{"id":"F2025L01110","name":"Financial Sector (Collection of Data) (reporting standard) determination No. 18 of 2025","slug":"financial-sector-collection-of-data-reporting-standard-determination-no-18-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":106850,"registerId":"commonwealth-F2025L01110-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Financial Sector (Collection of Data) (reporting standard) determination No. 18 of 2025","content":"![Commonwealth Coat of Arms of Australia](image.001.png)\n\nFinancial Sector (Collection of Data) (reporting standard) determination No. 18 of 2025\n\nReporting Standard HRS 604.0 Medical Specialty Block Grouping Information\n\nFinancial Sector (Collection of Data) Act 2001\n\nI, Andrew Robertson, delegate of APRA, under paragraph 13(1)(a) of the Financial Sector (Collection of Data) Act 2001 (the Act) and subsection 33(3) of the Acts Interpretation Act 1901:\n\n1. revoke Financial Sector (Collection of Data) (reporting standard) determination No. 34 of 2015, including Reporting Standard HRS 604.0 Medical Specialty Block Grouping Information made under that Determination; and\n\n1. determine Reporting Standard HRS 604.0 Medical Specialty Block Grouping Information, in the form set out in the Schedule, which applies to the financial sector entities to the extent provided in paragraph 3 of that reporting standard.\n\nUnder section 15 of the Act, I declare that Reporting Standard HRS 604.0 Medical Specialty Block Grouping Information shall begin to apply to those financial sector entities, and the revoked reporting standard shall cease to apply, on the day after this instrument is registered on the Federal Register of Legislation.\n\nThis instrument commences at the start of the day after the day it is registered on the Federal Register of Legislation.\n\nDated: 11 September 2025\n\nAndrew Robertson\n\nGeneral Manager - Chief Data Officer\n\nTechnology and Data Division\n\nInterpretation\n\nIn this Determination:\n\nAPRA means the Australian Prudential Regulation Authority.\n\nFederal Register of Legislation means the register established under section 15A of the Legislation Act 2003.\n\nfinancial sector entity has the meaning given by section 5 of the Act.\n\nSchedule\n\nReporting Standard HRS 604.0 Medical Specialty Block Grouping Information comprises the document commencing on the following page.\n\n![Commonwealth Coat of Arms of Australia](image.001.png)\n\nReporting Standard HRS 604.0\n\nMedical Specialty Block Grouping Information\n\nObjective of this Reporting Standard\n\nThis Reporting Standard sets out the requirements for the provision of information to APRA allowing for the publication of aggregate statistics on medical services by State and Territory.\n\nIt includes Form HRF 604.0 Medical Specialty Block Grouping Information and associated specific instructions.\n\nAuthority\n\n1. This Reporting Standard is made under section 13 of the Financial Sector (Collection of Data) Act 2001.\n\nPurpose\n\n1. Information collected under this Reporting Standard, as set out in Form HRF 604.0 Medical Specialty Block Grouping Information (HRF 604.0), is used by APRA for prudential supervision and publication to assist the Department of Health in performing its functions.\n\nApplication and commencement\n\n1. This Reporting Standard applies to all private health insurers.\n2. This Reporting Standard applies for reporting periods ending on or after 1 October 2025.\n\nInformation required\n\n1. A private health insurer must provide APRA with the information required by HRF 604.0 in respect of each reporting period.\n2. The information required by this Reporting Standard, as set out in HRF 604.0, must be provided for each health benefits fund of the private health insurer.\n\nForms and method of submission\n\n1. The information required by this Reporting Standard must be given to APRA:\n 1. in electronic format using an electronic method available on APRA’s website; or\n\n(b) by a method notified by APRA prior to submission.\n\nReporting periods and due dates\n\n1. A private health insurer to which this Reporting Standard applies must provide the information required by this Reporting Standard in respect of each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June).\n2. The information required by this Reporting Standard must be provided to APRA within 28 calendar days after the end of the reporting period to which the information relates.[\\[1\\]](#_ftn1)\n3. APRA may, in writing, grant a private health insurer an extension of a due date, in which case the new due date for the provision of the information will be the date on the notice of extension.\n\nQuality control\n\n1. All information provided by a private health insurer under this Reporting Standard must be subject to systems, processes and controls developed by the private health insurer for the internal review and authorisation of that information. It is the responsibility of the Board and senior management of the private health insurer to ensure that an appropriate set of policies and procedures for the authorisation of information submitted to APRA is in place.\n\nAuthorisation\n\n1. A person who submits the information required under this Reporting Standard must be suitably authorised by an officer of the private health insurer.\n\nVariations\n\n1. APRA may, in writing, vary the reporting requirements of this Reporting Standard in relation to a private health insurer.\n\nTransitional\n\n1. A private health insurer to which this Reporting Standard applies must report under the old reporting standard in respect of a transitional reporting period. For these purposes:\n\nold reporting standard means the reporting standard revoked in the determination making this Reporting Standard; and\n\ntransitional reporting period means a reporting period under the old reporting standard:\n\n1. that ended before the date of revocation; and\n2. in relation to which the private health insurer was required, under the old reporting standard, to report by a date on or after the date of revocation of the old reporting standard.\n\n Note: For the avoidance of doubt, if a private health insurer was required to report under an old reporting standard, and the reporting documents were due before the date of revocation of the old reporting standard, the private health insurer is still required to provide any overdue reporting documents in accordance with the old reporting standard.\n\nInterpretation\n\n1. In this Reporting Standard:\n\n1. unless the contrary intention appears, words and expressions have the meanings given to them in Prudential Standard CPS 001 Defined terms (CPS 001); and\n2. APRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998;\n\nofficer has the meaning in the Private Health Insurance (Prudential Supervision) Act 2015;\n\nprivate health insurer has the meaning in the Private Health Insurance (Prudential Supervision) Act 2015; and\n\nreporting period means a period mentioned in paragraph 8.\n\n| HRF_604_0: Medical Speciality Block Grouping Information |\n| -------------------------------------------------------- |\n\n| Australian Business Number | Institution Name |\n| -------------------------- | ----------------------------------- |\n| | |\n| Reporting Period | Scale Factor |\n| Quarterly | Whole dollars to two decimal places |\n| Reporting Consolidation | |\n| Health Benefits Fund | |\n\n```html\n

