{"id":"F2024L00146","name":"Financial Sector (Collection of Data) (reporting standard) determination No. 3 of 2024","slug":"financial-sector-collection-of-data-reporting-standard-determination-no-3-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":105083,"registerId":"commonwealth-F2024L00146-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Reporting Standard HRS 605.0","sectionType":"part","heading":"Reporting Standard HRS 605.0","content":"![Commonwealth Coat of Arms of Australia](image.002.png)\n\n# Reporting Standard HRS 605.0\n\n# Private Health Insurance Reform Data Collection\n\n![](image.003.png)\n\n## Authority\n\n1. This Reporting Standard is made under section 13 of the Financial Sector (Collection of Data) Act 2001.\n\n## Purpose\n\n2. Information collected under this Reporting Standard is for the purpose of enabling APRA to assist the Department of Health in performing its functions. This information may also be used by APRA for prudential and publication purposes.\n\n## Application\n\n3. This Reporting Standard applies to all private health insurers.\n\n4. This Reporting Standard applies to reporting periods ending on or after 31 March 2024.\n\n## Information required\n\n5. A private health insurer must provide APRA with the information required by HRF 605.0 in respect of each reporting period.\n\n6. The information required by this Reporting Standard, as set out in HRF 605.0, must be provided for each health benefits fund of the private health insurer.\n\n## Method of submission\n\n7. The information required by this Reporting Standard must be given to APRA:\n\n(a) in electronic format using an electronic method available on APRA’s website;\n\n(b) or by a method notified by APRA prior to submission.\n\n## Reporting periods and due dates\n\n8. Subject to paragraph 10 of this Reporting Standard, 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).\n\n9. Subject to paragraph 11 of this Reporting Standard, 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.\n\n10. APRA may change the reporting periods, or specified reporting periods, for a particular private health insurer, to require it to provide the information required by this Reporting Standard more frequently, or less frequently, having regard to:\n\n(a) the particular circumstances of the private health insurer;\n\n(b) the extent to which the information is required for the purposes of prudential supervision of the private health insurer; and\n\n(c) the requirements of the Department of Health.\n\n11. APRA may, in writing, grant a private health insurer an extension of a due date in which case the new due date will be the date specified in the notice of extension.\n\nNote: 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.\n\n## Quality control\n\n12. All information provided by a private health insurer under this Reporting Standard must be the product of systems, processes and controls that have been reviewed and tested by the appointed auditor of the private health insurer as set out in Prudential Standard HPS 310 Audit and Related Matters. Relevant standards and guidance statements issued by the Auditing and Assurance Standards Board provide information on the scope and nature of the review and testing required from external auditors. This review and testing must be done on an annual basis or more frequently if necessary to enable the external auditor to form an opinion on the accuracy and reliability of the information provided by a private health insurer under this Reporting Standard.\n\n13. 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. These systems, processes and controls are to assure the completeness and reliability of the information provided.\n\n## Authorisation\n\n14. A person who submits the information required under this Reporting Standard must be authorised, in writing, by an officer of the private health insurer.\n\n## Minor alterations to forms and instructions\n\n15. APRA may make minor variations to:\n\n(a) a form that is part of this Reporting Standard, and the instructions to such a form, to correct technical, programming or logical errors, inconsistencies or anomalies; or\n\n(b) the instructions to a form, to clarify the application to the form,\n\nwithout changing any substantive requirement in the form or instructions.\n\n16. If APRA makes such a variation, it must notify each private health insurer that is required to report under this Reporting Standard.\n\nTransitional\n\n17. A private health insurer 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\n(a) which ended before 31 March 2024; and\n\n(b) 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\nNote: 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\n## Interpretation\n\n18. In this Reporting Standard:\n\nAPRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998.\n\ndue date means the relevant due date under paragraph 9 or, if applicable, the date on a notice of extension given under paragraph 11 of this Reporting Standard.\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.\n\nreporting period means a period mentioned in paragraph 8 or, if applicable, a period specified under paragraph 10 of this Reporting Standard.\n\n19. Unless the contrary intention appears, a reference to an Act, Prudential Standard or Reporting Standard is a reference to the instrument as in force or existing from time to time.\n\n20. Where this Reporting Standard provides for APRA to exercise a power or discretion, this power or discretion is to be exercised in writing.","sortOrder":0},{"sectionNumber":"Private Health Insurance Reform Data Col","sectionType":"part","heading":"Private Health Insurance Reform Data Collection","content":"# Private Health Insurance Reform Data Collection\n\n![](image.003.png)","sortOrder":1},{"sectionNumber":"Authority","sectionType":"part","heading":"Authority","content":"## Authority\n\n1. This Reporting Standard is made under section 13 of the Financial Sector (Collection of Data) Act 2001.","sortOrder":2},{"sectionNumber":"Purpose","sectionType":"part","heading":"Purpose","content":"## Purpose\n\n2. Information collected under this Reporting Standard is for the purpose of enabling APRA to assist the Department of Health in performing its functions. This information may also be used by APRA for prudential and publication purposes.","sortOrder":3},{"sectionNumber":"Application","sectionType":"part","heading":"Application","content":"## Application\n\n3. This Reporting Standard applies to all private health insurers.