Prudential and Reporting Standards for Private health insurance

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.

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.

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

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.

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

The objective of this Prudential Standard is to ensure that APRA-regulated entities maintain remuneration arrangements which appropriately incentivise individuals to prudently manage the risks they are responsible for, and that there are appropriate consequences for poor risk outcomes.

This PPG sets out guidance for all APRA-regulated entities on remuneration practices, to support Prudential Standard CPS 511 Remuneration (CPS 511). CPS 511 sets out requirements to ensure entities maintain remuneration arrangements which appropriately incentivise individuals to prudently manage the risks they are responsible for, and apply consequences for poor risk outcomes.   |  File type: PDF  |  File size: 735.25 KB

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.

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

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

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

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.

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

This PPG aims to assist an APRA-regulated institution in complying with Prudential Standards CPS 220 Risk Management (CPS 220), SPS 220 Risk Management (SPS 220), CPS 510 Governance(CPS 510), SPS 510 Governance (SPS 510) and, more generally, to outline prudent practices in relation to climate change financial risk management.  |  File type: PDF  |  File size: 1.38 MB

The aim of this Prudential Standard is to ensure that an APRA-regulated entity is resilient to operational risks and disruptions. An APRA-regulated entity must effectively manage its operational risks, maintain its critical operations through disruptions, and manage the risks arising from service providers.

This Prudential Standard sets out minimum requirements for outsourcing of a private health insurer’s business activities.

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.

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

This Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s supplementary information for its regulatory income statement. It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 115 Capital Adequacy: Insurance Risk Charge (HPS 115), and Prudential Standard HPS 340 Insurance Liability Valuation (HPS 340).

This Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s forecasts and targets. It includes associated specific instructions and should be read in conjunction with Prudential Standard HPS 110 Capital Adequacy (HPS 110).

This Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s claims. It includes associated specific instructions.

This guide assists regulated institutions to develop their Internal Capital Adequacy Assessment Process, including required documents, and to understand APRA’s approach to the supervisory review process for setting supervisory adjustments to required capital. This information supports compliance with Prudential Standard APS 110 Capital Adequacy (APS 110), Prudential Standard GPS 110 Capital Adequacy (GPS 110), Prudential Standard HPS 110 Capital Adequacy (HPS 110) and Prudential Standard LPS 110 Capital Adequacy (LPS 110). These prudential standards set out requirements in relation to the capital adequacy of a regulated institution, including the need for a regulated institution to have an ICAAP, and establish a framework for supervisory review and adjustment of a regulated institution’s capital requirements.(APS 110), Prudential Standard GPS 110 Capital Adequacy (GPS 110) and Prudential Standard LPS 110 Capital Adequacy (LPS 110). These prudential standards set out requirements in relation to the capital adequacy of a regulated institution, including the need for a regulated institution to have an ICAAP, and establish a framework for supervisory review and adjustment of a regulated institution’s capital requirements.   |  File type: PDF  |  File size: 606.94 KB

This Prudential Standard requires a private health insurer to maintain adequate capital against the risks associated with its activities. Some of the key requirements of this Prudential Standard are that a private health insurer must have an Internal Capital Adequacy Assessment Process; maintain required levels of capital within each of its funds and for the private health insurer; determine each fund’s prescribed capital amount; and to seek APRA’s approval for certain capital reductions.

This Reporting Standard sets out the requirements to provide information to APRA about a private health insurer’s prescribed capital amount. It includes associated specific instructions must be read in conjunction with Prudential Standard HPS 110 Capital Adequacy (HPS 110).

This Reporting Standard sets out the requirements for the provision of information to APRA relating to a private health insurer’s adjustments. It includes associated specific instructions.

This Reporting Standard sets out the requirements for the provision of information to APRA regarding the determination of a private health insurer’s capital base. It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 110 Capital Adequacy (HPS 110) and Prudential Standard HPS 112 Capital Adequacy: Measurement of Capital (HPS 112).

This Reporting Standard sets out the requirements for the provision of information to APRA regarding the determination of a private health insurer’s capital base. It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 110 Capital Adequacy (HPS 110) and Prudential Standard HPS 112 Capital Adequacy: Measurement of Capital (HPS 112).

This Reporting Standard sets out the requirements for the provision of information to APRA regarding the determination of a private health insurer’s related party exposures. It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 110 Capital Adequacy (HPS 110) and Prudential Standard HPS 112 Capital Adequacy: Measurement of Capital (HPS 112).