Total number of services

Total amount charged for hospital and general medical services

MBS Speciality Block Groupings

No gap agreement

Known gap agreement

No agreement

No gap agreement

Known gap agreement

No agreement

(1)

(2)

(3)

(4)

(5)

(6)

1) Specialist, consultant physician, and consultant psychiatric attendances: Groups A3, A4 and A8; items 104-108, 110-131, 300-352.

2) Procedures associated with intensive care and cardiopulmonary support and management: Subgroups T1.9 and T1.10; items 13815 - 13888.

3) Obstetrics and gynaecology obstetrics: Subgroup T4; items 16500 - 16636; and Surgical operations gynaecological: Subgroup T8.4; items 35500 - 35759.

4) Anaesthesia: Groups T6, T7, and T10; items 17603 - 18298, 20100-25205.

5) General surgical operations: Subgroup T8.1; items 30001 - 31472.

6) Colorectal surgical operations: Subgroup T8.2; items 32000 - 32212.

7) Vascular surgical operations: Subgroup T8.3; items 32500 - 35330.

8) Urology: Subgroup T8.5, items 36500 - 37854

9) Cardio-thoracic surgical operations: Subgroup T8.6; items 38200 - 38766; and Diagnostic procedures and investigations cardiovascular: Subgroup D1.6; items 11700-11724

10) Neurosurgical surgical operations: Subgroup T8.7; items 39000 - 40903.

11) Ear, nose and throat surgical operations: Subgroup T8.8; items 41500 - 41910.

12) Ophthalmology surgical operations: Subgroup T8.9; items 42503 - 42872.

13) Plastic and reconstructive surgical operations: Subgroup T8.13; items 45000-45797.

14) Orthopaedic surgical operations: Subgroup T8.15; items 47000 - 50426.

