Private Health Insurance (Data Provision) Rules 2012

Administered by Department of Health, Disability and Ageing

Legislation au F2012L01053 Rules Not in force Legislative Instrument

Legislation content

 

Private Health Insurance (Data Provision) Rules 2012


as amended

 

made under item 9 of the table in section 333-20 of the Private Health Insurance Act 2007.

 

 

 

Compilation start date:  1 July 2013

 

 

Includes amendments up to: Private Health Insurance (Data Provision)                                                                        Amendment Rules 2013 (No. 1)

 

 

 

 

 

 

 

 

Prepared by the Department of Health and Ageing, Canberra.

About this compilation

The compiled instrument

This is a compilation of the Private Health Insurance (Data Provision) Rules 2012 as amended and in force on 1 July 2013. It includes any amendment affecting the compiled instrument to that date.

This compilation was prepared on 1 July 2013.

The notes at the end of this compilation (the endnotes) include information about amending Acts and instruments and the amendment history of each amended provision.

Uncommenced provisions and amendments

If a provision of the compiled instrument is affected by an uncommenced amendment, the text of the uncommenced amendment is set out in the endnotes.

Application, saving and transitional provisions for amendments

If the operation of an amendment is affected by an application, saving or transitional provision, the provision is identified in the endnotes.

Modifications

If a provision of the compiled instrument is affected by a textual modification that is in force, the text of the modifying provision is set out in the endnotes.

Provisions ceasing to have effect

If a provision of the compiled instrument has expired or otherwise ceased to have effect in accordance with a provision of the instrument, details of the provision are set out in the endnotes.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contents

 

 

1. Name of Rules 

2. Commencement and revocation 5

3. Definitions 

4. Information to be provided 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.                      Name of Rules

These Rules are the Private Health Insurance (Data Provision) Rules 2012.

2.                      Commencement and revocation

(1) These Rules commence on 1 November 2012.

(2) These Rules revoke the Private Health Insurance (Data Provision) Rules 2011.

3.                      Definitions

Note: Terms used in these Rules have the same meaning as in the Act ―see section 13 of the Legislative Instruments Act 2003.  These terms include:

health fund

hospital

hospital treatment

policy holder

 private health insurer

 

In these Rules:

Act means the Private Health Insurance Act 2007.

GT-Dental Data from Insurers to the Department means the protocol set out in the document approved by the Assistant Secretary of the Private Health Insurance Branch of the Department of Health and Ageing on 13 May 2012 which consists of “Data Specifications (GT-Dental)” and “Explanatory Notes (GT-Dental)”. 

HCP1 Data from Insurers to the Department means the protocol set out in the document approved by the Assistant Secretary of the Financing and Analysis Branch of the Department of Health and Ageing on 9 May 2013 which consists of “Data Specifications (HCP1)” and “Explanatory Notes (HCP1)”.

HCP2 Data from Insurers to the Department means the protocol set out in the document approved by the Assistant Secretary of the Private Health Insurance Branch of the Department of Health and Ageing on 13 May 2012 which consists of “Data Specifications (HCP2)” and “Explanatory Notes (HCP2)”.  

4.                      Information to be provided

(1)        For section 172-10 of the Act, 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:

(a)                    GT-Dental Data from Insurers to the Department;

(b)                    HCP1 Data from Insurers to the Department; and

(c)                    HCP2 Data from Insurers to the Department.

(2)        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)”.

(3)        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)”.

(4)        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)”.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Endnotes

 

Endnote 1—Legislation history

This endnote sets out details of the legislation history of the Private Health Insurance (Data Provision) Rules 2012.

 

Title

FRLI registration
date

Commencement
date

Application, saving and transitional provisions

Private Health Insurance

(Data Provision) Rules 2012

22 May 2012 (see F2012L01053)

1 November 2012

 

Private Health Insurance

(Data Provision) Amendment

Rules 2013 (No. 1)

14 May 2013 (see F2013L00771)

1 July 2013

—

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Endnote 2—Amendment history

This endnote sets out the amendment history of the Private Health Insurance (Data Provision) Rules 2012.

