Private health insurance resources
Private Health Insurance Clinical Categories Review Advisory Committee Report
This report sets out 24 recommendations for the department to better clarify the coverage requirements of the categories and the regulations in the Private Health Insurance.
Natural Therapies Review 2024 – Reflexology evidence evaluation
This report outlines the evaluation of evidence on the clinical effectiveness of reflexology as part of the Natural Therapies Review 2024.
Natural Therapies Review 2024 – Kinesiology evidence evaluation
This report outlines the evaluation of evidence on the clinical effectiveness of kinesiology as part of the Natural Therapies Review 2024.
Natural Therapies Review 2024 – Alexander Technique evidence evaluation
This report outlines the evaluation of evidence on the clinical effectiveness of the Alexander Technique as part of the Natural Therapies Review 2024.
Natural Therapies Review 2024 – Bowen Therapy evidence evaluation
This report outlines the evaluation of evidence on the clinical effectiveness of Bowen Therapy as part of the Natural Therapies Review 2024.
Natural Therapies Review 2024 – Feldenkrais evidence evaluation
This report outlines the evaluation of evidence on the clinical effectiveness of Feldenkrais as part of the Natural Therapies Review 2024.
Baseline evaluation of the Prostheses List reforms – Final 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 clinical category definitions 1 November 2024
Standard clinical category definitions for private health insurance hospital policies, released on 11 October 2024 and effective 1 November 2024.
Private Health Insurance classification of MBS items 1 November 2024
This spreadsheet classifies MBS items by private health insurance clinical category or procedure type and includes MBS items effective 1 November 2024.
Prescribed List billing codes – Removal of medicine and medicine accessories – 1 November 2024
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.
Natural Therapies Review 2024 – Naturopathy supplements evidence evaluation
This report outlines the evaluation of evidence on the clinical effectiveness of naturopathy supplements as part of the Natural Therapies Review 2024.
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.
HCP annual report 2022-23 – updated
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 2018-19 to 2022-23.
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 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).
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.
Natural Therapies Review 2024 – Western herbal medicine evidence evaluation
This report outlines the evaluation of evidence on the clinical effectiveness of western herbal medicine as part of the Natural Therapies Review 2024.
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Prescribed List – practical tips on submitting applications
This webinar recording provides practical tips on submitting applications.
Natural Therapies Review 2024 – Homeopathy evidence evaluation
This report outlines the evaluation of evidence on the clinical effectiveness of homeopathy as part of the Natural Therapies Review 2024.
NTREAP meeting outcomes – 18 July 2024
Natural Therapies Review Expert Advisory Panel (NTREAP) meeting outcomes for 18 July 2024 meeting.
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.
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 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.
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