15) Assistance at operations: Group T9; items 51300 - 51318.

16) Diagnostic imaging services; Category 5; all Groups I1-I5; items 55028-63946.

17) Pathology services: Category 6; all Groups P1-P10; items 65060 and over.

18) All other items.

Total all services

\n```\n\n```html\n

Total Medicare benefits paid for hospital and general medical services

Total fund benefits paid for hospital and general medical services

MBS Speciality Block Groupings

No gap agreement

Known gap agreement

No agreement

No gap agreement

Known gap agreement

No agreement

(1)

(2)

(3)

(4)

(5)

(6)

1) Specialist, consultant physician, and consultant psychiatric attendances: Groups A3, A4 and A8; items 104-108, 110-131, 300-352.

2) Procedures associated with intensive care and cardiopulmonary support and management: Subgroups T1.9 and T1.10; items 13815 - 13888.

3) Obstetrics and gynaecology obstetrics: Subgroup T4; items 16500 - 16636; and Surgical operations gynaecological: Subgroup T8.4; items 35500 - 35759.

4) Anaesthesia: Groups T6, T7, and T10; items 17603 - 18298, 20100-25205.

5) General surgical operations: Subgroup T8.1; items 30001 - 31472.

6) Colorectal surgical operations: Subgroup T8.2; items 32000 - 32212.

7) Vascular surgical operations: Subgroup T8.3; items 32500 - 35330.

8) Urology: Subgroup T8.5, items 36500 - 37854

9) Cardio-thoracic surgical operations: Subgroup T8.6; items 38200 - 38766; and Diagnostic procedures and investigations cardiovascular: Subgroup D1.6; items 11700-11724

10) Neurosurgical surgical operations: Subgroup T8.7; items 39000 - 40903.

11) Ear, nose and throat surgical operations: Subgroup T8.8; items 41500 - 41910.

12) Ophthalmology surgical operations: Subgroup T8.9; items 42503 - 42872.

13) Plastic and reconstructive surgical operations: Subgroup T8.13; items 45000-45797.

14) Orthopaedic surgical operations: Subgroup T8.15; items 47000 - 50426.

15) Assistance at operations: Group T9; items 51300 - 51318.

16) Diagnostic imaging services; Category 5; all Groups I1-I5; items 55028-63946.

17) Pathology services: Category 6; all Groups P1-P10; items 65060 and over.

18) All other items.

Total all services

\n```\n\n```html\n

Gap Services

Number of gap services

Average gap per service where gap paid

MBS Speciality Block Groupings

No gap agreement

Known gap agreement

No agreement

No gap agreement

Known gap agreement

No agreement

(1)

(2)

(3)

(4)

(5)

(6)

1) Specialist, consultant physician, and consultant psychiatric attendances: Groups A3, A4 and A8; items 104-108, 110-131, 300-352.

2) Procedures associated with intensive care and cardiopulmonary support and management: Subgroups T1.9 and T1.10; items 13815 - 13888.

3) Obstetrics and gynaecology obstetrics: Subgroup T4; items 16500 - 16636; and Surgical operations gynaecological: Subgroup T8.4; items 35500 - 35759.

4) Anaesthesia: Groups T6, T7, and T10; items 17603 - 18298, 20100-25205.

5) General surgical operations: Subgroup T8.1; items 30001 - 31472.

6) Colorectal surgical operations: Subgroup T8.2; items 32000 - 32212.

7) Vascular surgical operations: Subgroup T8.3; items 32500 - 35330.

8) Urology: Subgroup T8.5, items 36500 - 37854

9) Cardio-thoracic surgical operations: Subgroup T8.6; items 38200 - 38766; and Diagnostic procedures and investigations cardiovascular: Subgroup D1.6; items 11700-11724

10) Neurosurgical surgical operations: Subgroup T8.7; items 39000 - 40903.

11) Ear, nose and throat surgical operations: Subgroup T8.8; items 41500 - 41910.

12) Ophthalmology surgical operations: Subgroup T8.9; items 42503 - 42872.

