Licensing guidelines for private health insurers
Understand APRA’s licensing process as a private health insurer.
Licensing process at a glance
Engaging early with APRA's licensing team is highly recommended. This helps prospective applicants understand the licensing process, clarify expectations and identify potential issues before lodging an application.
The pre-application process is structured to support applicants in refining their business plans and receive feedback to ensure alignment with APRA's prudential requirements. This stage typically involves several engagements where APRA provides feedback and understands your readiness to apply. Key focus areas include governance, ownership and controllers, financial resources, risk management, IT strategy, outsourcing, and contingency planning.
When ready, businesses submit their formal application with Board-approved documentation and pay the application fee. APRA begins its assessment when a substantial and high-quality set of material has been received. Applicants must provide detailed information about their ownership, financial position, governance and risk frameworks. The licensing assessment process is iterative, often taking 12-18 months, as APRA reviews, requests updates, and assesses the applicant’s ability to operate safely and soundly within the financial system.
Once APRA completes its review, a decision is typically issued within 90 days. If approved, licences may include conditions tailored to the specific business model. If declined, APRA will provide written reasons and information outlining review and appeal options.
After licensing, entities are subject to APRA's prudential standards, ongoing supervision, and annual levies. Entities must report regularly through APRA's data collection systems, promptly notify APRA of material changes, and comply with industry-specific disclosure and approval requirements. Additional conditions or reporting may apply depending on the licence type.
All licensed institutions are listed on APRA's public registers, supporting transparency and accountability across the financial system.
Read APRA's licensing process in more detail
Key documents
Who needs a private health insurance licence?
Under the Private Health Insurance (Prudential Supervision) Act 2015 (the PHIPS Act), a person must not provide health insurance unless they are registered to do so. If your business intends to conduct any business that can be classed as health insurance business, you need a licence from APRA registering you to conduct health insurance business in Australia.
Health insurance business is defined in sub-section 121-1 of the Private Health Insurance Act 2007 as business that consists of undertaking liability by way of insurance, or an employee health benefit scheme, that relates to hospital or general treatment. There are some exclusions, such as accident and sickness business, as this is covered under the Insurance Act 1973.
The PHIPS Act only allows corporations to carry out health insurance business in Australia, which means APRA cannot consider applications from partnerships or unincorporated entities.
Application guidelines
For more information on the licensing of private health insurers see the ‘Instruction Guide – registration as a private health insurer’. The guide outlines APRA’s registration process for private health insurers, including the minimum criteria to be addressed by applicants and the necessary information and documents to be lodged with an application.
Before you lodge your application for a private health insurer licence, ensure you have read and are familiar with the prudential framework for private health insurers, including relevant legislation, APRA rules, prudential standards and prudential practice guides. You can find all of this information on private health insurance supervision page.
Application form
The applicable approved form should be completed and lodged with APRA with the required supporting information and applicable additional attachments. The form must be lodged with APRA at least 90 days before the date specified in the application as the day on which the applicant proposes to become registered as a private health insurer.
Download registration as a private health insurer application form
Additional attachments for private health application form
Change of details
Where an application has been lodged with APRA and changes have been made to the composition of the board before APRA has ruled on the application, you must notify APRA on the changes using the above additional attachments to the approved form.