\n\n4. This Reporting Standard applies to reporting periods ending on or after 31 March 2024.","sortOrder":4},{"sectionNumber":"Information required","sectionType":"part","heading":"Information required","content":"## Information required\n\n5. A private health insurer must provide APRA with the information required by HRF 605.0 in respect of each reporting period.\n\n6. The information required by this Reporting Standard, as set out in HRF 605.0, must be provided for each health benefits fund of the private health insurer.","sortOrder":5},{"sectionNumber":"Method of submission","sectionType":"part","heading":"Method of submission","content":"## Method of submission\n\n7. The information required by this Reporting Standard must be given to APRA:\n\n(a) in electronic format using an electronic method available on APRA’s website;\n\n(b) or by a method notified by APRA prior to submission.","sortOrder":6},{"sectionNumber":"Reporting periods and due dates","sectionType":"part","heading":"Reporting periods and due dates","content":"## Reporting periods and due dates\n\n8. Subject to paragraph 10 of this Reporting Standard, 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).\n\n9. Subject to paragraph 11 of this Reporting Standard, 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.\n\n10. APRA may change the reporting periods, or specified reporting periods, for a particular private health insurer, to require it to provide the information required by this Reporting Standard more frequently, or less frequently, having regard to:\n\n(a) the particular circumstances of the private health insurer;\n\n(b) the extent to which the information is required for the purposes of prudential supervision of the private health insurer; and\n\n(c) the requirements of the Department of Health.\n\n11. APRA may, in writing, grant a private health insurer an extension of a due date in which case the new due date will be the date specified in the notice of extension.\n\nNote: 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":7},{"sectionNumber":"Quality control","sectionType":"part","heading":"Quality control","content":"## Quality control\n\n12. All information provided by a private health insurer under this Reporting Standard must be the product of systems, processes and controls that have been reviewed and tested by the appointed auditor of the private health insurer as set out in Prudential Standard HPS 310 Audit and Related Matters. Relevant standards and guidance statements issued by the Auditing and Assurance Standards Board provide information on the scope and nature of the review and testing required from external auditors. This review and testing must be done on an annual basis or more frequently if necessary to enable the external auditor to form an opinion on the accuracy and reliability of the information provided by a private health insurer under this Reporting Standard.\n\n13. 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. These systems, processes and controls are to assure the completeness and reliability of the information provided.","sortOrder":8},{"sectionNumber":"Authorisation","sectionType":"part","heading":"Authorisation","content":"## Authorisation\n\n14. A person who submits the information required under this Reporting Standard must be authorised, in writing, by an officer of the private health insurer.","sortOrder":9},{"sectionNumber":"Minor alterations to forms and instructi","sectionType":"part","heading":"Minor alterations to forms and instructions","content":"## Minor alterations to forms and instructions\n\n15. APRA may make minor variations to:\n\n(a) a form that is part of this Reporting Standard, and the instructions to such a form, to correct technical, programming or logical errors, inconsistencies or anomalies; or\n\n(b) the instructions to a form, to clarify the application to the form,\n\nwithout changing any substantive requirement in the form or instructions.\n\n16. If APRA makes such a variation, it must notify each private health insurer that is required to report under this Reporting Standard.\n\nTransitional\n\n17. A private health insurer 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\n(a) which ended before 31 March 2024; and\n\n(b) 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\nNote: 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.","sortOrder":10},{"sectionNumber":"Interpretation","sectionType":"part","heading":"Interpretation","content":"## Interpretation\n\n18. In this Reporting Standard:\n\nAPRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998.\n\ndue date means the relevant due date under paragraph 9 or, if applicable, the date on a notice of extension given under paragraph 11 of this Reporting Standard.\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.\n\nreporting period means a period mentioned in paragraph 8 or, if applicable, a period specified under paragraph 10 of this Reporting Standard.\n\n19. Unless the contrary intention appears, a reference to an Act, Prudential Standard or Reporting Standard is a reference to the instrument as in force or existing from time to time.\n\n20. Where this Reporting Standard provides for APRA to exercise a power or discretion, this power or discretion is to be exercised in writing.","sortOrder":11},{"sectionNumber":"Reporting Form HRF 605.0","sectionType":"part","heading":"Reporting Form HRF 605.0","content":"# Reporting Form HRF 605.0\n\n# Private Health Insurance Reform Data Collection\n\n# Instruction Guide\n\nThis instruction guide is designed to assist in the completion of Reporting Form HRF 605.0 Private Health Insurance Reform Data Collection (HRF 605.0). This form collects information on a private health insurer’s (PHI’s) implementation of the Government’s private health insurance reforms announced in October 2017.