Skip to main content
Return to Private health insurance

Prudential and Reporting Standards for Private health insurance

Capital

100

Solvency Standard

HPS
100
Prudential Standards (1)
In Force
In effect from 26 June 2015
The purpose of this Prudential Standard is to ensure as far as practicable that at any time the financial position of a health benefits fund conducted by a private health insurer is such that the private health insurer will be able to meet, out of the fund’s assets, all liabilities that are referrable to the fund, as those liabilities become due. This Prudential Standard requires the private health insurer to demonstrate that it will be able to meet the liabilities of its health benefits fund, allowing for adverse circumstances.
110

Capital Adequacy

HPS
110
Prudential Standards (1)
In Force
In effect from 26 June 2015
The purpose of this Prudential Standard is to ensure, as far as practicable, that there are sufficient assets in a health benefits fund conducted by a private health insurer to provide adequate capital for the conduct of the health benefits fund in accordance with the Act and in the interests of the policy holders of the fund. This Prudential Standard requires the private health insurer to demonstrate that the assets of its health benefits fund will be able to meet the liabilities of the fund after a 12 month period, allowing for the future business plans of the fund and adverse circumstances.

Financial statements

601

Statistical Data by State

HRS
601.1
Reporting Standards (1)
In Force
In effect from 31 August 2016
This Reporting Standard sets out the requirements for the provision of information to APRA allowing for the calculation of the risk equalisation special account and calculation of levies in respect of private health insurers, administered by APRA. It includes Form HRF 601.1 Statistical Data – Cover Page, Form HRF 601.1 Statistical Data - by State and associated specific instructions.
Reporting Forms (0)
602

Financial and Capital Data

HRS
602.0
Reporting Standards (1)
In Force
In effect from 26 June 2015
This Reporting Standard sets out the requirements for the provision of information to APRA regarding a private health insurer’s capital adequacy, solvency and financial position. It includes Form HRF 602.0 Financial and Capital Data – Cover Page, Form HRF 602.1 Financial and Capital Data – CA Forecasts, Form HRF 602.2 Financial and Capital Data – Solvency Forecasts, Form HRF 602.3 Financial and Capital Data – Revenue, Form HRF 602.4 Financial and Capital Data – Expenses, Form HRF 602.5 Financial and Capital Data – Capital Transfers, Form HRF 602.6 Financial and Capital Data – Assets, Form HRF 602.7 Financial and Capital Data – Liabilities, Form HRF 602.8 Financial and Capital Data – Related Party Disclosures and Form HRF 602.9 Financial and Capital Data – Claims Data and associated specific instructions.
Reporting Forms (0)

Governance

310

Audit and related matters

HPS
310
Prudential Standards (1)
In Force
In effect from 1 July 2019
This Prudential Standard establishes requirements for the provision, to the Board and senior management of a private health insurer, of independent advice in relation to the operations, financial position and risk controls of the business operations of the private health insurer. This independent advice is designed to assist the Board and senior management in carrying out their responsibilities for the sound and prudent management of the business operations of the private health insurer.
320

Actuarial and Related Matters

CPS
320
CPG
320
Prudential Standards (1)
In Force
In effect from 1 July 2019
This Prudential Standard aims to ensure that a general insurer, life company or private health insurer has access to appropriate actuarial advice to assist in the sound and prudent operation of its business. It sets out the requirements for insurers to appoint an Appointed Actuary and to establish a framework for the provision of actuarial advice. It also sets out the functions of the Appointed Actuary role.
Guidance (1)
In Force
In effect from 1 July 2019
This prudential practice guide was developed to support insurers and actuaries in fulfilling their responsibilities to comply with the requirements contained in CPS 320. Not all practices outlined in this guide will be relevant for every insurer, and some aspects may vary depending upon the size, business mix and complexity of the insurer’s business operations.  |  File type: PDF  |  File size: 503.62 KB
510

Governance

CPS
510
Prudential Standards (1)
In Force
Governance
This Prudential Standard sets out minimum foundations for good governance of an APRA-regulated institution in the deposit-taking, general insurance, life insurance and private health insurance industries, and of a Head of a group. Its objective is to ensure that an institution and group is managed soundly and prudently by a competent Board (or equivalent), which can make reasonable and impartial business judgements in the best interests of the institution and group and which duly considers the impact of its decisions on depositors and/or policyholders.
Related resources (1)
510

