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Regulatory Activities

Note: This page is a representation of information published on the PHIAC website prior to 1 July 2015. This information is provided for reference and research purposes only. 

Compliance: Regulatory Activities

To ensure that the health benefits funds conducted by insurers are well-run and financially sound, PHIAC maintains a strong and visible presence in the industry. This is done through a rolling program of fund reviews, quarterly reviews of key insurer financial data and statistics, face-to-face meetings and regular compliance checks. This ensures PHIAC has an up-to-date understanding of the individual private health insurers, and has a sound evidence base for its regulatory activities.

PHIAC’s Core Functions include:

  • Administration of the Risk Equalisation Trust Fund
  • Registration of new private health insurers
  • Information collection to obtain from each private health insurer regular reports about the insurer’s operations, including reports supported by actuarial certification
  • Ensuring industry compliance by developing standards such as solvency and capital adequacy. See all existing Standards.
  • Taking enforcement actions to encourage or compel compliance with Council supervised obligations.
  • Enforcement actions includes appointing inspectors, external managers, issuing notices, accepting undertakings, giving directions. See the list of Council Powers.
  • Advising the Minister about the financial operations and affairs of private health insurers
  • Cooperating with other regulatory agencies on matters affecting the insurers or the industry

Cost Recovery Impact Statements

Under the Australian Government Cost Recovery Guidelines government agencies with revenues exceeding $5 million per annum are required to undertake a periodic review of their cost recovery arrangements, by way of a cost recovery impact statement (CRIS)

The Private Health Insurance Administration Council initially published a cost recovery arrangements in 2009 CRIS following a significant increase to its regulatory functions arising out of legislative amendment and the Global Financial Crisis.

A 2012 review of PHIAC’s funding and charging arrangements found that the Council Administration Levy remains the most appropriate method of recovering PHIAC’s operational costs, ensures certainty and equity within the industry, without limiting or compromising the operational ability of PHIAC.

PHIAC’s 2013 CRIS assesses the impact on the private health insurance industry and consumers of a minor increase to the general administration costs of Council in 2013 – 2014.

This CRIS l fulfils an ongoing commitment by PHIAC to transparently account for all variances to its budgeted financial expenditures to the Parliament, the industry and consumers of private health insurance, and the agency’s ongoing compliance with the Guidelines.

Council Directions

The Private Health Insurance Act 2007 empowers to Council to issue directions. These directions are regulatory tools which PHIAC uses to protect the interests of consumers and the prudential safety of insurers. The Council may issue a Direction to:

  • prevent contravention of a Council supervised obligation (Section 200-1 (1) (b) of the Act) or address a contravention of a council supervised obligation.
  • comply with a prudential standard (Section 163-15 of the Act)
  • comply with the capital adequacy standard (Section 143-20 of the Act)
  • comply with the solvency standard (Section 140-20 of the Act).

The content of each Council direction is tailored to address specific issues. For example, a solvency or capital adequacy direction may impose additional financial obligations on an insurer. Additional details regarding Council Direction powers is contained in the Standard Operating Procedure Giving a Council Direction.

Council Directions relating to Section 200-1 of the Act must be published on PHIAC’s website. Currently, no direction relating to the Section 200-1 of the Act has been issued by the Council.