Private health insurance resources
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.
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.
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.
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
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
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 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 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).
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.
NTREAP meeting outcomes – 18 July 2024
Natural Therapies Review Expert Advisory Panel (NTREAP) meeting outcomes for 18 July 2024 meeting.
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.
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.
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.
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.
NTREAP meeting outcomes – 7 June 2024
Natural Therapies Review Expert Advisory Panel (NTREAP) meeting outcomes for 7 June 2024 meeting.
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.
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.
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.
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 – 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.
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.
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