Private Health Insurance (Data Provision) Amendment Rules 2025

Administered by Department of Health, Disability and Ageing

Legislation au F2025L00512 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

Private Health Insurance Act 2007

 

Private Health Insurance (Data Provision) Amendment Rules 2025  

 

Authority

 

Subsection 333-20(1) of the Private Health Insurance Act 2007 (the Act) authorises the Minister for Health and Aged Care 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(1). In particular, the Minister is authorised to make Private Health Insurance (Data Provision) Rules as specified in item 9 of the table in subsection 333-20(1). 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 2025 (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 and Aged Care (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 Private Hospitals Branch of the Department on 14 April 2025);
  • the matters contained in the document titled “HCP1 Data from Insurers to the Department”, (approved by the Assistant Secretary of the Private Hospitals Branch of the Department on 14 April 2025); and
  • the matters contained in the document titled “HCP2 Data from Insurers to the Department”, (approved by the Assistant Secretary of the Private Hospitals Branch of the Department on 14 April 2025),

 

from the time the Amendment Rules commence.

 

The documents referred to above can be accessed free of charge on the Department’s website using the following link: https://www.health.gov.au/resources/collections/hospital-data-resources.

 

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 2025/26 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 subsection 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 (paragraph 323-5(b)). The collective effect of these provisions limit the purposes for which protected information may be used or disclosed.

Commencement

The Amendment Rules commence on 1 July 2025.

Consultation

 

The Department has consulted with private health insurers and the hospital sector (private and public) about the Amendment Rules through existing working group arrangements. The working groups are comprised of representatives from the Department and industry stakeholders. 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.

 


Attachment

 

Details of the Private Health Insurance (Data Provision) Amendment Rules 2025

Section 1         Name

Section 1 provides that the name of the instrument is the Private Health Insurance (Data Provision) Amendment Rules 2025.

 

Section 2         Commencement

Section 2 provides that the instrument commences on 1 July 2025.

Section 3         Authority

Section 3 provides that the Amendment Rules are made under item 9 of the table in subsection 333-20(1) of the Private Health Insurance Act 2007.

Section 4         Schedules

Section 4 provides that each instrument that is specified in a Schedule to the instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to the instrument has effect according to its terms.

Schedule 1—Amendments

Private Health Insurance (Data Provision) Rules 2018

Item 1 repeals the existing definition of GT-Dental Data from Insurers to the Department and then substitutes a new definition of GT-Dental Data from Insurers to the Department. The new definition of GT-Dental Data from Insurers to the Department means the protocol set out in the document approved by the Assistant Secretary of the Private Hospitals Branch of the Department of Health and Aged Care on 14 April 2025 which consists of “Data Specifications (GT-Dental)” and “Explanatory Notes (GT-Dental)”.

Item 2 repeals the existing the definition of HCP1 Data from Insurers to the Department and then substitutes a new definition of HCP1 Data from Insurers to the Department. The new definition of HCP1 Data from Insurers to the Department means the protocol set out in the document approved by the Assistant Secretary of the Private Hospitals Branch of the Department of Health and Aged Care on 14 April 2025 which consists of “Data Specifications (HCP1)” and “Explanatory Notes (HCP1)”.

Item 3 repeals the existing definition of HCP2 Data from Insurers to the Department and then substitutes a new definition of HCP2 Data from Insurers to the Department. The new definition of HCP2 Data from Insurers to the Department means the protocol set out in the document approved by the Assistant Secretary of the Private Hospitals Branch of the Department of Health and Aged Care on 14 April 2025 which consists of “Data Specifications (HCP2)” and “Explanatory Notes (HCP2)”. 

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 2025

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) Amendment Rules 2025 (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 and Aged Care (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 Private Hospitals Branch of the Department) on 14 April 2025;
  • the matters contained in the document titled “HCP1 Data from Insurers to the Department”, (approved by the Assistant Secretary of the Private Hospitals Branch of the Department on 14 April 2025); and
  • the matters contained in the document titled “HCP2 Data from Insurers to the Department”, (approved by the Assistant Secretary of the Private Hospitals Branch of the Department on 14 April 2025),

 

from the time the Amendment Rules commence.

 

The Amendment Rules will commence on 1 July 2025.

 

These documents can be found on the Department’s website using the following link: https://www.health.gov.au/news/phi-circulars.

 

Human rights implications

The Amendment Rules engage the human right to privacy under Article 17 of the International Covenant on Civil and Political Rights, but does 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 subsection 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 (paragraph 323-5(b)). The collective effect of these provisions limit the purposes for which protected information may be used or disclosed.

