Private health insurance resources
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.
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.
Private Health Insurance clinical category definitions 1 January 2025
Standard clinical category definitions for private health insurance hospital policies, released on 12 December 2024 and effective 1 January 2025.
Private Health Insurance classification of MBS items 1 January 2025
This spreadsheet classifies MBS items by private health insurance clinical category or procedure type and includes MBS items effective 1 January 2025.
Interim Evaluation #1 of the Prescribed List Reforms
The interim evaluation report covers the period from May 2021 to June 2024 and reports on whether the reforms being implemented and achieving the expected outcomes.
Reforms to the Prescribed List Part B – Analysis of stakeholder feedback
This report is to provide an analysis of stakeholder feedback received.
Private Health Insurer pandemic commitment monitoring – 2024
A summary of 2024 funds returned from private health insurers to policyholders in response to the COVID-19 pandemic.
Private Health Insurer pandemic commitment monitoring – 2023
A summary of 2023 funds returned from private health insurers to policyholders in response to the COVID-19 pandemic.
Private Health Insurer pandemic commitment monitoring – 2022
A summary of 2022 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 undertakes cost recovery for administration of private health insurance second-tier default benefits eligibility.
Private Health Insurance Clinical Categories Review Advisory Committee Report
This report sets out 24 recommendations for the department to better clarify the coverage requirements of the categories and the regulations in the Private Health Insurance.
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 November 2024.
Baseline evaluation of the Prostheses List reforms – Final report
This evaluation focuses on the Prostheses List reforms, which are running from 1 July 2021 to 30 June 2025. Evaluation of these reforms will determine whether the reform program is being implemented as intended.
Prescribed List billing codes – Removal of medicine and medicine accessories – 1 November 2024
This list includes details of the 26 billing codes for medicines and related accessories scheduled to be removed from Part D of the Prescribed List effective 1 November 2024.
Private Health Insurance clinical category definitions 1 November 2024
Standard clinical category definitions for private health insurance hospital policies, released on 11 October 2024 and effective 1 November 2024.
Private Health Insurance classification of MBS items 1 November 2024
This spreadsheet classifies MBS items by private health insurance clinical category or procedure type and includes MBS items effective 1 November 2024.
PHDB annual report 2022-23 – 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 2022–23 financial year.
HCP annual report 2022-23 – updated
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 2022–23 financial year.
PHI 67/24 attachments – 2025 Private health insurance premium application form and templates
These attachments to PHI circular 59/24 are the 2025 private health insurance premium application form and templates.
Consultation Paper 8b – Alignment of amount charged for supply of a device with corresponding PL benefit
This report provides an analysis of stakeholder feedback received in response to the consultation paper on the proposed measure: alignment of amount charged for supply of a device with corresponding PL benefit.
Consultation Paper 7 – Proposed measures for compliance, assurance and information sharing
This report provides an analysis of stakeholder feedback received in response to the Consultation Paper on the proposed Compliance, Assurance and Information sharing measures for the Prescribed List (PL).
Consultation Paper 8a – Gifts, benefits and discounts reporting requirement
This report provides an analysis of stakeholder feedback received in response to the consultation paper on the proposed measure: Prescribed List (PL) gifts, benefits and discounts reporting requirements.
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Prescribed List – practical tips on submitting applications
This webinar recording provides practical tips on submitting applications.
NTREAP meeting outcomes – 18 July 2024
Natural Therapies Review Expert Advisory Panel (NTREAP) meeting outcomes for 18 July 2024 meeting.
Private hospital second-tier category list
Private health insurers use the list current as of 1 August each year to calculate the second-tier default benefits payable to individual hospitals.
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