Private Health Insurance (Data Provision) Rules 2013

Administered by Department of Health, Disability and Ageing

Legislation au F2013L02161 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

Issued by the Authority of the Minister for Health

 

Private Health Insurance Act 2007

 

Private Health Insurance (Data Provision) Rules 2013

 

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 Private Health Insurance (Data Provision) Rules 2013 revoke and replace the Private Health Insurance (Data Provision) Rules 2012 (the previous Rules).

 

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 of Health (the Department) under section 172-10 of the Act. 

 

The kinds of information specified by the Rules are those set out in the following documents, which were approved on 16 December 2013 by the Assistant Secretary of the Financing and Analysis Branch of the Department:

 

  •       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 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 and the HCP2 Data from Insurers to the Department documents approved by the Assistant Secretary of the Private Health Insurance Branch on 13 May 2012 and HCP1 Data from Insurers to the Department document approved by the Assistant Secretary of the Financing and Analysis Branch on 9 May 2013 and were referred to in the previous Rules.

 

The revised data specifications are necessary to facilitate a move to data submission via the Data Submission Portal of the Department’s Enterprise Data Warehouse. To facilitate the move, a number of minor ‘housekeeping’ type amendments have been made to improve clarity, remove ambiguities and standardise content, particularly in relation to definitions and error codes.

 

Consultation

 

In October 2013, the Department consulted with the private health insurance and private hospital industry through existing working group arrangements regarding the minor ‘housekeeping’ type amendments required to the GT-Dental, HCP1 and HCP2 specifications.  The working groups are  comprised of Department and industry stakeholder representatives.  Private health insurance and private hospital stakeholder representatives interested in developing the amendments participated in the process.  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.

 

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

 

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

 

The Rules commence on the day after the Rules are registered on the Federal Register of Legislative Instruments.

 

                                          
                                                                                 


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) Rules 2013

This 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 Legislative Instrument

The Private Health Insurance (Data Provision) 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 of Health (the Department) under section 172-10 of the Private Health Insurance Act 2007 (the Act).

The Private Health Insurance (Data Provision) Rules 2013 (the Rules) revoke and remake the Private Health Insurance (Data Provision) Rules 2012 (the previous Rules).

Section 172-10 of the Act enables the Rules to specify kinds of information, relating to the treatment of persons insured under complying health insurance products, that private health insurers are to give to the Secretary of the Department.

The Rules specify that the kinds of information that are required to be provided are set out in the following documents, each of which was approved on 16 December 2013 by the Assistant Secretary of the Financing and Analysis Branch of the Department:

  •       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 replace prior versions of the documents specified in the previous Rules.

 

The revised data specifications are necessary to facilitate a move to data submission via the Data Submission Portal of the Department’s Enterprise Data Warehouse. A number of minor ‘housekeeping’ type amendments have been made to improve clarity, remove ambiguities and standardise content, particularly in relation to definitions and error codes.

 

The specified information required to be provided to the Secretary does not include identified patient information. 

Human rights implications

This Legislative Instrument will engage the human right of privacy but will not result in any limitation of that right.

Supply of the GT-Dental Data from Insurers to the Department, HCP1 Data from Insurers to the Department and HCP2 Data from Insurers to the Department involves the disclosure of de-identified information about the treatment of insured patients, from private health insurers to the Department.  The information supplied could not reasonably be used by the Department to identify a patient.  Further, Part 6-8 of the Act, creates an offence for the unauthorised disclosure of information obtained by any person in the course of performing duties or powers, or exercising functions, under the Act. 

The revisions to the documents are essentially mechanical in nature, and do not substantively alter any legislative requirements.

 

Conclusion

This Legislative Instrument is compatible with human rights as although it engages the right of privacy in relation to personal information, it will not result in any limitation of that right.

 

Gareth Sebar

Assistant Secretary, Financing and Analysis Branch

Department of Health

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Overview

The Private Health Insurance (Data Provision) Rules 2013, issued under section 333-20 of the Private Health Insurance Act 2007, establish the requirements for private health insurers to provide specified kinds of data to the Secretary of the Department of Health. This Act was enacted in 2007 to regulate the private health insurance industry in Australia, aiming to ensure that insurers provide essential information to facilitate the monitoring and regulation of the industry. The 2013 Rules update the previous 2012 Rules, reflecting changes necessary for the transition to data submission through the Department's Enterprise Data Warehouse, while maintaining compliance with privacy protections. The rules specify the types of de-identified treatment data insurers must supply, which are outlined in approved documents: GT-Dental Data from Insurers to the Department, HCP1 Data from Insurers to the Department, and HCP2 Data from Insurers to the Department. These specifications were developed through consultation with industry stakeholders and are intended to improve clarity and standardisation. The Rules are a legislative instrument under the Legislative Instruments Act 2003 and came into effect upon registration on the Federal Register of Legislative Instruments.

Scope and Application

The Private Health Insurance (Data Provision) Rules 2013 apply to private health insurers operating in Australia who must provide specific data to the Department of Health, as mandated by section 172-10 of the Private Health Insurance Act 2007. These rules outline the types of information regarding the treatment of insured persons that must be submitted to the Secretary of the Department, replacing the previous rules from 2012. The specified data includes GT-Dental, HCP1, and HCP2 data, approved by the Assistant Secretary of the Financing and Analysis Branch of the Department on 16 December 2013. These data specifications are intended to facilitate data submission via the Department’s Enterprise Data Warehouse through the Data Submission Portal. While the rules engage the human right to privacy by requiring the disclosure of de-identified patient treatment information, they do not impose any limitation on this right. The amendments are primarily technical, ensuring clarity and standardising content, particularly in definitions and error codes, without altering the fundamental legislative requirements.

Key Provisions

The Private Health Insurance (Data Provision) Rules 2013, made under section 333-20 of the Private Health Insurance Act 2007 (the Act), specify the kinds of information that private health insurers are required to provide to the Secretary of the Department of Health. These Rules, which came into effect after being registered on the Federal Register of Legislative Instruments, revoke and replace the Private Health Insurance (Data Provision) Rules 2012. The information that insurers must supply is detailed in three documents: 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 were approved by the Assistant Secretary of the Financing and Analysis Branch of the Department on 16 December 2013 and are available on the Department of Health's website. The revisions are primarily to facilitate a transition to data submission via the Data Submission Portal of the Department's Enterprise Data Warehouse and include minor amendments for clarity and standardisation. The Rules impose specific obligations on private health insurers to submit detailed and de-identified information regarding the treatment of insured persons to the Department. Insurers must ensure that the information provided aligns with the specifications outlined in the approved documents, which include definitions and error codes. The data provided must not include any identified patient information, and the documents have been updated to improve clarity and standardise content. Insurers are required to comply with these specifications to ensure the accuracy and usefulness of the data submitted to the Department. Breaches of the requirements specified in the Rules can have legal consequences. While the Rules themselves do not detail specific offences or penalties, section 172-10 of the Act mandates the provision of information to the Secretary of the Department. Failure to comply with this requirement can be considered an offence under Part 6-8 of the Act, which creates an offence for the unauthorised disclosure of information obtained in the course of performing duties or exercising functions under the Act. Although the Rules do not specify penalties, non-compliance with the Act can lead to enforcement actions by the Department, including potential fines or other administrative penalties as prescribed by the relevant legislation.

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Area of Law
Privacy Law
Instrument
Regulation
Concepts
Definitions & Interpretation
Reporting & Disclosure Obligations
Compliance Obligations

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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.