Private health insurance resources
Private Health CEO Forum – 21 September 2026
The Private Health Chief Executive Forum Meeting Summary provides a summary of the agenda, discussion and presentations from its meeting of 21 September 2026.
PHI 78/26 attachments - Out of Round premium application form and templates
These attachments to PHI circular 78/26 are the Out of Round premium application form and templates.
PHI 78/26 attachments - 2027 Private health insurance premium application form and templates
These attachments to PHI circular 78/26 are the 2027 private health insurance premium application form and templates.
PHI 78/26 attachments – 2027 Private health insurance Premium Round Statement of Expectations
This attachment to PHI circular 78/26 is the Minister of Health and Ageing’s statement of expectations for the 2027 premium round which outlines matters that the Minister intends to pay particular regard to in his consideration of applications.
GTD annual report 2025-26 – Preliminary
This preliminary annual report provides an overview of General Treatment Dental (GTD) activity based on data submitted by private health insurers, including statistics on dental services and patients for the financial years 2023-24 to 2025-26.
Surgical guides and biomodels post-listing review – Department report
This department report summarises the post-listing review process and final outcome.
List of declared hospitals
The Minister for Health and Ageing 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.
Expert Clinical Advisory Groups Member Guidelines
These guidelines set out how the advisory groups will operate to deliver on their Terms of Reference.
Expert Clinical Advisory Groups – Terms of Reference
This document sets out the purpose, roles, function and membership of the Expert Clinical Advisory Groups.
Overseas Student Health Cover (OSHC) fact sheet
This fact sheet provides a summary of what OSHC is, why it is needed and how to use it.
Final evaluation of the Prescribed List Reforms
The final evaluation report covers the period from July 2025 to July 2026. It includes the final findings of the evaluation.
Second-tier default benefits eligibility – Application form
This form is for private hospitals to apply for second-tier default benefits eligibility.
Private health insurance reform data quarterly trends report
This report provides statistic and data trends on private health insurance reforms by quarter.
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 hospital second-tier category list – determinations made by 1 August 2026
Private health insurers use the list current as of 1 August each year to calculate the second-tier default benefits payable to individual hospitals.
Private Health Insurance clinical category classification and definitions 1 August 2026
This spreadsheet classifies MBS items by private health insurance clinical category or procedure type and includes MBS items effective 1 August 2026.
PHI Rebate changes – Modernising the Private Health Insurance Rebate
The fact sheet describes changes to the private health insurance rebate. The changes will mean people in the same income tier receive the same rebate rate.
HCP annual report 2024-25 – Updated
This updated 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 2020–21 to 2024–25.
PHDB annual report 2024-25 – Updated
This updated 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 2020–21 to 2024–25.
Private Health Insurer pandemic commitment monitoring – December 2025
A summary of December 2025 funds returned from private health insurers to policyholders in response to the COVID-19 pandemic.
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.
Cost Recovery Implementation Statement – Administration of the Prescribed List of Medical Devices and Human Tissue Products 2026-2027
This CRIS provides information on how the Department of Health, Disability and Ageing (the Department) implements cost recovery charging for applications for medical devices seeking to be listed on the Prescribed List of Medical Devices and Human Tissue Products.
Prescribed List of Medical Devices and Human Tissue Products
This page lists the benefits for medical devices and human tissue products private health insurers must pay to patients who have appropriate insurance policies. The latest version of the Prescribed List is effective from 1 July 2026.
Changes in HCP and PHDB data specifications – 2026–27
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 2026.
Private Health Insurance clinical category classification and definitions 1 July 2026
This spreadsheet classifies MBS items by private health insurance clinical category or procedure type and includes MBS items effective 1 July 2026.
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