Private Health Insurance (Data Provision) Rules 2016 (No. 1)

Administered by Department of Health, Disability and Ageing

Legislation au F2016L01406 Rules Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

Issued by the Authority of the Minister for Health

 

Private Health Insurance Act 2007

 

Private Health Insurance (Data Provision) Rules 2016 (No. 1)

 

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Data Provision) Rules 2016 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 2016 (the Rules) revoke and replace the previous Private Health Insurance (Data Provision) Rules 2016.

 

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

 

The information required by the Rules is specified in the following documents, which were approved by the Assistant Secretary of the Health System Financing Branch of the Department on the dates indicated:

 

  •       GT-Dental Data from Insurers to the Department, approved 25 April 2015;
  •       HCP1 Data from Insurers to the Department, approved 31 March 2016; and
  •       HCP2 Data from Insurers to the Department, approved 25 April 2015.

 

These documents can be found on the Department’s website at:

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

 

Consultation

 

The Department has consulted with the private health insurance and private hospital industry through existing working group arrangements.  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 amendments to be managed by this Working Group.  Previous 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 Legislation Act 2003. 

 

The Rules commence on the day after the Rules are registered.

 

 


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 2016

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 2016 (the Rules) specify the information, relating to the treatment of insured persons, that private health insurers must 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 Rules revoke and replace the Private Health Insurance (Data Provision) Rules 2016.

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

 

The information required by the Rules is specified in the following documents, which were approved by the Assistant Secretary of the Health System Financing Branch of the Department on the dates indicated:
 

  •       GT-Dental Data from Insurers to the Department, approved 25 April 2015;
  •       HCP1 Data from Insurers to the Department, approved 31 March 2016; and
  •       HCP2 Data from Insurers to the Department, approved 25 April 2015.

 

These documents can be found on the Department’s website at:

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

 

The information which, under these Rules, private health insurers must give to the Secretary does not include personal information about patients (i.e. information from which individual patients could be identified).

 

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, HCP1 Data and HCP2 Data involves private health insurers disclosing to the Department de-identified information about the treatment of insured patients.  The Department would not be able to readily use this de-identified information to identify an individual patient.  Further, section 323-1 of the Act creates an offence for a person to disclose protected information to another person that the first person obtains in the course of performing a duty, function or power under the Act, unless the disclosure is an authorised disclosure.  The effect of this provision is to limit the way in which the Department deals with information about individuals.

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 derogate from that right.

 

Shannon White

Assistant Secretary

Health System Financing Branch

Department of Health

 

Overview

The Private Health Insurance (Data Provision) Rules 2016, enacted under the Private Health Insurance Act 2007, were introduced to address the need for updated and revised data specifications that private health insurers must provide to the Secretary of the Department of Health. These rules specify the information insurers must supply, excluding personal data that could identify individual patients. The Rules were developed through consultation with industry stakeholders via working groups, a process considered appropriate by the industry. The primary objective of these rules is to ensure the efficient and effective management of data related to the treatment of insured persons, supporting policy objectives such as improving health outcomes and policy-making based on accurate and timely data. This Legislative Instrument, which is compatible with human rights, mandates the provision of de-identified data, thus engaging the right to privacy without limiting it.

Scope and Application

The Private Health Insurance (Data Provision) Rules 2016 outline the specific information private health insurers in Australia must provide to the Secretary of the Department of Health, as mandated by section 172-10 of the Private Health Insurance Act 2007. These Rules govern the data relating to the treatment of insured persons that must be shared with the Department, and they supersede the previous Private Health Insurance (Data Provision) Rules 2016. The required data is detailed in three documents, namely GT-Dental Data, HCP1 Data, and HCP2 Data, all approved by the Assistant Secretary of the Health System Financing Branch of the Department of Health. These documents, which exclude personal patient information that could identify individuals, are accessible on the Department's website. The Rules are applicable to all private health insurers operating within Australia, ensuring a consistent approach to data sharing across the industry. The Department has consulted with industry stakeholders, including private health insurance and private hospital representatives, through existing working groups to manage these amendments, ensuring industry involvement in the development process. The Rules are considered a Legislative Instrument under the Legislation Act 2003 and will commence on the day after their registration.

Key Provisions

The Private Health Insurance (Data Provision) Rules 2016 (sections 1-5) outline the specific data that private health insurers are required to provide to the Secretary of the Department of Health under section 172-10 of the Private Health Insurance Act 2007. The data specified includes GT-Dental Data, HCP1 Data, and HCP2 Data, which are approved by the Assistant Secretary of the Health System Financing Branch of the Department and can be found on the Department's website. These data sets pertain to the treatment of insured persons but do not include personal information that could identify individual patients. Private health insurers are obligated to supply the specified data to the Department as per the approved data sets. The Rules are designed to ensure that the information provided is relevant and specific, aiding the Department in its functions without compromising patient privacy. Insurers must ensure that the data provided is accurate and timely, adhering to the formats and specifications outlined in the approved documents. There are potential consequences for non-compliance with the Rules. Section 323-1 of the Act makes it an offence for a person to disclose protected information obtained in the course of performing a duty, function, or power under the Act, unless the disclosure is authorised. This means that any unauthorised disclosure of protected information by the Department could result in criminal penalties. The maximum penalties for such offences are not explicitly stated in the Explanatory Statement, but they would be in line with the penalties for breaches of privacy and data protection under Australian law, which can include substantial fines and imprisonment.

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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.