EXPLANATORY STATEMENT
Private Health Insurance Act 2007
Private Health Insurance (Data Provision) Amendment Rules (No.2) 2025
Authority
Subsection 333-20(1) of the Private Health Insurance Act 2007 (the Act) authorises the Minister for Health and Ageing 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 (No. 2) 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, Disability and Ageing (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 “Supplementary - HCP Data Specifications HCP1 Insurer to Department 2024-25”, (approved by the Assistant Secretary of the Private Hospitals Branch of the Department on 17 October 2025); and
- the matters contained in the document titled “Supplementary - HCP Data Specifications HCP1 Insurer to Department 2025-26”, (approved by the Assistant Secretary of the Private Hospitals Branch of the Department on 17 October 2025).
from the time the Amendment Rules commence.
The documents introduce supplementary HCP1 reporting requirements to private health insurers. The changes introduced are designed to facilitate improved data suppression to protect data from patient re-identification. The documents referred to above can be accessed free of charge on the Department’s website at: https://www.health.gov.au/resources/collections/hospital-data-resources.
The supplementary HCP1 data specifications update previously made documents by the Department and given effect under the Private Health Insurance (Data Provision) Amendment Rules 2024 and Private Health Insurance (Data Provision) Amendment Rules 2025. The key changes incorporated in the supplementary documents include:
- An addition of a new data item, Practitioner Provider Number, for separations from 1 July 2024.
- A prospective reporting requirement to submit HCP1 data for separations in the 2024-25 financial year which now includes the Practitioner Provider Number data item, along with a provision for the Department to extend deadlines for Private Health Insurers through written approval. Submissions of 2024-25 financial year HCP1 data must be provided on or after 1 November 2025 and before the end of 31 December 2025, unless an extension is provided in writing from the department before the end of 31 December 2025.
- An extension in reporting requirements for 2025-26 financial year HCP1 data from twenty to twenty-six and a half weeks. Submissions of data for separations during the month of July 2025 may commence from 1 November 2025 and must be submitted before the end of 31 January 2026. HCP1 Data for separations in the 2025-26 financial will also need to include the new Practitioner Provider Number data item.
These changes enable the department to apply suppression rules based on individual health professionals to protect data from re-identification. Without it, suppression is currently based on the number of hospitals contributing data, which is less precise and limits reporting details. These changes are made following consultation with external stakeholders through the Hospital Casemix Protocol and Private Hospital Data Bureau Working Group and changes introduced take effect on 1 November 2025.
Supply of HCP1 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 protected 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 November 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 group is 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: 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 (No. 2) 2025
Section 1 Name
Section 1 provides that the name of the instrument is the Private Health Insurance (Data Provision) Amendment Rules (No. 2) 2025.
Section 2 Commencement
Section 2 provides that the instrument commences on 1 November 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 – section 4 (definition of HCP1 Data from Insurers to the Department)
Item 1 repeals the existing the definition of HCP1 Data from Insurers to the Department in section 4 of the principal instrument 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 Supplementary – HCP Data Specifications HCP1 Insurer to Department 2025-26 approved by the Assistant Secretary of the Private Hospitals Branch of the Department of Health, Disability and Ageing on 17 October 2025 and which consists of:
(a) Explanatory Notes;
(b) Data Specifications – Episode;
(c) Data Specifications – Medical;
(d) Data Specifications – MDHT; and
(e) Data Specification – AN-SNAP.
Item 1 also inserts a new definition of HCP1 Data from Insurers to the Department 2024-25. The new definition of HCP1 Data from Insurers to the Department 2024-25 means the protocol set out in the document Supplementary – HCP Data Specifications HCP1 Insurer to Department 2024-25 approved by the Assistant Secretary of the Data and Analytics Branch of the Department of Health, Disability and Ageing on 17 October 2025 and which consists of:
(a) Explanatory Notes;
(b) Data Specifications – Episode;
(c) Data Specifications – Medical;
(d) Data Specifications – MDHT; and
(e) Data Specification – AN-SNAP.
Items 2 and 3 – section 5
Item 3 adds new paragraph 5(1)(ba) to the principal instrument to require private health insurers, for the purposes of subsection 172-10(1) of the Private Health Insurance Act 2007, to also provide the information specified in the HCP1 Data from Insurers to the Department 2024-25 to the Secretary of the Department.
Item 2 makes a consequential amendment to add “and” to the end of paragraph 5(1)(a).
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 (No. 2) 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 (No. 2) 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, Disability and Ageing (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 “Supplementary - HCP Data Specifications HCP1 Insurer to Department 2024-25”, (approved by the Assistant Secretary of the Private Hospitals Branch of the Department on 17 October 2025); and
- the matters contained in the document titled “Supplementary - HCP Data Specifications HCP1 Insurer to Department 2025-26”, (approved by the Assistant Secretary of the Private Hospitals Branch of the Department on 17 October 2025).
from the time the Amendment Rules commence.
The Amendment Rules will commence on 1 November 2025.
These documents can be found on the Department’s website at: https://www.health.gov.au/resources/collections/hospital-data-resources.
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 HCP1 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, Disability and Ageing