13) Plastic and reconstructive surgical operations: Subgroup T8.13; items 45000-45797.

14) Orthopaedic surgical operations: Subgroup T8.15; items 47000 - 50426.

15) Assistance at operations: Group T9; items 51300 - 51318.

16) Diagnostic imaging services; Category 5; all Groups I1-I5; items 55028-63946.

17) Pathology services: Category 6; all Groups P1-P10; items 65060 and over.

18) All other items.

Total all services

\n```\n\n---\n\n[\\[1\\]](#_ftnref1) For the avoidance of doubt, if the due date for a particular reporting period falls on a day other than a usual business day, a private health insurer is nonetheless required to submit the information required no later than the due date.","sortOrder":0}],"analysis":{"kimi_summary":{"_metrics":{"provider":"moonshot","completionTokens":2158},"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument is a direct replacement of Reporting Standard HRS 604.0 made in 2015. It maintains the same scope—collecting medical specialty block grouping information from private health insurers for prudential supervision and health statistics. The update appears to be a routine republication or technical amendment rather than an expansion of the data collection regime."},"complexity_factors":["Incorporation by reference of external documents including Prudential Standard CPS 001 (Defined Terms) and the Medicare Benefits Schedule (MBS) item numbers","Detailed form structure requiring data entry across 18 medical specialty categories with multiple sub-columns (18 rows × 6 data columns across three separate tables)","Cross-references to three separate Acts: Financial Sector (Collection of Data) Act 2001, Acts Interpretation Act 1901, and Private Health Insurance (Prudential Supervision) Act 2015","Transitional provisions managing overlap between the revoked 2015 standard and the new 2025 standard","Technical terminology requiring understanding of 'no gap agreements', 'known gap agreements', and MBS specialty block groupings"],"plain_english_summary":"**What this does:**\nThis is a data collection rule that requires all private health insurers to report detailed statistics about medical services to the Australian Prudential Regulation Authority (APRA). It revokes and replaces a 2015 version of the same reporting standard.\n\n**Who it affects:**\n* **Private health insurers** — companies selling private health insurance must comply.\n* **APRA** — uses the data for prudential supervision (ensuring insurers remain financially stable).\n* **Department of Health** — receives published aggregate statistics to understand medical service usage across states and territories.\n\n**What must be reported:**\nInsurers must submit **Form HRF 604.0** every quarter, breaking down medical services into 18 specialty categories (such as obstetrics, anaesthesia, surgery, pathology, and diagnostic imaging). For each category, insurers report:\n* Number of services provided\n* Total fees charged by doctors\n* Medicare benefits paid by the government\n* Benefits paid by the insurer\n* **Gap payments** — out-of-pocket costs paid by patients, categorized by whether the doctor had a \"no gap agreement\" (no out-of-pocket cost), a \"known gap agreement\" (capped out-of-pocket cost), or no agreement with the insurer.\n\n**Key requirements:**\n* **When:** Quarterly (for periods ending March, June, September, December), starting for reporting periods ending on or after 1 October 2025.\n* **Deadline:** Within 28 days after each quarter ends.\n* **How:** Electronic submission via APRA's website.\n* **Quality:** Boards and senior management must ensure systems are in place to review and authorise the accuracy of submitted data.\n\n**Why it matters:**\nThis data allows regulators to monitor trends in medical costs, gap payments, and insurer financial health. It helps identify which medical specialties are generating high out-of-pocket costs for patients and ensures insurers maintain adequate funds to pay claims."},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument primarily replaces and updates an existing reporting standard (revoking Determination No. 34 of 2015) without expanding the class of entities required to report. It continues the same basic data collection purpose (prudential supervision and publication to assist the Department of Health) and remains confined to private health insurers and their health benefits funds (Schedule \"Purpose\" and \"Application and commencement\"). Any changes appear to be to the form, item groupings or presentation rather than a material broadening of scope. Therefore there is no significant change of scope beyond the original objective of collecting aggregated medical service and payment statistics from private health insurers."