\n\nGeneral directions and notes\n\n## Reporting entity\n\nHRF 605.0 must be completed by all PHIs for each health benefits fund of the PHI.\n\n## Reporting period\n\nThis form is to be completed in respect of each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June).\n\n## Unit of measurement\n\nThis form must be completed in whole Australian dollars (no decimal place).\n\n## Definitions\n\nTerms highlighted in bold italics indicate that the definition is provided in these instructions.\n\n| Age Based Discount Percentages | Means the age based discount percentage applicable.If an age based discount of 2% applies, report 2%.If an age based discount of 4% applies, report 4%.If an age based discount of 6% applies, report 6%.If an age based discount of 8% applies, report 8%.If an age based discount of 10% applies, report 10%.If an age based discount does not apply, report Not Applicable. |\n| ------------------------------------------------------------------------------------------ | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| Basic (private hospital insurance product tier type) | Means a health insurance policy (policy) that:a) covers hospital treatment;b) covers at least the treatments in all of the clinical categories indicated for a basic policy in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015; andc) is not a Gold, Silver, or Bronze policy. |\n| Bronze (private hospital insurance product tier type) | Means a policy that:a) covers hospital treatment;b) covers at least the treatments in all of the clinical categories indicated for a bronze policy in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015; andc) is not a Gold or Silver policy. |\n| Couple (policy cover type) | Means a policy under which two adults are insured (and no-one else). |\n| Day (length of treatment type) | Means the treatment is one day only. |\n| Day (private hospital type) | Means a private hospital that is not licensed or otherwise permitted to provide treatment that includes part of an overnight stay at a hospital. |\n| Discontinued (policy or person movement) | Means policies and insured persons leaving the health fund. Represents the balancing item for the aggregate fund coverage from one quarter to the next. This includes:deaths (decrease in insured persons, not necessarily policies); andsuspended policies, where they are not included in the coverage count for risk equalisation purposes. |\n| Excess Amount | Means an amount of money a policy holder agrees to pay before private health insurance benefits are payable. An excess amount may be capped at a total amount for the year.For taxation purposes those taxpayers who would be subject to the Medicare Levy Surcharge are exempted if they have a hospital treatment policy with an excess amount no greater than $750 for a policy covering a single person or an excess amount no greater than $1,500 for a policy covering more than one person.Excess policies includes all policy holders who contribute to hospital treatment policies under which an agreed, excess amount is paid by the policy holder for hospital treatment and/or general treatment services, reducing the benefit otherwise payable in exchange for lower premium costs.Excess amount (front-end deductible)An excess amount is an amount of money a policy holder agrees to pay for a hospital stay before health fund benefits are payable. For example, if a policy has an excess amount of $200, the insured person will be required to pay the first $200 of the hospital costs if they go to hospital as a private patient. An excess amount could apply every time the insured person goes to hospital in a year, or it may be capped at a total amount that will be paid in each year. |\n| Family (policy cover type) | Means a policy under which three or more people are insured, only two of whom are adults. |\n| Female (sex) | Means persons who have female or predominantly feminine biological characteristics, or female sex assigned at birth. |\n| General Treatment | Has the meaning given by the Private Health Insurance Act 2007 (PHI Act). |\n| General Treatment Only (policy treatment type) | Means a policy that does not cover hospital treatment or hospital-substitute treatments. |\n| Gold (private hospital insurance product tier type) | Means a policy that:a) covers hospital treatment; andb) covers the treatments in all of the clinical categories indicated for a gold policy in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015. |\n| Hospital Cover Travel And Accommodation (hospital and hospital substitute treatment type) | Means accommodation expenses for a parent/partner to accompany a patient who is an in-patient of a public or private hospital. It is also in relation to travel costs where a patient receives treatment at a hospital more than a specified distance from a patient’s home and in circumstances where the patient chooses not to be an in-patient.These benefits should be recorded against the private health insured person age of the patient, not the parent/partner. |\n| Hospital And General Treatment Combined (policy treatment type) | Means a policy that covers hospital and general treatments. |\n| Hospital Treatment | Has the meaning given by the PHI Act. |\n| Hospital Treatment Only (policy treatment type) | Means a policy that covers only hospital treatments. |\n| Male (sex) | Means persons who have male or predominantly masculine biological characteristics, or male sex assigned at birth. |\n| Medical Services (hospital and hospital substitute treatment type) | Means benefits paid for medical services provided as part of hospital treatment or hospital-substitute treatment if a Medicare benefit is payable for the service. |\n| New (policy or person movement) | Means the policy or insured person has joined but has not transferred from another fund. |\n| Not Applicable (Hospital And Hospital Substitute Treatment Type) | Means the hospital and hospital substitute treatment type does not apply. |\n| Not Applicable (Length Of Treatment