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.
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.
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.
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 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.
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).
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Prescribed List – practical tips on submitting applications
This webinar recording provides practical tips on submitting applications.
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 8 August 2024.
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.
NTREAP meeting outcomes – 18 July 2024
Natural Therapies Review Expert Advisory Panel (NTREAP) meeting outcomes for 18 July 2024 meeting.
Prostheses List Post-Listing review – Consultants report
This report is a review of surgical guides and biomodels currently listed on the Prostheses List.
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 (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 category definitions 1 July 2024
Standard clinical category definitions for private health insurance hospital policies, released on 31 May 2024 and effective 1 July 2024.
Private Health Insurance classification of MBS items 1 July 2024
This spreadsheet classifies MBS items by private health insurance clinical category or procedure type and includes MBS items effective 1 July 2024.
NTREAP meeting outcomes – 7 June 2024
Natural Therapies Review Expert Advisory Panel (NTREAP) meeting outcomes for 7 June 2024 meeting.
PHDB data specification – Hospital to department – 2024–25
The Private Health Data Bureau (PHDB) data specifications for 2023–24 details the financial, clinical and demographic data that hospitals must provide to us. Effective from 1 July 2024.
HCP data specifications – HCP1 – Insurer to department – 2024–25
The Hospital Casemix Protocol (HCP) data specification for HCP1 files for 2024–25 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 2024.
GT-Dental data specification – Insurer to department – 2024–25
The Hospital Casemix Protocol (HCP) data specification for General Treatment-Dental files for 2024–25 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 2024.
Changes in HCP and PHDB data specifications – 2024–25
This fact sheet outlines changes in the data specifications for Hospital Casemix Protocol (HCP) and Private Hospital Data Bureau (PHDB) data for the 2024–25 financial year. They take effect on 1 July 2024.
HCP data specifications – HCP2 – Insurer to department – 2024–25
The Hospital Casemix Protocol (HCP) data specification for HCP2 files for 2024–25 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 2024.
HCP data specifications – Hospital to insurer – 2024–25
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 2024.
Health Insurance Legislation Amendment (Assignment of Medicare Benefits) Bill 2024 – Simplified billing overview
This document includes an overview of the key elements of the Health Insurance Legislation Amendment (Assignment of Medicare Benefits) Bill 2024 as introduced to Parliament on 29 May 2024. It focuses on simplified billing assignment.
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