Governance

HPG
510
Guidance (1)
In Force
July 2019
Prudential Standard CPS 510 Governance (CPS 510) sets out APRA’s requirements in relation to the governance of authorised deposit takers, general insurers, life companies, private health insurers, and Level 2 and Level 3 groups, collectively referred to as regulated institutions. This PPG aims to assist regulated institutions to comply with those requirements and, more generally, to outline prudent practices in relation to certain governance matters.   |  File type: PDF  |  File size: 234.94 KB
520

Fit and Proper

CPS
520
CRF
520
Prudential Standards (1)
In Force
In effect from 1 July 2019
This Prudential Standard sets out minimum requirements for APRA-regulated institutions in determining the fitness and propriety of individuals to hold positions of responsibility. Its objective is to ensure that an institution prudently manages the risks that persons acting in responsible person positions who are not fit and proper pose to the institution’s business and financial standing.
Guidance (0)
Reporting Forms (1)
In Force
May 2013
In order to assist entities in complying with the requirement to ensure that information provided to APRA remains correct for all responsible persons, the form can be submitted at any time, however it will be provided on an annual basis to all entities submitting annual returns via D2A. Entities can use the annual form to correct and update the information they have provided to APRA throughout the year.  |  File type: PDF  |  File size: 130.35 KB
520

Fit and Proper

HPG
520
HRF
520.0
Guidance (1)
Current
July 2019
Prudential Standard CPS 520 Fit and Proper (CPS 520) sets out APRA’s requirements in relation to assessing the fitness and propriety of responsible persons of authorised deposit taking institutions, general insurers, life companies and private health insurers, collectively referred to as APRA-regulated institutions. This PPG aims to assist private health insurers in complying with those requirements and, more generally, to outline prudent practices in relation to fitness and propriety.  |  File type: PDF  |  File size: 243.64 KB
Reporting Forms (1)
Current
September 2019
Responsible Persons - Changes to the responsible persons (CEO, directors, senior managers, Appointed Actuary or Appointed Auditor) of the Insurer should be submitted using this form.  |  File type: PDF  |  File size: 117.99 KB

Other requirements

001

Definitions

HPS
1
Prudential Standards (1)
In Force
In effect from 1 July 2019
This Prudential Standard defines key terms referred to in other prudential standards which are applicable to private health insurers. All prudential standards applicable to private health insurers must be read in conjunction with this Prudential Standard.
Reporting Standards (0)
Reporting Forms (0)

Risk management

220

Risk Management

CPS
220
CPG
220
Prudential Standards (1)
In Force
In effect from 1 July 2019
This Prudential Standard requires an APRA-regulated institution and a Head of a group to have systems for identifying, measuring, evaluating, monitoring, reporting, and controlling or mitigating material risks that may affect its ability, or the ability of the group it heads, to meet its obligations to depositors and/or policyholders. These systems, together with the structures, policies, processes and people supporting them, comprise an institution’s or group’s risk management framework.
Guidance (1)
In Force
April 2018
This PPG aims to assist APRA-regulated institutions in complying with Prudential Standard CPS 220 Risk Management (CPS 220) and, more generally, to outline prudent practices in relation to risk management.  |  File type: PDF  |  File size: 675.49 KB
231

Outsourcing

HPS
231
Prudential Standards (1)
In Force
In effect from 26 June 2015
This Prudential Standard sets out minimum requirements for outsourcing of a private health insurer’s business activities.
Related resources (1)
234

Information Security

CPS
234
CPG
234
Prudential Standards (1)
In Force
In effect from 1 July 2019
This Prudential Standard aims to ensure that an APRA-regulated entity takes measures to be resilient against information security incidents (including cyber-attacks) by maintaining an information security capability commensurate with information security vulnerabilities and threats.
Guidance (1)
In Force
June 2019
This PPG aims to assist regulated entities in maintaining information security. It is designed to provide guidance to Boards, senior management, risk management and information security specialists (management and operational).  |  File type: PDF  |  File size: 837.05 KB
Related resources (2)