Type) | Means the length of treatment type does not apply. |\n| Not Applicable (private hospital type) | Means a public hospital or a hospital substitute facility. |\n| Not Applicable (private hospital insurance product tier type) | Means the private hospital insurance product tier type does not apply. |\n| Not Day (private hospital type) | Means a private hospital that is licensed or otherwise permitted to provide treatment that includes part of an overnight stay at a hospital. |\n| Not Stated Or Inadequately Described (sex) | Means the sex of a person is not stated or is inadequately described. |\n| Other (hospital and hospital substitute treatment type) | Means a treatment other than Medical Services, Medical Devices Or Human Tissue Products, or Hospital Cover Travel And Accommodation. |\n| Other (sex) | Means persons who have mixed or non-binary biological characteristics (if known), or a non-binary sex assigned at birth. |\n| Overnight (length of treatment type) | Means the treatment involves more than one day. |\n| Persons Movement Count | Means the count of insured persons movements.Includes changes in the policy cover type. |\n| Policy | Means a health insurance policy. |\n| Policy Treatment Type | Means the type of treatment covered by a policy. The policy treatment types are:General Treatment Only;Hospital And General Treatment Combined; andHospital Treatment Only. |\n| Policy Cover Type | Means the type and number of people covered by a policy.The policy cover types are:Single;Family;Single Parent;Couple;Two Plus Persons No Adults; andThree Plus Adults. |\n| Private Health Insured Person Age | Means the age of the insured person at the date of treatment, or where no treatment is provided, the age of the person at the end of the reporting period.Where an insured person changes age during an episode:a) the episode is to be reported in the age that the episode was finalised;b) the days and benefits are to be reported for the age in which they were incurred (e.g. a 20 day episode with an accommodation cost of $200 per day, where the insured person turned 50 on day 4, is reported as: 1 episode under 50, 3 days under 49 and 17 days under 50, $600 under 49 and $3,400 under 50)Note: apportionment of benefits by the number of days in each age only relates to the case where the treatment covers more than one age, for example an invoice is received for accommodation for a period where the person had a number of days in one age and a number of days in another age. In the case where individual treatments are paid during a single episode where the person moves from one age to another the benefits paid for those treatments should be reported against the age of the person as at the date of the treatment. Do not sum all benefits paid over an episode spanning two ages and then apportion them over the ages; andc) services are reported under the age at the date of treatment. |\n| Private Hospital Insurance Product Tier Type | Means the private hospital insurance product tiers as listed in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015.The private hospital insurance product tier types are:Basic;Bronze;Silver; andGold. |\n| Medical Devices Or Human Tissue Products (hospital and hospital substitute treatment type) | Means a treatment related to medical devices or human tissue products of the kinds listed in the Rules made under item 4 of the table in section 333-20 of the PHI Act. |\n| Risk Equalisation Jurisdiction | Means the risk equalisation jurisdiction as defined in the Private Health Insurance (Prudential Supervision) Act 2015.The jurisdictions are:New South Wales (NSW);Victoria (VIC);Queensland (QLD);South Australia (SA);Western Australia (WA);Tasmania (TAS);Australian Capital Territory (ACT); andNorthern Territory (NT). |\n| Silver (private hospital insurance product tier type) | Means a policy that:a) covers hospital treatment;b) covers at least the treatments in all of the clinical categories indicated for a silver policy in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015; andc) is not a Gold policy. |\n| Sex | Means the distinction between male, female, and others who do not have biological characteristics typically associated with either the male or female sex. |\n| Single (policy cover type) | Means a policy under which only one person is insured. |\n| Single Parent (policy cover type) | Means a policy under which two or more people are insured, only one of whom is an adult. |\n| Three Plus Adults (policy cover type) | Means a policy under which three or more people are insured, at least three of whom are adults. |\n| Transfer From Another Fund (policy or person movement) | Means the policy or insured person has transferred from another fund but is not joining as a new fund member to private health insurance. |\n| Transfer From Another Policy (policy or person movement) | Means the policy or insured person has transferred from another policy treatment type with the same insurer.Transfer from another policy refers to transfers between the treatment types of hospital treatment only, hospital treatment and general treatment combined and general treatment only. Note that a change in the policy cover type (e.g. single to couple) does not constitute a change in treatment policy. |\n| Transfer From Another State (policy or person movement) | Means the policy or insured person has transferred from another state within the same fund. |\n| Transfer To Another Policy (policy or person movement) | Means the policy or insured person has transferred to another policy treatment type with the same insurer.Transfer to another policy refers to transfers between the treatment types of hospital treatment only, hospital treatment and general treatment combined and general treatment only. Note that a change in the policy cover type (e.g. single to couple) does not constitute a change in treatment policy. |\n| Transfer To Another State (policy or person movement) | Means the policy or insured person has transferred to another state within the same fund. |\n| Two Plus Persons No Adults (policy cover type) | Means a policy under which