Private health insurance resources
Second-tier default benefits eligibility – Application form
This form is for private hospitals to apply for second-tier default benefits eligibility.
Deed for the provision of Overseas Student Health Cover 1 July 2025
This legal document sets out the conditions that registered Australian health funds must comply with to provide Overseas Student Health Cover (OSHC) policies.
Cost Recovery Implementation Statement (CRIS) – Administration of Private Health Insurance second-tier default benefits
This document provides information on how the Department of Health, Disability and Ageing undertakes cost recovery for administration of private health insurance second-tier default benefits eligibility.
Second-tier default benefits guidelines
These guidelines outline how private hospitals can apply for second-tier default benefits eligibility and the assessment criteria. It also explains how we administer eligibility.
Private Health Insurance clinical category classification 1 July 2025
This spreadsheet classifies MBS items by private health insurance clinical category or procedure type and includes MBS items effective 1 July 2025.
Private Health Insurance clinical category definitions 1 July 2025
Standard clinical category definitions for private health insurance hospital policies, released on 12 June 2025 and effective 1 July 2025.
Consultation Paper 10 – General Use Items utilisation, expenditure and integrity
This circular is to advise stakeholders of the publication of a high level summary and individual submissions.
Private hospital second-tier category list for consultation as of 1 June 2025
This list current as of 1 June 2025 is for consultation only and is not the final list used by private health insurers to calculate the second-tier default benefits payable to individual hospitals.
List of declared hospitals
The Minister for Health and Aged Care must declare a facility to be a hospital under section 121–5(6) of the Private Health Insurance Act 2007. View the current list of declared hospitals.
Advice on the benefit reductions to Cardiac Implantable Electronic Devices
The document contains advice on the third and final reduction of benefits for Cardiac Implantable Electronic Devices (CIED) effective 1 July 2025.
HCP data specifications – Hospital to insurer – 2025–26
The Hospital Casemix Protocol (HCP) data specifications for HCP files details the financial, clinical and demographic data that hospitals must provide to private health insurers. Private health insurers must then provide this data to us. Effective from 1 July 2025.
PHDB data specification – Hospital to department – 2025–26
The Private Health Data Bureau (PHDB) data specifications for 2024–25 details the financial, clinical and demographic data that hospitals must provide to us. Effective from 1 July 2025.
HCP data specifications – HCP1 – Insurer to department – 2025–26
The Hospital Casemix Protocol (HCP) data specification for HCP1 files for 2025–26 details the financial, clinical and demographic data that hospitals must provide private health insurers. Private health insurers must then provide this data to us. Effective from 1 July 2025.
GT-Dental data specification – Insurer to department – 2025–26
The Hospital Casemix Protocol (HCP) data specification for General Treatment-Dental files for 2025–26 details the financial, clinical and demographic data that hospitals must provide private health insurers. Private health insurers must then provide this data to us. Effective from 1 July 2025.
HCP data specifications – HCP2 – Insurer to department – 2025–26
The Hospital Casemix Protocol (HCP) data specification for HCP2 files for 2025–26 details the financial, clinical and demographic data that hospitals must provide private health insurers. Private health insurers must then provide this data to us. Effective from 1 July 2025.
Changes in HCP and PHDB data specifications – 2025–26
This fact sheet outlines changes in the data specifications for Hospital Casemix Protocol (HCP) and Private Hospital Data Bureau (PHDB) data for the 2025–26 financial year. They take effect on 1 July 2025.
Natural Therapies Review 2024 – Report and recommendations
Read the final report from the Chair of the Natural Therapies Review Expert Advisory Panel. The review considered a range of natural therapies and recommends which ones should be eligible for subsidy through private health insurance rebates.
NTREAP meeting outcomes – 10 December 2024
Natural Therapies Review Expert Advisory Panel (NTREAP) meeting outcomes for 10 December 2024 meeting.
Private Health Insurance clinical category definitions 1 March 2025
Standard clinical category definitions for private health insurance hospital policies, released on 19 February 2025 and effective 1 March 2025.
Prescribed List of Medical Devices and Human Tissue Products
This page lists the medical devices and human tissue products private health insurers must pay benefits for to the patients who have appropriate insurance policies. The latest version of the Prescribed List is effective from 1 July 2025.
HCP annual report 2023-24 – Preliminary
This preliminary annual report of Hospital Casemix Protocol (HCP) data outlines health statistics received from private health insurers detailing information relating to patient, medical and financial data for the financial years 2019-20 to 2023-24.
PHDB annual report 2023-24 – Preliminary
This preliminary annual report of Private Hospital Data Bureau (PHDB) data outlines health statistics received from private hospitals detailing information relating to patient data for the financial years 2019–20 to 2023–24.
Stakeholder feedback summary – Consultation Paper 9 – CIED and the cost of technical support services
This document provides a high-level summary of stakeholder feedback received in response to Consultation Paper 9 – CIED and the cost of technical support services.
Natural Therapies Review 2024 – NHMRC process report
This report from the National Health and Medical Research Council (NHMRC) details the methods used to assess, for a range of therapies, whether they are suitable to be covered by private health insurance.
Prescribed List post-listing review framework
We have developed a Prescribed List Post-listing Review Framework that is used to guide the post-listing review process as part of the Prescribed List Reforms.
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