Private health insurance resources
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.
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.
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 – 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.
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.
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 medical devices and human tissue products private health insurers must pay benefits for to patients who have appropriate insurance policies. The latest version of the Prescribed List is effective from 28 April 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
Spinal fusion cages
These documents clarify claiming benefits for spinal fusion cage devices in product group 13.10.01 on the Prescribed List and list the spinal fusion cages under integral fixation.
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 reform data quarterly trends report
This report provides statistic and data trends on private health insurance reforms by quarter.
Prescribed List grouping schemes
View the grouping schemes for devices in Part A, Part C and Part D of the Prescribed List.
Private Health Insurer pandemic commitment monitoring – 2025
A summary of 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 2025–26
This cost recovery implementation statement describes how we recover the costs of administering the Prescribed List from 1 July 2025 to 30 June 2026.
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