Private health insurance resources
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.
Final evaluation of the Prescibed List Reforms
The final evaluation report covers the period from July 2025 to July 2026. It includes the final findings of the evaluation.
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.
Second-tier default benefits eligibility – Application form
This form is for private hospitals to apply for second-tier default benefits eligibility.
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 – 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.
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.
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.
PHDB data specification – Hospital to department – 2026–27
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 2026.
Surgical guides and biomodels post-listing review - Draft report
The draft departmental report summarises the review process and outcomes. Stakeholders can provide feedback on the proposed recommendations.
HCP data specifications – HCP2 – Insurer to department – 2026–27
The Hospital Casemix Protocol (HCP) data specification for HCP2 files for 2026–27 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 2026.
HCP data specifications – Hospital to insurer – 2026–27
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 2026.
HCP data specifications – HCP1 – Insurer to department – 2026–27
The Hospital Casemix Protocol (HCP) data specification for HCP1 files for 2026–27 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 2026.
GT-Dental data specification – Insurer to department – 2026–27
The Hospital Casemix Protocol (HCP) data specification for General Treatment-Dental files for 2026–27 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 2026.
Assignment of Benefit – Simplified Billing Legislation changes
Presentation slides presented to a practice managers information session on Assignment of Benefit – Simplified Billing Legislation changes.
Cost Recovery Implementation Statement – Australian Orthopaedic Association National Joint Replacement Registry 2025–2029
This Cost Recovery Implementation Statement (CRIS) describes how the Department of Health, Disability and Ageing (the Department) recovers the costs of administering the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR).
Health technology assessment committee members – conflicts of interest process guide
A guide for health technology assessment committee members and department staff on the declaration, assessment, management and recording of conflicts of interest. Covering member nomination, appointment and terms of service.
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