Private health insurance resources
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.
Second-tier default benefits eligibility – Application form
This form is for private hospitals to apply for 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.
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.
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.
Private hospital second-tier category list – determinations made by 1 June 2026
Private health insurers use the list current as of 1 June each year to calculate the second-tier default benefits payable to individual hospitals.
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.
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.
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 – 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.
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.
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.
PHDB annual report 2024-25 – 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 2020-21 to 2024-25.
HCP annual report 2024-25 – 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 2020-21 to 2024-25.
Average annual price changes in private health insurance premiums
View the average annual price changes in premiums from 1997 to 2026 for each insurer and the industry. Premium price changes take effect from 1 April each year. Premium price changes for some policies may be higher or lower than the industry or insurer’s average.
Spinal cord stimulator post-listing review – Draft report
The draft department report is to summarise the review process to date and outline the proposed recommendations. The report is provided as a draft for stakeholder feedback on the proposed recommendations.
Private Health Insurance clinical category definitions 1 March 2026
Standard clinical category definitions for private health insurance hospital policies, released on 13 February 2026 and effective 1 March 2026.
Private Health Insurance clinical category classification 1 March 2026
This spreadsheet classifies MBS items by private health insurance clinical category or procedure type and includes MBS items effective 1 March 2026.
Assignment of Benefit – Simplified Billing Legislation changes
Presentation slides presented at a Stakeholder information session on Assignment of Benefit – Simplified Billing Legislation changes
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