Private Health Insurance (Health Insurance Business) Amendment Rules 2011 (No. 2)

Administered by Department of Health, Disability and Ageing

Legislation au F2011L01516 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 (Health Insurance Business) Amendment Rules 2011 (No.2)  

 

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Health Insurance Business) Rules providing for matters required or permitted by Part 4-2 of the Act, or necessary or convenient in order to carry out or give effect to Part 4-2 of the Act.

 

The Private Health Insurance (Health Insurance Business) Rules 2010 (the Principal Rules), which commenced on 1 July 2010, provides for inclusions and exclusions to the definitions of ‘hospital treatment’, ‘general treatment’ and sets out a range of activities which do not fall within the scope of ‘health insurance business’ as defined in the Act. 

 

The Private Health Insurance (Health Insurance Business) Amendment Rules 2011 (No.2) (the Amendment Rules) amend Rules 4 and 7 of the Principal Rules.  Rules 4 and 7 of the Principal Rules specify the kinds of information, relating to the treatment of insured persons, that hospitals are required to give to insurers and that private hospitals are required to give to the Department.

 

The Private Health Insurance (Health Insurance Business) Amendment Rules 2011 (No.1) recently amended the Principal Rules to give effect to the HCP Data from Hospitals to Insurers and PHDB Data from Private Hospitals to the Department documents which were approved on the 8 March 2011.  However, errors were subsequently identified in those documents and the purpose of these Amendment Rules is to refer to the correct HCP Data from Hospitals to Insurers and PHDB Data from Private Hospitals to the Department documents for the 2011/12 data collection period.

 

The correct HCP Data from Hospitals to Insurers and PHDB Data from Private Hospitals to the Department documents were approved on 15 July 2011 by the Assistant Secretary of the Private Health Insurance Branch of the Department of Health and Ageing and 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 Act does not specify any conditions that need to be met before the power to make the Amendment Rules may be exercised.

 

Consultation

In 2010-11, the Department consulted with the private health insurance industry at quarterly HCP Data Working Group meetings regarding minor ‘housekeeping’ type amendments required to the HCP specifications.  HCP Data Working Group meetings comprise of Department and industry stakeholder representatives.  Private health insurance representatives interested in developing the amendments participate 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.  Minor amendments have previously been managed in this way.  The revised data specifications are distributed to industry via a Private Health Insurance Circular.

 

Details of the Amendment Rules are set out in the Attachment.

 

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

 

The Amendment Rules commence 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 (HEALTH INSURANCE BUSINESS) AMENDMENT RULES 2011 (No.2)  

 

Part 1 Preliminary

 

1. Name of Rules

 

Rule 1 provides that the title of the Rules is the Private Health Insurance (Health Insurance Business) Amendment Rules 2011 (No.2) (the Amendment Rules).

 

2. Commencement

 

Rule 2 provides that the Amendment Rules are to commence on the day after registration.

 

3. Amendment of Private Health Insurance (Health Insurance Business) Rules 2010

 

Rule 3 provides that the Schedule to the Amendment Rules amend the Private Health Insurance (Health Insurance Business) Rules 2010 (the Principal Rules) which commenced on 1 July 2010.

 

Schedule – Amendments

 

Item 1 – Part 2 Hospitals, subrule 4(2)

 

Item 1 deletes subrule 4(2) and replaces it with a new subrule 4(2), which defines HCP Data from Hospitals to Insurers to mean 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 15 July 2011.

 

Item 2 – Part 2 Hospitals, subrule 7(3)

 

Item 2 deletes subrule 7(3) and replaces it with a new subrule 7(3), which defines PHDB Data from Private Hospitals to the Department to mean 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 15 July 2011.

 

 

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

JULY 2011

Overview

The Private Health Insurance (Health Insurance Business) Amendment Rules 2011 (No. 2) was introduced to correct errors identified in the Private Health Insurance (Health Insurance Business) Rules 2010, which were implemented to provide for matters required or permitted by Part 4-2 of the Private Health Insurance Act 2007. The Amendment Rules were made under the authority of Section 333-20 of the Act and were enacted by the Minister for Health and Ageing. The policy objective behind these amendments was to ensure the accurate and efficient transmission of health care provider (HCP) data from hospitals to insurers and private hospital data to the Department. This was achieved through the amendment of Rules 4 and 7 of the Principal Rules to refer to the correct HCP Data from Hospitals to Insurers and Private Hospital Data from Private Hospitals to the Department documents approved by the Assistant Secretary of the Private Health Insurance Branch of the Department of Health and Ageing on 15 July 2011. These Amendment Rules serve to maintain the integrity of the data collection process within the private health insurance sector.

Scope and Application

The Private Health Insurance (Health Insurance Business) Amendment Rules 2011 (No.2) pertains to entities within the private health insurance industry, specifically hospitals and private health insurers, and aims to ensure the correct specifications for data collection between these entities and the Department of Health and Ageing. The Amendment Rules are amendments to the Private Health Insurance (Health Insurance Business) Rules 2010, which commenced on 1 July 2010, and are made under the authority of Section 333-20 of the Private Health Insurance Act 2007. The rules apply nationally across Australia, as they are a legislative instrument governed by the Commonwealth. The Amendment Rules clarify and correct errors in the previously issued HCP Data from Hospitals to Insurers and PHDB Data from Private Hospitals to the Department documents, which outline the protocols for data exchange between hospitals, insurers, and the Department. These rules commenced on the day after their registration and are applicable for the 2011/12 data collection period. The Amendment Rules do not specify any particular exclusions or thresholds; however, they do provide for the necessary amendments to ensure the correct implementation of the data exchange protocols.

Key Provisions

The Private Health Insurance (Health Insurance Business) Amendment Rules 2011 (No.2) amend existing rules under the Private Health Insurance Act 2007, specifically Rules 4 and 7 of the Private Health Insurance (Health Insurance Business) Rules 2010. Rule 4, now amended, redefines the HCP Data from Hospitals to Insurers to mean 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 15 July 2011. Rule 7, also amended, redefines PHDB Data from Private Hospitals to the Department in the same manner, referencing the approved document from the same date. These amendments ensure that hospitals and private hospitals are providing the correct and updated data specifications for the 2011/12 data collection period. The Amendment Rules impose specific obligations on hospitals and private hospitals to adhere to the newly defined data specifications for HCP Data from Hospitals to Insurers and PHDB Data from Private Hospitals to the Department. These entities must ensure that their data collection and reporting processes align with the protocols outlined in the approved document from 15 July 2011. This requirement is essential for maintaining the accuracy and integrity of health insurance data, which is crucial for policy assessment and health service planning. Failure to comply with the amended rules may result in non-conformance with the legislative requirements of the Private Health Insurance Act 2007. Although the explanatory statement does not specify explicit offences, penalties, or consequences for breach, non-compliance could potentially lead to investigations, corrective actions, or further regulatory scrutiny by the Department of Health and Ageing. Ensuring adherence to these amended rules is therefore vital for hospitals and private hospitals to avoid any regulatory repercussions and to support the effective functioning of the private health insurance system in Australia.

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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.