Consequential amendments to private health insurance (PHI) reporting standards

TO: ALL PRIVATE HEALTH INSURERS

Following the passing of three bills to amend PHI legislation, APRA is proposing consequential updates to three PHI reporting standards. These updates will ensure consistency between terminology used across the updated PHI legislation and APRA PHI reporting standards. 

Background

On 1 December 2022, three bills were introduced into Parliament to amend four PHI Acts. These bills were passed in March 2023 and will come into effect on 1 July 2023. The bills are:

• Private Health Insurance Legislation Amendment (Medical Device and Human Tissue Product List and Cost Recovery) Bill 2022;
   
• Private Health Insurance (Prostheses Application and Listing Fees) Amendment (Cost Recovery) Bill 2022; and
   
• Private Health Insurance (National Joint Replacement Register Levy) Amendment (Consequential Amendments) Bill 2022. 

In addition, the Department of Health and Aged Care (the Department) is also preparing minor amendments to remove inactive definitions from the Health Insurance Act 1973 (Health Insurance Act). The Department intends to repeal the definitions of patient contribution and nursing-home type patient for the purposes of private health insurance benefits and for patients in public hospitals in Part I Subsection 3(1).

Proposed consequential amendments

To align with the changes to the PHI legislation, consequential amendments are required to three APRA PHI reporting standards: 

• Reporting Standard HRS 601.0 Statistical Data by State (HRS 601.0);
   
• Reporting Standard HRS 603.0 Statistical Data on Prosthetic Benefits (HRS 603.0); and 
   
• Reporting Standard HRS 605.0 Private Health Insurance Reform Data Collection (HRS 605.0). 

To ensure consistency between terminology used in PHI legislation and APRA reporting standards, APRA proposes replacing references to the terms prosthesis, prostheses and prosthetic with medical device/s or human tissue product/s. These references are primarily names of data items in the reporting forms contained in HRS 601.0, HRS 603.0, and HRS 605.0. APRA has also made other minor updates to update references to relevant legislation, including removing references to the Health Insurance Act in the definition for nursing home type patient in HRS 601.0.

APRA proposes the amended reporting standards will apply to reporting periods ending on, or after, 31 December 2023. In the meantime, APRA expects entities to continue reporting in line with the current reporting standards.

Next steps

APRA invites submissions on the proposed changes, including (but not limited to) feedback on the feasibility of making any necessary updates in time for the reporting period ending 31 December 2023.

Please refer to the draft reporting standards released together with this letter, which include the proposed changes marked up. Written submissions on the proposal should be sent to DataConsultations@apra.gov.au by 31 August 2023.

Yours sincerely,
 
Surabhi Jain
Chief Data Officer
Technology and Data Division