Private Health Insurance (Data Provision) Rules 2007

Administered by Department of Health, Disability and Ageing

Legislation au F2007L00900 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

Issued by the Authority of the Minister for Health and Ageing

 

Private Health Insurance Act 2007

 

Private Health Insurance (Data Provision) Rules 2007

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Data Provision) Rules (the Rules) providing 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.

As part of reforms to private health insurance announced by the Australian Government on 26 April 2006, regulation of private health insurance was moved from the National Health Act 1953 (NHA) (and regulations under the NHA), into the new Private Health Insurance Act 2007 (PHI) (and Private Health Insurance Rules made under the PHI).

 

These Rules specify the kinds of information, relating to the treatment of insured persons of health benefits funds, that private health insurers are to give to the Secretary of the Department. 

 

The kinds of information specified are those set out in the Hospital Casemix Protocol.  The Hospital Casemix Protocol is defined as the protocol set out in Schedule 7 of the National Health Regulations 1954 as in force immediately before the commencement of the Act, with some updating to reflect the terms used in the PHI.

 

Under subsection 73AB(1) of the NHA it was a condition of registration of a private health insurer that it must give to the Department information required under the Hospital Casemix Protocol.  These Rules do not introduce new requirements.

 

The Act does not specify any conditions that need to be met before the power to make the Rules may be exercised. 

 

Private health insurers were extensively consulted and provided with opportunities to comment upon the new Private Health Insurance legislative package.  Draft Rules were published on the Departmental website for comment, and information sessions were held to provide industry stakeholders with the opportunity to be consulted on the making of the Rules.

 

Consultations were attended by representatives from individual private health insurers and peak industry bodies (the Australian Health Insurance Association and Health Insurance Restricted Membership Association members funds), private hospitals and their industry representatives (Australian Private Hospitals Association and Catholic Health Australia), the Australian Medical Association, the Private Health Insurance Administration Council, the Private Health Insurance Ombudsman, Consumers’ Health Forum of Australia and central agencies.  All of the industry representatives have expressed strong support for the proposed legislative framework including the Private Health Insurance Rules.

 

The Office of Best Practice Regulation has advised that no additional Regulation Impact Statement (RIS) is required.  A RIS that was prepared for the Private Health Insurance Bill 2006 (PHI Bill) which analysed the options associated with the Australian Government’s recent initiatives to improve the attractiveness of and participation in private health insurance for consumers.  The measures include those under the Private Health Insurance Act 2007 and associated legislative instruments.

 

Details of the Rules are set out in the Attachment.

 

The Rules are a legislative instrument for the purposes of the Legislative Instruments Act 2003. 

 

The Rules commence at the same time as the Act commences if they are registered before the Act commences; or, if the Rules are registered on or after the Act commences, the Rules commence on the day they are registered.

 

Authority: Section 333-20 of the Private Health Insurance Act 2007.


ATTACHMENT

 

DETAILS OF THE PRIVATE HEALTH INSURANCE (DATA PROVISION) RULES 2007

 

1. Name of Rules

 

Rule 1 provides that the title of the Rules is the Private Health Insurance (Data Provision) Rules 2007.

 

2. Commencement

 

Rule 2 provides for the Rules to commence at the same time as the Act commences if they are registered before the Act commences; or, if the Rules are registered on or after the Act commences, the Rules commence on the day they are registered.

 

3. Definitions

 

Rule 3 provides for the Definitions of these Rules.  The terms used in these Rules have the same meaning as in the Act.  Hospital Casemix Protocol means the protocol set out in Schedule 7 of the National Health Regulation 1954 as in force immediately before the commencement of the Act, but as if certain changes were made, as set out in Rule 3.

 

4. Information to be provided

 

Subrule 4 (1) provides, for the purpose of section 172-10 of the Act, that the kinds of information, relating to the treatment of insured persons, that private health insurers are to give to the Secretary of the Department are the kinds of information specified in the Hospital Casemix Protocol. 

 

Subrule 4 (2) provides that reference should be made to the explanatory notes in Part 1 of the Hospital Casemix Protocol for the interpretation of the kinds of information to be provided.

 

 

Overview

The Private Health Insurance (Data Provision) Rules 2007 were enacted to facilitate the implementation of data provision requirements under the Private Health Insurance Act 2007. This Act was introduced to overhaul the regulation of private health insurance in Australia, shifting the responsibility from the National Health Act 1953 to a dedicated legislation that aims to better address the complexities and needs of the private health insurance sector. The Private Health Insurance (Data Provision) Rules were made under the authority of Section 333-20 of the Act and were designed to specify the types of information that private health insurers must provide to the Secretary of the Department of Health. These Rules mandate that private health insurers submit data in accordance with the Hospital Casemix Protocol, ensuring that the information provided is consistent with the existing national health data standards while accommodating updates to reflect current terminology within the private health insurance context. The Rules were developed following extensive consultation with various stakeholders, including private health insurers, hospitals, medical associations, and consumer groups, all of which expressed support for the proposed legislative framework.

Scope and Application

The Private Health Insurance (Data Provision) Rules 2007 apply to private health insurers operating within Australia, requiring them to provide specific data to the Secretary of the Department as outlined in the Hospital Casemix Protocol. These Rules are subordinate instruments made under Section 333-20 of the Private Health Insurance Act 2007 and are designed to ensure that private health insurers supply necessary information about the treatment of insured persons to facilitate better regulation and oversight of the private health insurance sector. This data provision is essential for the implementation of reforms aimed at improving the attractiveness and participation in private health insurance. The Rules do not introduce new requirements but mandate the provision of data already stipulated in the Hospital Casemix Protocol, which has been updated to reflect the terms used in the Private Health Insurance Act. The Rules have a national reach, applying to all private health insurers within Australia, and do not specify any exclusions, exemptions, or thresholds for their application.

Key Provisions

The Private Health Insurance (Data Provision) Rules 2007 (the Rules) were established under Section 333-20 of the Private Health Insurance Act 2007 (the Act). These Rules mandate that private health insurers provide specific types of information to the Secretary of the Department. According to Rule 4(1), the information must pertain to the treatment of insured persons and must adhere to the specifications outlined in the Hospital Casemix Protocol. The Hospital Casemix Protocol is defined in Rule 3, which refers to the protocol set forth in Schedule 7 of the National Health Regulations 1954, with updates to align with the terms used in the Act. The obligations under the Rules require private health insurers to furnish detailed information on the treatment of their insured persons to the Department. This includes, but is not limited to, data on patient demographics, diagnoses, procedures, and other relevant health care details as specified in the Hospital Casemix Protocol. By Rule 4(2), insurers are directed to consult the explanatory notes in Part 1 of the Hospital Casemix Protocol for interpreting the kinds of information to be provided. The aim is to ensure consistency and accuracy in the data submitted, facilitating better regulation and oversight of the private health insurance sector. Failure to comply with the data provision requirements under the Rules can lead to civil or criminal consequences, although specific penalties are not detailed within the explanatory statement. However, it is implied that breaches of the Act, including non-compliance with the Rules, could result in sanctions under the general provisions of the Private Health Insurance Act 2007. The penalties for such breaches could range from fines to more severe criminal charges, depending on the nature and severity of the non-compliance. These provisions are designed to enforce adherence to the data requirements and maintain the integrity of the health insurance data collection process.

Legal classification tags

Area of Law
Health Law
Instrument
Regulation
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.