Private Health Insurance (Data Provision) Rules 2016

Administered by Department of Health, Disability and Ageing

Legislation au F2016L00497 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 2016

 

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Data Provision) 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 2016 (the Rules) revoke and replace the Private Health Insurance (Data Provision) Rules 2015 (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 31 March 2016 by the Assistant Secretary of the Health System Financing Branch of the Department:

 

  •       Private Hospital Data Bureau (PHDB) (from Hospital to the Department);
  •       HCP Data from (Hospital to the Insurers); and
  •       HCP1 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 PHDB, HCP Data and the HCP1 documents approved by the First Assistant Secretary of the Financing and Analysis Branch on 25 April 2015 and were referred to in the previous Rules.

 

The changes are minor housekeeping in nature.

 

Consultation

 

The Department has consulted with the private health insurance and private hospital industry through existing working group arrangements regarding the minor ‘housekeeping’ type amendments required to the PHDB, HCP and HCP1 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 1 July 2016.

 

 


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

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 2016 (the Rules) revoke and remake the Private Health Insurance (Data Provision) Rules 2015 (the previous Rules).

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 31 March 2016 by the Assistant Secretary of the Health System Financing Branch of the Department:

  •       Private Hospital Data Bureau (PHDB) (from Hospital to the Department);
  •       HCP Data (from Hospital to the Insurers); and
  •       HCP1 Data (from Insurers to the Department).

 

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

 

The changes consist of minor housekeeping type changes.

 

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 PHDB, HCP Data and HCP1 Data 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.

 

Shannon White

Assistant Secretary

Health System Financing Branch

Department of Health

 

Overview

The Private Health Insurance (Data Provision) Rules 2016 were enacted to revise and update the requirements for data provision under the Private Health Insurance Act 2007. This legislation was introduced to address the need for streamlined and up-to-date data specifications for private health insurers to provide to the Department of Health. The rules were made under the authority of the Minister for Health and specify the types of information that insurers must supply regarding the treatment of insured individuals, as mandated by section 172-10 of the Act. The changes were minor and primarily involved housekeeping adjustments to the data specifications, ensuring they remain relevant and effective. The Private Health Insurance (Data Provision) Rules 2016 thus serve to maintain the integrity and utility of health data collection within the private health insurance sector, facilitating better health outcomes and policy development. The Private Health Insurance (Data Provision) Rules 2016 were developed following consultations with the private health insurance and private hospital industries through existing working groups. These groups, comprising representatives from the Department of Health and industry stakeholders, reviewed and approved the amended data specifications. The changes were minor and primarily aimed at maintaining the accuracy and relevance of the data provided. This collaborative approach ensures that the rules reflect industry needs and are practical for implementation. The rules are compatible with human rights, particularly the right to privacy, as they involve the disclosure of de-identified patient information, which cannot be used to identify individuals. The Private Health Insurance (Data Provision) Rules 2016 thus provide a framework for the continuous and effective collection of health data, supporting better healthcare delivery and policy formulation.

Scope and Application

The Private Health Insurance (Data Provision) Rules 2016, made under section 333-20 of the Private Health Insurance Act 2007, govern the types of information that private health insurers must provide to the Secretary of the Department of Health. These rules apply to private health insurers operating within Australia, requiring them to supply specified data relating to the treatment of insured persons, as outlined in approved documents like the Private Hospital Data Bureau (PHDB), HCP Data, and HCP1 Data. These documents, which underwent minor amendments in 2016, detail the format and content of the data to be submitted and replace the previous versions referenced in the 2015 rules. Notably, the information required does not include any identifiable patient details, ensuring privacy compliance. The rules commenced on 1 July 2016, and they represent a legislative instrument under the Legislative Instruments Act 2003. The Department of Health consulted with industry stakeholders to manage these minor amendments, ensuring the process aligns with the needs of the private health insurance and private hospital sectors.

Key Provisions

The Private Health Insurance (Data Provision) Rules 2016, under section 172-10 of the Private Health Insurance Act 2007, specify the types of information regarding the treatment of insured persons that private health insurers must provide to the Secretary of the Department of Health. These rules are designed to streamline and update the data specifications for information sharing, ensuring that the information provided is relevant and up-to-date. They replace the previous rules from 2015 with minor adjustments, primarily aimed at housekeeping and maintaining the accuracy and utility of the data being exchanged. The obligations imposed by the Rules on private health insurers include the timely and accurate provision of specified data to the Department. This data encompasses de-identified information from private hospitals and insurers, as outlined in the approved documents: the Private Hospital Data Bureau (PHDB), HCP Data, and HCP1 Data. These documents detail the structure and content of the data that must be submitted, ensuring that there is a consistent and standardised format for the information provided. Insurers are also required to ensure that the data they provide does not include any identifiable patient information, thereby maintaining patient privacy and confidentiality. Failure to comply with the data provision requirements under these rules can result in significant consequences. The Act itself includes provisions that make the unauthorised disclosure of information obtained in the course of performing duties or exercising functions under the Act an offence. While the Rules themselves do not specify particular penalties for non-compliance, breaches of the Act’s data protection provisions can lead to substantial penalties. For example, under section 333-20 of the Act, individuals found guilty of unauthorised disclosure can face criminal penalties, including fines and imprisonment, depending on the severity of the breach. These penalties underscore the importance of adhering to the data provision requirements and maintaining the integrity of patient information.

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Privacy Law
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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.