Private Health Insurance (Data Provision) Rules 2011

Administered by Department of Health, Disability and Ageing

Legislation au F2011L01079 Rules Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

Issued by the Authority of the Minister for Health and Ageing

 

Private Health Insurance Act 2007

 

Private Health Insurance (Data Provision) Rules 2011

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.

 

The Rules specify the kinds of information, relating to the treatment of insured persons, that private health insurers are to give to the Secretary of the Department under section 172-10 of the Act. 

 

The kinds of information specified are those set out in the following documents, which were approved on 8 March 2011 by the Acting Assistant Secretary of the Private Health Insurance Branch of the Department of Health and Ageing:

 

  • 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 found on the Department of Health and Ageing website at:

 

http://www.health.gov.au/internet/main/publishing.nsf/Content/health-casemix-data-collections-about-HCP

 

The documents above replace the GT-Dental Data from Insurers to the Department, HCP1 Data from Insurers to the Department and the HCP2 Data from Insurers to the Department documents approved by the Assistant Secretary of the Private Health Insurance Branch on 2 June 2010 and were referred to in the Private Health Insurance (Data Provision) Rules 2010 (the previous Rules).  

 

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

 

Consultation

 

In 2010-11, the Department consulted with the private health insurance industry through quarterly HCP Data Working Group meetings regarding minor ‘housekeeping’ type amendments required to the GT-Dental, HCP1 and HCP2 specifications.  HCP Data Working Group meetings comprise of Department and industry stakeholder representatives.  Private health insurance stakeholder representatives interested in developing the amendments participated at the HCP Data Working Group meetings.  Industry is of the view that it is appropriate for minor amendments to be managed by this Working Group.  Previous minor amendments to the data specifications have been managed in this way.  The amended data specifications are distributed to industry via a Private Health Insurance Circular.

 


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 on 1 July 2011 or, if the Rules are registered after 1 July 2011, on the day after they are registered.

 

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


ATTACHMENT

 

DETAILS OF THE PRIVATE HEALTH INSURANCE (DATA PROVISION) RULES 2011  

 

1. Name of Rules

 

Rule 1 provides that the title of the Rules is the Private Health Insurance (Data Provision) Rules 2011.

 

2. Commencement and revocation

 

Subrule 2(1) provides that the Rules are to commence on 1 July 2011 or, if the Rules are registered after 1 July 2011, on the day after they are registered.

 

Subrule 2(2) provides that the Rules revoke the Private Health Insurance (Data Provision) Rules 2010.

 

3. Definitions

 

Rule 3 defines the terms used in the Rules.  The terms used in the Rules have the same meaning as in the Act.

 

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 GT-Dental Data from Insurers to the Department, HCP1 Data from Insurers to the Department and HCP2 Data from Insurers to the Department. 

 

Subrule 4(2) provides that for the purposes of interpreting the kinds of information to be provided with respect to “Data Specifications (GT-Dental)”, reference must be made to “Explanatory Notes (GT-Dental)”.

 

Subrule 4 (3) provides that for the purposes of interpreting the kinds of information to be provided with respect to “Data Specifications (HCP1)”, reference must be made to “Explanatory Notes (HCP1)”.

 

Subrule 4 (4) provides that for the purposes of interpreting the kinds of information to be provided with respect to “Data Specifications (HCP2)”, reference must be made to “Explanatory Notes (HCP2)”.

 

 

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

JUNE 2011

 

Overview

The Private Health Insurance (Data Provision) Rules 2011 were enacted to ensure that private health insurers provide the necessary data to the Secretary of the Department as required under the Private Health Insurance Act 2007. This legislation was introduced to address the need for consistent and comprehensive data collection on the treatment of insured persons, which is vital for policy development, healthcare planning, and performance monitoring within the private health insurance sector. The Rules were enacted by the Minister for Health and Ageing and are intended to facilitate the effective administration of the Act by specifying the types of information that must be reported. These data provisions are essential for ensuring transparency and accountability in the private health insurance industry, and the rules themselves provide the framework for the kind of data to be collected and the methods for its interpretation.

Scope and Application

The Private Health Insurance (Data Provision) Rules 2011, under the Private Health Insurance Act 2007, govern the information that private health insurers must provide to the Secretary of the Department of Health and Ageing. These rules apply to private health insurers, who are required to furnish specified kinds of information relating to the treatment of insured persons as outlined in the GT-Dental Data, HCP1 Data, and HCP2 Data documents. The Rules, which were approved by the Acting Assistant Secretary of the Private Health Insurance Branch on 8 March 2011, replace the previous specifications that were in effect since 2 June 2010. The Rules outline the types of data that need to be submitted and reference explanatory notes to clarify the data specifications. These Rules are in force from 1 July 2011 or the day after their registration if promulgated later, and they revoke the Private Health Insurance (Data Provision) Rules 2010. There are no specified conditions or thresholds mentioned in the Act for exercising the power to make these Rules.

Key Provisions

The Private Health Insurance (Data Provision) Rules 2011 (the Rules) under section 333-20 of the Private Health Insurance Act 2007 (the Act) outline the kinds of information that private health insurers must provide to the Secretary of the Department. Specifically, Rule 4(1) states that the information pertains to the treatment of insured persons and must be in the format specified in the GT-Dental Data from Insurers to the Department, HCP1 Data from Insurers to the Department, and HCP2 Data from Insurers to the Department documents. These documents were approved by the Acting Assistant Secretary of the Private Health Insurance Branch of the Department of Health and Ageing on 8 March 2011 and are available on the Department's website. The Rules further clarify that the information must be interpreted with reference to the corresponding explanatory notes for each data specification. The Rules impose specific obligations on private health insurers. According to Rule 4(1), insurers must ensure that the data they provide to the Department is in the prescribed formats and pertains to the treatment of insured persons. This includes providing data specified in the approved documents, namely GT-Dental, HCP1, and HCP2. Furthermore, Rule 4(2) to 4(4) mandate that the data must be interpreted with reference to the explanatory notes for each respective specification. These obligations are designed to ensure consistency and clarity in the data provided, facilitating effective monitoring and analysis by the Department. In the event of non-compliance, the Act does not explicitly outline specific offences, penalties, or consequences. However, failure to comply with the Rules could potentially result in enforcement actions by the Department, which might include requests for corrective data submissions, administrative penalties, or other corrective measures. Although the Rules themselves do not specify maximum penalties, non-compliance could lead to broader legal repercussions under other provisions of the Act or related legislation, depending on the severity and impact of the breach. It is essential for private health insurers to adhere to these requirements to avoid any potential enforcement actions or legal consequences.

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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.