Conclusion

The Amendment Rules are compatible with human rights as although it engages the right to privacy in relation to the disclosure of personal information, it does not derogate from that right.

 

Brian Kelleher

Assistant Secretary

Private Hospitals Branch

Department of Health and Aged Care

 

 

Overview

The Private Health Insurance (Data Provision) Amendment Rules 2025 were enacted to update the information that private health insurers must provide to the Secretary of the Department of Health and Aged Care regarding the treatment received by insured persons. The rules amend the Private Health Insurance (Data Provision) Rules 2018 to reflect changes in national metadata standards and to improve data quality, ensuring alignment with the Australian Institute of Health and Welfare’s Metadata Online Registry (METeOR). Authorised by subsection 333-20(1) of the Private Health Insurance Act 2007, these rules are designed to facilitate the disclosure of de-identified patient treatment data in a manner compliant with privacy protections under subsection 323-1(1) of the Act. The rules, which commence on 1 July 2025, were developed following consultations with private health insurers and the hospital sector through existing working group arrangements and are distributed to industry via Private Health Insurance Circulars. The amendment ensures that the data specifications are updated annually, reflecting a commitment to maintaining high data quality and relevance for policy and program purposes.

Scope and Application

The Private Health Insurance (Data Provision) Amendment Rules 2025 amends the Private Health Insurance (Data Provision) Rules 2018 to update the information, specifically relating to the treatment received by insured persons, that private health insurers are required to provide to the Secretary of the Department of Health and Aged Care under the Private Health Insurance Act 2007. These Amendment Rules apply to private health insurers who must supply de-identified data regarding the treatment received by insured patients to the Department. The data specifications involved are reviewed annually and updated to align with national metadata standards and improve data quality. The rules ensure that the information is protected by the Act, which makes unauthorised disclosure an offence, except under specific circumstances authorised by the Act, such as enabling functions related to the Medicare program. These Amendment Rules commence on 1 July 2025 and are made under the authority provided by the Private Health Insurance Act 2007. The Department has consulted with relevant stakeholders, including private health insurers and the hospital sector, about these amendments through existing working group arrangements, ensuring that the changes are managed appropriately. The Amendment Rules also address human rights considerations, particularly the right to privacy under Article 17 of the International Covenant on Civil and Political Rights. While the rules require the disclosure of personal information, they do not result in any limitation of this right as the Act provides stringent protections for the information being disclosed. The rules ensure that the data provided to the Department is limited to authorised purposes, thereby safeguarding the privacy of individuals whose data is included in the reporting requirements.

Key Provisions

The Private Health Insurance (Data Provision) Amendment Rules 2025, which amend the Private Health Insurance (Data Provision) Rules 2018, update the data specifications for the information that private health insurers must provide to the Secretary of the Department of Health and Aged Care. These specifications pertain to the treatment received by insured patients and include the GT-Dental Data, HCP1 Data, and HCP2 Data (Schedule 1, Item 1-3). The amendment rules are designed to align with national metadata standards and to improve data quality, as stated in the explanatory statement. These rules commence on 1 July 2025 and are accessible on the Department's website. The Amendment Rules impose several obligations on private health insurers, primarily concerning the provision of updated and accurate data to the Department. Insurers must ensure that the information they disclose aligns with the revised data specifications set out in the amended rules. This includes supplying de-identified information about the treatment received by insured patients, which is protected under subsection 323-1(1) of the Private Health Insurance Act 2007. The data must be provided in accordance with the protocols outlined in the documents approved by the Assistant Secretary of the Private Hospitals Branch of the Department on 14 April 2025. These documents, detailing the data specifications and explanatory notes for GT-Dental, HCP1, and HCP2 data, are incorporated by reference in the rules. Failure to comply with the obligations set out in the Amendment Rules may result in legal consequences. Under subsection 323-1(1) of the Private Health Insurance Act 2007, it is an offence to disclose protected information without authorisation, with certain exceptions provided by the Act, such as disclosures necessary for Medicare-related functions. Breaches of these provisions may lead to civil or criminal penalties. While the Amendment Rules themselves do not specify penalties, the overarching Act and related regulations may impose sanctions, including fines and potential imprisonment, for unauthorised disclosures of protected information. The exact penalties would depend on the specific breach and applicable laws.

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Area of Law
Health Law
Instrument
Regulation
Concepts
Reporting & Disclosure Obligations
Compliance Obligations
Data Protection

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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.