two or more people are insured, none of whom is an adult. |\n| Waiting Period | The waiting period for a benefit under an insurance policy is the period:starting at the time the person becomes insured under the policy; andending at the time specified in policy;during which the person is not entitled to the benefit. |\n\n \n\n## Psychiatric care definitions\n\n| Benefits Paid Amount | The benefits paid amount under a psychiatric care waiting period exemption means the total eligible benefits paid by the PHI for an episode that occurred during the two months waived period for the quarter. |\n| ----------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| First Admission | To be considered a first admission with psychiatric care waiting period exemption, a first admission must have occurred within the first two months of the upgrade and the person must have decided to use the once-off exemption for the admission. |\n| Not Applicable (Admission Type) | Means the admission type does not apply. |\n| Psychiatric Care Indicators | Report Yes if psychiatric care has been provided, otherwise report No. |\n| Psychiatric Care Waiting Period Exemption Types | A psychiatric care waiting period exemption has been used if:a person transfers to a policy which provides higher benefits for psychiatric treatment than the benefit for psychiatric treatment under the old policy;the person makes a claim under the new policy for psychiatric treatment within the first two months following the product upgrade; andthe person decides to utilise the once-off exemption and receive higher benefits for that admission.A psychiatric care waiting period exemption is not used if all of the above do not apply. If the waiting period exemption is not applicable, then report not applicable. |\n| Subsequent Admission | Means subsequent admissions to a hospital for the same condition as the initial admission. To be considered a subsequent admission with waiting period exemption, a subsequent admission must have occurred within the waived period. |","sortOrder":12},{"sectionNumber":"Instruction Guide","sectionType":"part","heading":"Instruction Guide","content":"# Instruction Guide\n\nThis instruction guide is designed to assist in the completion of Reporting Form HRF 605.0 Private Health Insurance Reform Data Collection (HRF 605.0). This form collects information on a private health insurer’s (PHI’s) implementation of the Government’s private health insurance reforms announced in October 2017.\n\nGeneral directions and notes","sortOrder":14},{"sectionNumber":"Reporting entity","sectionType":"part","heading":"Reporting entity","content":"## Reporting entity\n\nHRF 605.0 must be completed by all PHIs for each health benefits fund of the PHI.","sortOrder":15},{"sectionNumber":"Reporting period","sectionType":"part","heading":"Reporting period","content":"## Reporting period\n\nThis form is to be completed in respect of each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June).","sortOrder":16},{"sectionNumber":"Unit of measurement","sectionType":"part","heading":"Unit of measurement","content":"## Unit of measurement\n\nThis form must be completed in whole Australian dollars (no decimal place).","sortOrder":17},{"sectionNumber":"Definitions","sectionType":"part","heading":"Definitions","content":"## Definitions\n\nTerms highlighted in bold italics indicate that the definition is provided in these instructions.\n\n| Age Based Discount Percentages | Means the age based discount percentage applicable.If an age based discount of 2% applies, report 2%.If an age based discount of 4% applies, report 4%.If an age based discount of 6% applies, report 6%.If an age based discount of 8% applies, report 8%.If an age based discount of 10% applies, report 10%.If an age based discount does not apply, report Not Applicable. |\n| ------------------------------------------------------------------------------------------ | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| Basic (private hospital insurance product tier type) | Means a health insurance policy (policy) that:a) covers hospital treatment;b) covers at least the treatments in all of the clinical categories indicated for a basic policy in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015; andc) is not a Gold, Silver, or Bronze policy. |\n| Bronze (private hospital insurance product tier type) | Means a policy that:a) covers hospital treatment;b) covers at least the treatments in all of the clinical categories indicated for a bronze policy in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015; andc) is not a Gold or Silver policy. |\n| Couple (policy cover type) | Means a policy under which two adults are insured (and no-one else). |\n| Day (length of treatment type) | Means the treatment is one day only. |\n| Day (private hospital type) | Means a private hospital that is not licensed or otherwise permitted to provide treatment that includes part of an overnight stay at a hospital. |\n| Discontinued (policy or person movement) | Means policies and insured persons leaving the health fund. Represents the balancing item for the aggregate fund coverage from one quarter to the next. This includes:deaths (decrease in insured persons, not necessarily policies); andsuspended policies, where they are not included in the coverage count for risk equalisation purposes. |\n| Excess Amount | Means an amount of money a policy holder agrees to pay before private health insurance benefits are payable. An excess amount may be capped at a total amount for the year.For taxation purposes those taxpayers who would be subject to the Medicare Levy Surcharge are exempted if they have a hospital treatment policy with an excess amount no greater than $750 for a policy covering a single person or an excess amount no greater than $1,500 for a policy covering more than one person.Excess policies includes all policy holders who contribute to hospital treatment policies under which an agreed, excess amount is paid by the policy holder for hospital treatment and/or general treatment services, reducing the benefit otherwise payable in exchange