 

ad. = added or inserted    am. = amended    rep. = repealed    rs. = repealed and substituted    exp. = expired or ceased to have effect

Provision affected

How affected

r. 3………………………

 

am. F2013L00771

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Endnote 3 – Uncommencted amendments (none)

 

There are no uncommenced amendments.

Endnote 4—Misdescribed amendments (none)

There are no misdescribed amendments.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Overview

The Private Health Insurance (Data Provision) Rules 2012, as amended, were enacted under the Private Health Insurance Act 2007 to address the need for streamlined data provision processes between private health insurers and the Department of Health and Ageing. These rules were designed to facilitate the efficient exchange of data related to the treatment of insured persons, ensuring that the Department has the necessary information to monitor and regulate the private health insurance industry effectively. The rules were formulated by the Department of Health and Ageing and came into effect on 1 November 2012, replacing the previous Private Health Insurance (Data Provision) Rules 2011. The overarching policy objective of these rules is to enhance transparency and accountability within the private health insurance sector by mandating specific types of data to be provided, thereby supporting informed policy-making and consumer protection.

Scope and Application

The Private Health Insurance (Data Provision) Rules 2012, as amended, pertain to the private health insurance sector in Australia, specifically governing the data provision requirements imposed on private health insurers under the Private Health Insurance Act 2007. These rules apply to private health insurers who are mandated to provide certain specified data to the Secretary of the Department of Health and Ageing. This includes information relating to the treatment of insured persons as detailed in protocols such as GT-Dental Data from Insurers to the Department, HCP1 Data from Insurers to the Department, and HCP2 Data from Insurers to the Department. The rules define the types of information that need to be provided and reference explanatory notes for each data specification to ensure clarity in interpretation. These rules have a national reach, applying across Australia as they are made under the authority of the Commonwealth. The rules commenced on 1 November 2012 and revoked the earlier Private Health Insurance (Data Provision) Rules 2011. The application of these rules can be extended or restricted through subordinate instruments, such as the Private Health Insurance (Data Provision) Amendment Rules 2013 (No. 1), which came into effect on 1 July 2013.

Key Provisions

The Private Health Insurance (Data Provision) Rules 2012 (the "Rules") provide the detailed information required to be submitted by private health insurers to the Secretary of the Department of Health and Ageing under section 172-10 of the Private Health Insurance Act 2007 (the "Act"). Specifically, Rule 4(1) mandates that private health insurers provide the kinds of information specified in three main data protocols: GT-Dental Data from Insurers to the Department, HCP1 Data from Insurers to the Department, and HCP2 Data from Insurers to the Department. These data protocols, in turn, consist of "Data Specifications" and "Explanatory Notes" approved by the Department of Health and Ageing. Rule 4(2) to (4) directs that the "Explanatory Notes" should be referred to for interpreting the "Data Specifications" for each respective protocol. The obligations under the Rules primarily involve the accurate and timely provision of specified health-related data by private health insurers to the Department. Rule 4(1) sets out the kinds of information that must be provided, while Rules 4(2) to (4) specify that the "Explanatory Notes" should be consulted for interpretation purposes. These obligations ensure that the Department receives consistent, interpretable, and useful data from private health insurers, which can be used for policy analysis, regulatory oversight, and other purposes as authorised under the Act. Non-compliance with the Rules can result in civil or criminal penalties, although the specific penalties are not detailed within the Rules themselves. Under the Act, non-compliance with the data provision requirements may be considered a breach of legislative requirements, which could lead to enforcement actions by the Department or other regulatory bodies. These actions might include fines, corrective measures, or other sanctions as deemed appropriate under the relevant sections of the Act. The specific maximum penalties for breaches are not explicitly stated within the Rules but would be governed by the broader legislative framework under which the Act operates.

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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.