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.
Overseas Student Health Cover (OSHC) fact sheet
This fact sheet provides a summary of what OSHC is, why it is needed and how to use it.
Supplementary 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.
Supplementary changes in HCP1 data specifications – 2024–25 and 2025–26
This fact sheet outlines changes in the supplementary data specifications for Hospital Casemix Protocol – Inpatient (HCP1) data for the 2024-25 and 2025–26 financial year. They take effect on 1 November 2025.
Supplementary HCP data specifications – HCP1 – Insurer to department – 2025–26
The Hospital Casemix Protocol (HCP) data specification for HCP1 files for 2025–26 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 2025.
Private Health Insurance clinical category classification 1 November 2025
This spreadsheet classifies MBS items by private health insurance clinical category or procedure type and includes MBS items effective 1 November 2025.
Private Health Insurance clinical category definitions 1 November 2025
Standard clinical category definitions for private health insurance hospital policies, released on 16 October 2025 and effective 1 November 2025.
PL reforms – summary of objectives and achievements
The Prescribed List reforms finished in June 2025. This document list the reforms objectives and achievements.
Interim Evaluation #2 of the Prescribed List Reforms
This interim evaluation report 2 covers the period from July 2024 to June 2025. It builds on the interim evaluation report 1.
PHI 75/25 attachments – 2026 Private health insurance premium application form and templates
These attachments to PHI circular 75/25 are the 2026 private health insurance premium application form and templates.
PHI 75/25 attachments – 2026 Private health insurance premium round statement of expectations
This attachment to PHI circular 75/25 is the Minister for Health and Ageing’s statement of expectations for the 2026 premium round which outlines matters that the Minister intends to pay particular regard to in his consideration of applications.
Explanatory document for insurers – Deed for the Provision of Overseas Student Health Cover 1 July 2025
This document is an accompanying document to the Deed for the Provision of Overseas Student Health Cover 1 July 2025. It is intended as an explanatory document for insurers, to provide clarity on the content of the Deed, and in particular, changes to the Deed.
Prescribed List Post-Listing review – Consultants report
This report informs stage 2 of the post-listing review of surgical guides and biomodels.
Private hospital second-tier category list – determinations made by 1 August 2025
Private health insurers use the list current as of 1 August each year to calculate the second-tier default benefits payable to individual hospitals.
HCP annual report 2023-24
This 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 2019-20 to 2023-24.
PHDB annual report 2023–24
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 2023–24 financial year.
Cost Recovery Implementation Statement – Administration of the Prescribed List of Medical Devices and Human Tissue Products
This cost recovery implementation statement describes how the Department of Health and Aged Care recovers the costs of administering the Prescribed List from 1 July 2025 to 30 June 2026.
Prescribed List Compliance Strategy – Safeguarding the Prescribed List
The below document outlines Prescribed List compliance obligations for relevant stakeholders and the Australian Government.
Second-tier default benefits eligibility – Application form
This form is for private hospitals to apply for 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.
Deed for the provision of Overseas Student Health Cover 1 July 2025
This legal document sets out the conditions that registered Australian health funds must comply with to provide Overseas Student Health Cover (OSHC) policies.
Private Health Insurance clinical category definitions 1 July 2025
Standard clinical category definitions for private health insurance hospital policies, released on 12 June 2025 and effective 1 July 2025.
Private Health Insurance clinical category classification 1 July 2025
This spreadsheet classifies MBS items by private health insurance clinical category or procedure type and includes MBS items effective 1 July 2025.
Consultation Paper 10 – General Use Items utilisation, expenditure and integrity
This circular is to advise stakeholders of the publication of a high level summary and individual submissions.
Advice on the benefit reductions to Cardiac Implantable Electronic Devices
The document contains advice on the third and final reduction of benefits for Cardiac Implantable Electronic Devices (CIED) effective 1 July 2025.
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