for lower premium costs.Excess amount (front-end deductible)An excess amount is an amount of money a policy holder agrees to pay for a hospital stay before health fund benefits are payable. For example, if a policy has an excess amount of $200, the insured person will be required to pay the first $200 of the hospital costs if they go to hospital as a private patient. An excess amount could apply every time the insured person goes to hospital in a year, or it may be capped at a total amount that will be paid in each year. |\n| Family (policy cover type) | Means a policy under which three or more people are insured, only two of whom are adults. |\n| Female (sex) | Means persons who have female or predominantly feminine biological characteristics, or female sex assigned at birth. |\n| General Treatment | Has the meaning given by the Private Health Insurance Act 2007 (PHI Act). |\n| General Treatment Only (policy treatment type) | Means a policy that does not cover hospital treatment or hospital-substitute treatments. |\n| Gold (private hospital insurance product tier type) | Means a policy that:a) covers hospital treatment; andb) covers the treatments in all of the clinical categories indicated for a gold policy in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015. |\n| Hospital Cover Travel And Accommodation (hospital and hospital substitute treatment type) | Means accommodation expenses for a parent/partner to accompany a patient who is an in-patient of a public or private hospital. It is also in relation to travel costs where a patient receives treatment at a hospital more than a specified distance from a patient’s home and in circumstances where the patient chooses not to be an in-patient.These benefits should be recorded against the private health insured person age of the patient, not the parent/partner. |\n| Hospital And General Treatment Combined (policy treatment type) | Means a policy that covers hospital and general treatments. |\n| Hospital Treatment | Has the meaning given by the PHI Act. |\n| Hospital Treatment Only (policy treatment type) | Means a policy that covers only hospital treatments. |\n| Male (sex) | Means persons who have male or predominantly masculine biological characteristics, or male sex assigned at birth. |\n| Medical Services (hospital and hospital substitute treatment type) | Means benefits paid for medical services provided as part of hospital treatment or hospital-substitute treatment if a Medicare benefit is payable for the service. |\n| New (policy or person movement) | Means the policy or insured person has joined but has not transferred from another fund. |\n| Not Applicable (Hospital And Hospital Substitute Treatment Type) | Means the hospital and hospital substitute treatment type does not apply. |\n| Not Applicable (Length Of Treatment Type) | Means the length of treatment type does not apply. |\n| Not Applicable (private hospital type) | Means a public hospital or a hospital substitute facility. |\n| Not Applicable (private hospital insurance product tier type) | Means the private hospital insurance product tier type does not apply. |\n| Not Day (private hospital type) | Means a private hospital that is licensed or otherwise permitted to provide treatment that includes part of an overnight stay at a hospital. |\n| Not Stated Or Inadequately Described (sex) | Means the sex of a person is not stated or is inadequately described. |\n| Other (hospital and hospital substitute treatment type) | Means a treatment other than Medical Services, Medical Devices Or Human Tissue Products, or Hospital Cover Travel And Accommodation. |\n| Other (sex) | Means persons who have mixed or non-binary biological characteristics (if known), or a non-binary sex assigned at birth. |\n| Overnight (length of treatment type) | Means the treatment involves more than one day. |\n| Persons Movement Count | Means the count of insured persons movements.Includes changes in the policy cover type. |\n| Policy | Means a health insurance policy. |\n| Policy Treatment Type | Means the type of treatment covered by a policy. The policy treatment types are:General Treatment Only;Hospital And General Treatment Combined; andHospital Treatment Only. |\n| Policy Cover Type | Means the type and number of people covered by a policy.The policy cover types are:Single;Family;Single Parent;Couple;Two Plus Persons No Adults; andThree Plus Adults. |\n| Private Health Insured Person Age | Means the age of the insured person at the date of treatment, or where no treatment is provided, the age of the person at the end of the reporting period.Where an insured person changes age during an episode:a) the episode is to be reported in the age that the episode was finalised;b) the days and benefits are to be reported for the age in which they were incurred (e.g. a 20 day episode with an accommodation cost of $200 per day, where the insured person turned 50 on day 4, is reported as: 1 episode under 50, 3 days under 49 and 17 days under 50, $600 under 49 and $3,400 under 50)Note: apportionment of benefits by the number of days in each age only relates to the case where the treatment covers more than one age, for example an invoice is received for accommodation for a period where the person had a number of days in one age and a number of days in another age. In the case where individual treatments are paid during a single episode where the person moves from one age to another the benefits paid for those treatments should be reported against the age of the person as at the date of the treatment. Do not sum all benefits paid over an episode spanning two ages and then apportion them over the ages; andc) services are reported under the age at the date of treatment. |\n| Private Hospital Insurance Product Tier Type | Means the private hospital insurance product tiers as listed in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015.The private hospital insurance product tier types are:Basic;Bronze;Silver; andGold. |\n| Medical Devices Or Human Tissue Products (hospital and hospital substitute treatment type) | Means a treatment related to medical