Private health insurance resources
Prescribed List of Medical Devices and Human Tissue Products
Report
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.
List of declared hospitals
Dataset
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.
Draft National Joint Replacement Registry Cost Recovery Implementation Statement
Report
This statement describes how the Department of Health and Aged Care recovers the costs of administering the National Joint Replacement Registry.
Baseline evaluation of the Prostheses List reforms – Final report
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.
Private Health Insurance classification of MBS items 1 November 2024
Dataset
This spreadsheet classifies MBS items by private health insurance clinical category or procedure type and includes MBS items effective 1 November 2024.
Private Health Insurance clinical category definitions 1 November 2024
Dataset
Standard clinical category definitions for private health insurance hospital policies, released on 11 October 2024 and effective 1 November 2024.
Prescribed List billing codes – Removal of medicine and medicine accessories – 1 November 2024
Fact sheet
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.
HCP annual report 2022-23 – updated
Dataset
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
Dataset
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
Form
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
Report
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
Report
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
Report
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
Presentation
This webinar recording provides practical tips on submitting applications.
NTREAP meeting outcomes – 18 July 2024
Meeting minutes
Natural Therapies Review Expert Advisory Panel (NTREAP) meeting outcomes for 18 July 2024 meeting.
Private hospital second-tier category list
Report
Private health insurers use the list current as of 1 August each year to calculate the second-tier default benefits payable to individual hospitals.
Prostheses List Post-Listing review – Consultants report
Report
This report is a review of surgical guides and biomodels currently listed on the Prostheses List.
Second-tier default benefits guidelines
Guideline
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.
Cost Recovery Implementation Statement (CRIS) – Administration of Private Health Insurance second-tier default benefits
Procedure
This document provides information on how the Department of Health undertakes cost recovery for administration of private health insurance second-tier default benefits eligibility.
Second-tier default benefits eligibility – Application form
Form
This form is for private hospitals to apply for second-tier default benefits eligibility.
Private Health Insurance clinical category definitions 1 July 2024
Dataset
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
Dataset
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
Meeting minutes
Natural Therapies Review Expert Advisory Panel (NTREAP) meeting outcomes for 7 June 2024 meeting.
HCP data specifications – HCP2 – Insurer to department – 2024–25
Standard
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.
PHDB data specification – Hospital to department – 2024–25
Standard
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.
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