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PHI 23/08

This circular issued by the Private Health Insurance Branch contains information relating to the Private Health Insurance (Data Provision) Rules 2008 and Private Health Insurance (Health Insurance Business) Rules 2008

Printable version of PHI 23/08 (PDF 28 KB)

23 June 2008

Private Health Insurance (Data Provision) Rules 2008 and Private Health Insurance (Health Insurance Business) Rules 2008

This circular is to advise that the Private Health Insurance (Data Provision) Rules 2008 and the Private Health Insurance (Health Insurance Business) Rules 2008 have been registered with the Federal Register of Legislative Instruments (FRLI) on 13 June 2008 (FRLI no: F2008L02089 and F2008L02090 respectively) and will commence on 1 July 2008.

These rules revoke and remake the Private Health Insurance (Data Provision) Rules 2007 and the Private Health Insurance (Health Insurance Business) Rules 2007.

Please note that the term ‘outreach’ is no longer included in the data specifications as the outreach program and the related default benefit ceases on 30 June 2008 (as per previous PHI Circulars: 17/07 and 02/07).

Changes to the Rules:

Private Health Insurance (Data Provision) Rules 2008

1. Health Insurers must report non-admitted hospital treatment to the Department via a service record file called ‘HCP2 Data from Insurers to the Department’.
The ‘HCP2 Data from Insurers to the Department’ document specifies the data health insurers must supply the Department in respect of hospital treatment they have paid benefits for, which do not qualify as an 'episode of admitted patient care' and are therefore out of scope of the ‘HCP1 Data from Insurers to the Department’.

Private Health Insurance (Health Insurance Business) Rules 2008

1. Rule 17 (3) specifies that Rule 17 does not apply to Complying Health Insurance Policies (CHIPs) from 1 July 2008.
2. The HCP Data from Hospitals to Insurer document referred to under Rule 4 (2) requires hospitals to provide a monthly data submission to the insurer within 6 weeks after the end of a hospital separation month.
3. The document that contains the data specifications from hospitals to health insurers is now referred to as ‘HCP Data from Hospitals to Insurers’.
4. The document that contains the data specifications from hospitals to the Department is now referred to as ‘PHDB Data from Private Hospitals to the Department’.

The following documents can be found at on the Department's website:

• HCP1 Data from Insurers to the Department
• HCP2 Data from Insurers to the Department
• HCP Data from Hospitals to Insurers
• PHDB Data from Private Hospitals to the Department

These rules are available on the Comlaw website.

If you require further information please telephone: (02) 6289 9853/24 hr answering machine or email the enquiry to Private Health Insurance Branch

For more information visit 2008 Private Health Insurance (PHI) Circulars.

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