This Prudential Standard requires a private health insurer to maintain adequate capital against the asset risks associated with its activities. The ultimate responsibility for the prudent management of capital of a private health insurer rests with its Board of directors. The Asset Risk Charge is the minimum amount of capital required to be held against asset risks. This Prudential Standard sets out the method for calculating the Asset Risk Charge. This charge is one of the components of the Standard Method for calculating the prescribed capital amount for private health insurers and their funds.

This Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s asset risk charge. It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 114 Capital Adequacy: Asset Risk Charge (HPS 114).

This Prudential Standard requires a private health insurer to maintain adequate capital against the insurance risks associated with its insurance activities. The ultimate responsibility for the prudent management of capital of a private health insurer rests with its Board of directors. The Insurance Risk Charge is the minimum amount of capital required to be held against insurance risks. This Prudential Standard sets out the method for calculating the Insurance Risk Charge. This charge is one of the components of the prescribed capital amount for private health insurers.

This Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s insurance risk charge. It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 115 Capital Adequacy: Insurance Risk Charge (HPS 115) and Prudential Standard HPS 340 Insurance Liability Valuation (HPS 340).

This Prudential Standard requires a private health insurer to maintain adequate capital against the risks associated with asset concentration in its activities. The ultimate responsibility for the prudent management of capital of a private health insurer rests with its Board of directors. The Asset Concentration Risk Charge is the minimum amount of capital required to be held against asset concentration risks. This Prudential Standard sets out the method for calculating the Asset Concentration Risk Charge. This charge is one of the components of the prescribed capital amount for private health insurers.

This Reporting Standard sets out the requirements for the provision of information to APRA relating to a private health insurer’s Asset Concentration Risk Charge. It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 117 Capital Adequacy: Asset Concentration Risk Charge (HPS 117).

This Prudential Standard requires a private health insurer to maintain adequate capital against the operational risks associated with its activities. The ultimate responsibility for the prudent management of capital of a private health insurer with its Board of directors. The Operational Risk Charge is the minimum amount of capital required to be held against operational risks. This Prudential Standard sets out the method for calculating the Operational Risk Charge. This charge is one of the components of the prescribed capital amount for private health insurers.

This Reporting Standard sets out the requirements for the provision of information to APRA relating to a private health insurer’s Operational Risk Charge. It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 118 Capital Adequacy: Operational Risk Charge (HPS 118).

This Prudential Standard sets out requirements for the valuation of insurance liabilities of a private health insurer. The ultimate responsibility for the valuation of insurance liabilities rests with the Board of the private health insurer.

The objective of this Prudential Standard is to ensure that all APRA-regulated entities are adequately prepared for scenarios that may impact the financial viability of their business. It requires APRA-regulated entities to develop and maintain a recovery and exit plan, and capabilities to be able to anticipate, manage and respond to periods of stress.

This PPG sets out guidance for all APRA-regulated entities to assist in the implementation of CPS 190. It sets out the key areas of focus that APRA supervisors will have when assessing an entity’s recovery and exit planning.  |  File type: PDF  |  File size: 1.52 MB

The objective of this Prudential Standard is to ensure that APRA-regulated entities can be resolved by APRA in an orderly manner if needed, where bespoke planning and pre-positioning is required. It requires significant financial institutions (SFIs), and non-SFIs that provide critical functions, to support resolution planning when notified by APRA.

This PPG provides guidance to support the implementation of CPS 900. It sets out the outcomes that APRA is seeking to achieve at each stage of the resolution planning process, and the factors that APRA will have regard to in developing a bespoke resolution plan for a particular entity.  |  File type: PDF  |  File size: 955.46 KB

This Reporting Standard sets out the requirements for the provision of information to APRA in relation to a private health insurer’s financial position. It includes associated specific instructions.

This Reporting Standard sets out the requirements for the provision of information to APRA in relation to a private health insurer’s profit or loss and other comprehensive income. It includes associated specific instructions.

This Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s reconciliations of insurance contract liabilities required by AASB 17 Insurance Contracts. It includes associated specific instructions.

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.

This Reporting Standard sets out the requirements for the provision of information to APRA allowing for the publication of aggregate statistics on the use of medical devices or human tissue products by State and Territory. It includes Form HRF 603.0 Statistical Data on Medical Devices or Human Tissue Products Benefits and associated specific instructions.

This Reporting Standard sets out the requirements for the provision of information to APRA allowing for the publication of aggregate statistics on medical services by State and Territory. It includes Form HRF 604.0 Medical Specialty Block Grouping Information and associated specific instructions.

This Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer's implementation of private health insurance reforms. It includes Reporting Form HRF 605.0 Private Health Insurance Reform Data Collection (HRF 605.0) and associated specific instructions.

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.