devices or human tissue products of the kinds listed in the Rules made under item 4 of the table in section 333-20 of the PHI Act. |\n| Risk Equalisation Jurisdiction | Means the risk equalisation jurisdiction as defined in the Private Health Insurance (Prudential Supervision) Act 2015.The jurisdictions are:New South Wales (NSW);Victoria (VIC);Queensland (QLD);South Australia (SA);Western Australia (WA);Tasmania (TAS);Australian Capital Territory (ACT); andNorthern Territory (NT). |\n| Silver (private hospital insurance product tier type) | Means a policy that:a) covers hospital treatment;b) covers at least the treatments in all of the clinical categories indicated for a silver policy in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015; andc) is not a Gold policy. |\n| Sex | Means the distinction between male, female, and others who do not have biological characteristics typically associated with either the male or female sex. |\n| Single (policy cover type) | Means a policy under which only one person is insured. |\n| Single Parent (policy cover type) | Means a policy under which two or more people are insured, only one of whom is an adult. |\n| Three Plus Adults (policy cover type) | Means a policy under which three or more people are insured, at least three of whom are adults. |\n| Transfer From Another Fund (policy or person movement) | Means the policy or insured person has transferred from another fund but is not joining as a new fund member to private health insurance. |\n| Transfer From Another Policy (policy or person movement) | Means the policy or insured person has transferred from another policy treatment type with the same insurer.Transfer from another policy refers to transfers between the treatment types of hospital treatment only, hospital treatment and general treatment combined and general treatment only. Note that a change in the policy cover type (e.g. single to couple) does not constitute a change in treatment policy. |\n| Transfer From Another State (policy or person movement) | Means the policy or insured person has transferred from another state within the same fund. |\n| Transfer To Another Policy (policy or person movement) | Means the policy or insured person has transferred to another policy treatment type with the same insurer.Transfer to another policy refers to transfers between the treatment types of hospital treatment only, hospital treatment and general treatment combined and general treatment only. Note that a change in the policy cover type (e.g. single to couple) does not constitute a change in treatment policy. |\n| Transfer To Another State (policy or person movement) | Means the policy or insured person has transferred to another state within the same fund. |\n| Two Plus Persons No Adults (policy cover type) | Means a policy under which two or more people are insured, none of whom is an adult. |\n| Waiting Period | The waiting period for a benefit under an insurance policy is the period:starting at the time the person becomes insured under the policy; andending at the time specified in policy;during which the person is not entitled to the benefit. |","sortOrder":18},{"sectionNumber":"Psychiatric care definitions","sectionType":"part","heading":"Psychiatric care definitions","content":"## Psychiatric care definitions\n\n| Benefits Paid Amount | The benefits paid amount under a psychiatric care waiting period exemption means the total eligible benefits paid by the PHI for an episode that occurred during the two months waived period for the quarter. |\n| ----------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| First Admission | To be considered a first admission with psychiatric care waiting period exemption, a first admission must have occurred within the first two months of the upgrade and the person must have decided to use the once-off exemption for the admission. |\n| Not Applicable (Admission Type) | Means the admission type does not apply. |\n| Psychiatric Care Indicators | Report Yes if psychiatric care has been provided, otherwise report No. |\n| Psychiatric Care Waiting Period Exemption Types | A psychiatric care waiting period exemption has been used if:a person transfers to a policy which provides higher benefits for psychiatric treatment than the benefit for psychiatric treatment under the old policy;the person makes a claim under the new policy for psychiatric treatment within the first two months following the product upgrade; andthe person decides to utilise the once-off exemption and receive higher benefits for that admission.A psychiatric care waiting period exemption is not used if all of the above do not apply. If the waiting period exemption is not applicable, then report not applicable. |\n| Subsequent Admission | Means subsequent admissions to a hospital for the same condition as the initial admission. To be considered a subsequent admission with waiting period exemption, a subsequent admission must have occurred within the waived period. |","sortOrder":19},{"sectionNumber":"Table 1: Movements of insured persons","sectionType":"part","heading":"Table 1: Movements of insured persons","content":"## Table 1: Movements of insured persons\n\nReport data as at the end of the reporting period.