},"complexity_factors":["Applies to all private health insurers and to each health benefits fund separately (Schedule \"Application and commencement\" and \"Information required\")","Quarterly frequency with 28 calendar day due date and an APRA extension mechanism (Schedule \"Reporting periods and due dates\")","Form HRF 604.0 contains 18 MBS specialty block groupings and multiple reporting columns (services, amounts charged, Medicare benefits, fund benefits, gap counts, average gap) — multi‑field, structured return","Numerous MBS item ranges and subgroup references in the form (tables list item ranges across 18 groupings)","Cross‑references to external definitions (Prudential Standard CPS 001, Private Health Insurance (Prudential Supervision) Act 2015) in the Interpretation section","APRA discretion to vary reporting requirements in writing for individual insurers (Schedule \"Variations\")","Transitional reporting rules requiring reporting under the old standard for certain overdue or in‑flight reporting periods (Schedule \"Transitional\")","Quality control and board/senior management responsibility for authorisation add governance and process requirements (Schedule \"Quality control\" and \"Authorisation\")","Submission method flexibility (electronic via APRA website or other method APRA notifies), creating possible operational variability (Schedule \"Forms and method of submission\")"],"plain_english_summary":"**What this instrument does (mechanics)\n\n- Revokes the previous reporting standard (Financial Sector (Collection of Data) (reporting standard) determination No. 34 of 2015) and substitutes a new Reporting Standard called \"HRS 604.0 Medical Specialty Block Grouping Information\" (see instrument paragraphs 1–2 and Schedule Authority paragraph 1).\n- Requires all private health insurers to submit a specific quarterly form (HRF 604.0) to APRA with counts and dollar amounts for medical services broken down by Medicare Benefits Schedule (MBS) specialty block groupings and by type of gap/price agreement (see Schedule \"Application and commencement\" paragraphs 1–2 and \"Information required\" paragraphs 1–2).\n- Sets the reporting frequency as quarterly and the due date as within 28 calendar days after each quarter end (Schedule \"Reporting periods and due dates\" paragraphs 1–2). APRA can grant written extensions (paragraph 3).\n- Prescribes submission method (electronic via APRA website or a method APRA notifies) and requires that each health benefits fund of an insurer be reported separately (Schedule \"Forms and method of submission\" paragraph 1; \"Information required\" paragraph 2).\n- Requires insurers to have internal systems, policies and board/senior management responsibility for quality control of submitted information, and an authorised officer to sign submissions (Schedule \"Quality control\" paragraph 1; \"Authorisation\" paragraph 1).\n- Gives APRA the power to vary reporting requirements in writing for an insurer and contains transitional rules for reports due under the revoked (old) standard (Schedule \"Variations\" and \"Transitional\").\n\n**Who is affected\n\n- Directly affected: all entities that meet the statutory definition of \"private health insurer\" under the Private Health Insurance (Prudential Supervision) Act 2015; the requirement applies to each health benefits fund within an insurer (Schedule \"Application and commencement\" paragraph 1; \"Information required\" paragraph 2).\n- APRA will receive and process the data and can publish aggregate statistics (Schedule Objective and Purpose paragraphs).\n- The Department of Health is an identified user of the published statistics (Schedule \"Purpose\" paragraph 1).\n\n**Why it matters (official purpose and practical implications)\n\n- Officially: APRA says the data are used for prudential supervision and for publication to assist the Department of Health (Schedule \"Purpose\" paragraph 1).\n- Practically: the standard imposes a regular data-collection and reporting obligation on private health insurers. Insurers must map their paid services and amounts to MBS specialty block groupings and the three agreement categories shown on the form (\"no gap agreement\", \"known gap agreement\", \"no agreement\") and report counts and monetary values for several columns (services, amounts charged, Medicare benefits paid, fund benefits paid, number of gap services, average gap where paid).\n\n**Key implementation and incentive points to note (tested against costs, incentives and trade‑offs)\n\n- Who pays: private health insurers bear the compliance costs — IT/system work to extract and map transaction data to the required MBS groupings, ongoing quarterly reporting processes, internal review and board oversight (Schedule \"Quality control\" paragraph 1; \"Information required\" paragraphs 1–2).