Private Health Insurance (Data Provision) Amendment Rules 2021

Administered by Department of Health, Disability and Ageing

Legislation au F2021L00110 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

Private Health Insurance Act 2007

 

Private Health Insurance (Data Provision) Amendment Rules 2021  

 

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 2021 (the Amendment Rules) amends 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 4 Feb 2021);
  • 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 4 Feb 2021); 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 4 Feb 2021),

 

     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 2021/22 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. This information is protected by s 323-1(1) of the Act, which makes it an offence to disclose the information where the disclosure is not authorised by the Act.  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 (subsection 323-5(b)). The collective effect of these provisions limit the purposes for which protected information may be used or disclosed.

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://www.health.gov.au/news/phi-circulars

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

 

The Amendment Rules commence on 1 July 2021.


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 2021

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 2021 (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 4 Feb 2021;
  • 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 4 Feb 2021); 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 4 Feb 2021),

 

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 2021.

 

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. This information is protected by s 323-1(1) of the Act, which makes it an offence to disclose the information where the disclosure is not authorised by the Act.   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 (subsection 323-5(b)). The collective effect of these provisions limit the purposes for which protected information may be used or disclosed.

 

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.

 

Richard Hurley

 Acting Assistant Secretary

Data and Analytics Branch

Department of Health

 

 

Overview

The Private Health Insurance (Data Provision) Amendment Rules 2021, enacted to amend the Private Health Insurance (Data Provision) Rules 2018, were introduced to update the information private health insurers must provide to the Department of Health. Authorised by the Minister of Health under subsection 333-20(1) of the Private Health Insurance Act 2007, these Amendment Rules aim to ensure that the data specifications align with national metadata standards and improve data quality. The Rules require private health insurers to disclose de-identified information about the treatment received by insured patients to the Department, which is protected under the Act, and can only be disclosed in authorised circumstances, such as enabling functions related to the Medicare program. The changes are designed to be effective from 1 July 2021, following consultations with private health insurance and private hospital industry stakeholders.

Scope and Application

The Private Health Insurance (Data Provision) Amendment Rules 2021, made under the authority of the Private Health Insurance Act 2007, serve to update the information requirements for private health insurers in relation to the treatment of insured persons. These rules apply to private health insurers and mandate that they provide specific de-identified information to the Secretary of the Department of Health. The amendment rules incorporate the updated data specifications approved on 4 February 2021, which align with national metadata standards to improve data quality. These specifications pertain to GT-Dental Data, HCP1 Data, and HCP2 Data, and are intended to support the Department’s data collection efforts, particularly in relation to Medicare programs. The rules are designed to ensure that the data provided is protected and can only be used for authorised purposes, thereby safeguarding the privacy of insured patients. The amendment rules came into effect on 1 July 2021 and are subject to review and potential further amendment annually.

Key Provisions

The Private Health Insurance (Data Provision) Amendment Rules 2021 (Amendment Rules) amend the Private Health Insurance (Data Provision) Rules 2018 (Rules) to update the information, relating to the treatment received by insured persons, that private health insurers must provide to the Secretary of the Department of Health (Department) under subsection 172-10(1) of the Private Health Insurance Act 2007 (Act). The amendment includes updating the information specifications for GT-Dental Data, HCP1 Data, and HCP2 Data, which are incorporated without modifications from documents approved by the Assistant Secretary of the Data and Analytics Branch of the Department on 4 February 2021. These specifications are designed to align with national metadata standards and improve data quality. The changes will come into effect on 1 July 2021, and the relevant documents can be accessed on the Department’s website. The Amendment Rules impose specific obligations on private health insurers to supply updated de-identified information about the treatment received by insured patients to the Department. This requirement ensures that the Department receives the most current and accurate data to support health policy and program functions, particularly in relation to Medicare. The data must be de-identified to protect patient privacy, and its disclosure is strictly regulated under section 323-1(1) of the Act. Authorised disclosures are limited to those necessary for performing functions in connection with a Medicare program, as specified in subsection 323-5(b) of the Act. These provisions ensure that the use and disclosure of protected information are limited to specific purposes, thereby safeguarding patient privacy. Failure to comply with the requirements of the Amendment Rules may result in legal consequences. Section 323-1(1) of the Act makes it an offence to disclose protected information without authorisation. The penalty for such an offence is set out in section 323-2 of the Act, which may include fines and imprisonment. Additionally, non-compliance with the data provision requirements under the Act may lead to administrative actions, such as penalties or sanctions, as prescribed by the Department. These measures are in place to ensure that private health insurers adhere to the data provision obligations and maintain the integrity of the health information system. The Amendment Rules are compatible with human rights, particularly the right to privacy, as they require the disclosure of de-identified information for specified purposes. The Act’s provisions limit the purposes for which protected information may be used or disclosed, ensuring that patient privacy is maintained. The Department has consulted with industry stakeholders during the development of the Amendment Rules, ensuring that the changes are appropriate and manageable within existing working group arrangements. The compatibility statement confirms that the Amendment Rules engage the right of privacy but do not result in any limitation of that right.

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Area of Law
Privacy Law
Health Law
Instrument
Regulation
Concepts
Reporting & Disclosure Obligations
Compliance Obligations
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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.