (Data Provision) Rules 2018, which specify the information insurers must disclose about the treatment received by insured persons. The Amendment Rules update these information requirements, aligning them with national metadata standards and improving data quality. The scope of these rules is national, as they apply across Australia and are enforced by the Commonwealth. There are no exclusions or exemptions specified within these Amendment Rules, though the Act itself provides for certain authorised disclosures that protect privacy and limit the use of personal information. The Amendment Rules, which are a legislative instrument, commenced on 1 July 2020 and are compatible with human rights, ensuring that while engaging the right to privacy, they do not result in any limitation of that right.

Key Provisions

The Private Health Insurance (Data Provision) Amendment Rules 2020 (the Amendment Rules) amend the Private Health Insurance (Data Provision) Rules 2018 (the Rules) to update the information that private health insurers must provide to the Secretary of the Department of Health under subsection 172-10(1) of the Private Health Insurance Act 2007 (the Act). The amendment rules specifically incorporate three documents approved by the Assistant Secretary of the Data and Analytics Branch of the Department on 6 May 2020, namely the "GT-Dental Data from Insurers to the Department", "HCP1 Data from Insurers to the Department", and "HCP2 Data from Insurers to the Department". These documents can be accessed on the Department’s website. The changes to the 2020/21 data specifications aim to align with national metadata standards and improve data quality. The Amendment Rules impose several obligations on private health insurers. Primarily, they must provide updated de-identified information about the treatment received by insured patients to the Department. This requirement is in accordance with subsection 172-10(1) of the Act. Furthermore, the Act mandates that any disclosure of protected information obtained in the course of performing duties under the Act must be an authorised disclosure. The amended rules ensure that the Department receives the necessary information for its functions related to Medicare programs while respecting privacy limitations. Failure to comply with the requirements set forth in the Amendment Rules can result in legal consequences. Under subsection 323-1(1) of the Act, it is an offence for a person to disclose protected information unless it is an authorised disclosure. This provision ensures that the Department can only use the information in ways that are permissible under the Act. The penalties for such breaches are not specified in the Amendment Rules but would be determined under the broader provisions of the Act. The Amendment Rules are 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. Although the rules engage the right to privacy, they do not result in any limitation of that right. The supply of de-identified information ensures that privacy is maintained while allowing the Department to use the data for its mandated functions. The rules reflect a balanced approach that respects privacy while enabling necessary data collection and analysis for health-related purposes.

Legal classification tags

Area of Law
Health Law
Instrument
Rules
Concepts
Definitions & Interpretation
Reporting & Disclosure Obligations
Compliance Obligations

Interactions

Authorises

All Versions

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.