\n- Who decides and exercises discretion: APRA prescribes the standard, can vary requirements in writing for an insurer, and can notify submission methods (Schedule \"Variations\" paragraph 1; \"Forms and method of submission\" paragraph 1). That gives APRA operational discretion over format and timing in individual cases.\n- Behaviour changes required: insurers must (a) ensure each health benefits fund is reported separately, (b) map billed items to the listed MBS block groupings and item ranges in the form, (c) implement internal controls and board-level sign‑off, and (d) meet the 28‑day submission deadline (or obtain an extension from APRA) (Schedule \"Information required\", \"Quality control\", \"Reporting periods and due dates\").\n- Compliance burden detail: the form includes 18 MBS specialty block groupings and multiple monetary/count columns (services, charged amounts, Medicare benefits, fund benefits, gap counts and average gap). That is a structured, multi‑field return requiring reliable item‑level mapping (the Schedule tables and item ranges).\n- Data publication and market effects: APRA will publish aggregate statistics by State/Territory. Aggregated, fund‑level statistics can inform public policy and market analysis. This is unlikely to disclose individual patients but may affect market transparency about pricing and gap arrangements — a diffuse benefit to policymakers and researchers, and possible strategic information for competitors.\n- Privacy and commercial sensitivity: the standard collects monetary and counts data at the fund/specialty level. Because reporting is aggregated (not individual patient identifiers), the privacy risk is reduced, but insurers may consider some fields commercially sensitive (the instrument contains no explicit confidentiality carve‑outs; publication intent is stated in \"Objective\" and \"Purpose\").\n- Opportunity costs and operational risk: resources spent on mapping, validation, and governance of quarterly reporting are diverted from other projects. Incorrect mapping or weak controls can produce misleading public statistics and potential supervisory follow‑up by APRA.\n- Risk of administrative variability: because APRA can vary requirements for individual insurers, insurers face some uncertainty about future scope or format changes (Schedule \"Variations\" paragraph 1). That increases the need for flexible reporting systems.\n\n**Concrete legal references (where to look in the instrument)\n\n- Revocation and replacement: main instrument paragraphs 1–2.\n- Authority for the standard: Schedule \"Authority\" paragraph 1 (section 13 of the Financial Sector (Collection of Data) Act 2001).\n- Purpose and users: Schedule \"Purpose\" paragraph 1.\n- Who must report and when it starts: Schedule \"Application and commencement\" paragraphs 1–2 (applies to all private health insurers; reporting periods ending on or after 1 October 2025).\n- Data required and per‑fund reporting: Schedule \"Information required\" paragraphs 1–2 and the attached Form HRF 604.0 tables.\n- Submission method and format: Schedule \"Forms and method of submission\" paragraph 1.\n- Timing and extensions: Schedule \"Reporting periods and due dates\" paragraphs 1–3.\n- Internal controls and board responsibility: Schedule \"Quality control\" paragraph 1.\n- Authorisation to submit: Schedule \"Authorisation\" paragraph 1.\n- APRA discretion to vary requirements: Schedule \"Variations\" paragraph 1.\n- Transitional reporting rules for reports due under the old standard: Schedule \"Transitional\" paragraph 1.\n\n**Bottom line\n\nThis is a targeted, operational reporting standard that replaces an earlier form. It requires quarterly, per‑fund reporting by private health insurers of service counts and monetary values disaggregated by MBS specialty block groupings and gap/agreement status. The principal effects are (1) a recurring compliance and systems cost for insurers, (2) stronger data and possible public statistics for APRA/Department of Health use, and (3) some operational discretion and variation risk because APRA may alter requirements in writing for individual insurers."}},"importantCases":[],"_links":{"self":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-18-of-2025","history":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-18-of-2025/history","analysis":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-18-of-2025/analysis","conflicts":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-18-of-2025/conflicts","importantCases":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-18-of-2025/important-cases","documents":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-18-of-2025/documents"}}