\n\n| | Name | Unique identifier | Applicable to: | Valid values | Description |\n| --- | ---------------------------------------------- | ----------------- | --------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------- |\n| 1 | Persons Movement Count | Y | All private health insurers | Whole numbers | Report the persons movements count during the reporting period. |\n| 2 | Sex | Y | All private health insurers | FemaleMaleOtherNot Stated Or Inadequately Described | Report according to the sex of the insured persons. |\n| 3 | Private Health Insured Person Age | Y | All private health insurers | Whole numbers | Report the private health insured person age of the insured persons. |\n| 4 | Policy Or Person Movement Reason Type | Y | All private health insurers | DiscontinuedNewTransfer From Another FundTransfer From Another PolicyTransfer From Another StateTransfer To Another PolicyTransfer To Another State | Report the policy or person movement reason type. |\n| 5 | Private Hospital Insurance Product Tier Type | Y | All private health insurers | BasicBronzeSilverGoldNot Applicable | Report the private hospital insurance product tier type. |\n| 6 | Policy Treatment Type | Y | All private health insurers | General Treatment OnlyHospital And General Treatment CombinedHospital Treatment Only | Report the policy treatment type. |\n| 7 | Risk Equalisation Jurisdiction (Geography) | Y | All private health insurers | NSWVICQLDSAWATASACTNT | Report the relevant risk equalisation jurisdiction. |\n| 8 | Psychiatric Care Waiting Period Exemption Type | Y | All private health insurers | UsedNot UsedNot Applicable | Report whether a psychiatric care waiting period exemption has been used. |","sortOrder":20},{"sectionNumber":"Table 2: Insured persons","sectionType":"part","heading":"Table 2: Insured persons","content":"## Table 2: Insured persons\n\nReport data as at the last day of the reporting period.\n\n| | Name | Unique identifier | Applicable to: | Valid values | Description |\n| --- | ---------------------------------------------- | ----------------- | --------------------------- | ------------------------------------------------------------------------------------ | ------------------------------------------------------------------------------- |\n| 1 | Insured Person Count | | All private health insurers | Whole numbers | Report the count of insured persons as at the last day of the reporting period. |\n| 2 | Sex | Y | All private health insurers | FemaleMaleOtherNot Stated Or Inadequately Described | Report according to the sex of the insured persons. |\n| 3 | Private Health Insured Person Age | Y | All private health insurers | Whole numbers | Report the private health insured person age of the insured persons. |\n| 4 | Private Hospital Insurance Product Tier Type | Y | All private health insurers | BasicBronzeSilverGoldNot Applicable | Report the private hospital insurance product tier type. |\n| 5 | Policy Cover Type | Y | All private health insurers | SingleFamilySingle ParentCoupleTwo Plus Persons No AdultsThree Plus Adults | Report the policy cover type. |\n| 6 | Policy Treatment Type | Y | All private health insurers | General Treatment OnlyHospital And General Treatment CombinedHospital Treatment Only | Report the policy treatment type. |\n| 7 | Excess Amount | Y | All private health insurers | Dollar amount | Report the value of the excess amount. |\n| 8 | Age Based Discount Percent | Y | All private health insurers | 2%4%6%8%10%Not Applicable | Report the age-based discount percent as a percentage. |\n| 9 | Risk Equalisation Jurisdiction (Geography) | Y | All private health insurers | NSWVICQLDSAWATASACTNT | Report the relevant risk equalisation jurisdiction. |\n| 10 | Psychiatric Care Waiting Period Exemption Type | Y | All private health insurers | UsedNot UsedNot Applicable | Report whether a psychiatric care waiting period exemption has been used. |","sortOrder":21},{"sectionNumber":"Table 3: Policies","sectionType":"part","heading":"Table 3: Policies","content":"## Table 3: Policies\n\nReport data as at the last day of the reporting period.\n\n| | Name | Unique identifier | Applicable to: | Valid values | Description |\n| --- | -------------------------------------------- | ----------------- | --------------------------- | ------------------------------------------------------------------------------------ | ------------------------------------------------------------------- |\n| 1 | Policy Count | | All private health insurers | Whole numbers | Report the policy count as at the last day of the reporting period. |\n| 2 | Private Hospital Insurance Product Tier Type | Y | All private health insurers | BasicBronzeSilverGoldNot Applicable | Report the private hospital insurance product tier. |\n| 3 | Policy Cover Type | Y | All private health insurers | SingleFamilySingle ParentCoupleTwo Plus Persons No AdultsThree Plus Adults | Report the policy cover type. |\n| 4 | Policy Treatment Type | Y | All private health insurers | General Treatment OnlyHospital And General Treatment CombinedHospital Treatment Only | Report the policy treatment type. |\n| 5 | Excess Amount | Y | All private health insurers | Dollar amount | Report the value of the excess amount. |\n| 6 | Risk Equalisation Jurisdiction (Geography) | Y | All private health insurers | NSWVICQLDSAWATASACTNT | Report the relevant risk equalisation jurisdiction. |","sortOrder":22},{"sectionNumber":"Table 4: Hospital services, benefits, fe","sectionType":"part","heading":"Table 4: Hospital services, benefits, fees charged, treatment days and episodes","content":"## Table 4: Hospital services, benefits, fees charged, treatment days and episodes\n\nReport data as at the last day of the reporting period.\n\n| | Name | Unique identifier | Applicable to: | Valid values | Description |\n| --- | ----------------------------------------------- | ----------------- | --------------------------- | ------------------------------------------------------------------------------------------------------------------ | ------------------------------------------------------------------------- |\n| 1 | Services Count | | All private health insurers | Whole numbers | Report the count of services during the reporting period. |\n| 2 | Benefits Paid Amount | | All private health insurers | Dollar amount | Report the value of benefits paid during the reporting period. |\n| 3 | Fees Charged Amount | | All private health insurers | Dollar amount | Report the value of fees charged during the reporting period. |\n| 4 | Treatment Days Count | | All private health insurers | Whole numbers | Report the count of treatment days during the reporting period. |\n| 5 | Episode Count | | All private health insurers | Whole numbers | Report the count of episodes during the reporting period. |\n| 6 | Private Health Insured Person Age | Y | All private health insurers | Whole numbers | Report the private health insured person age of the insured persons. |\n| 7 | Hospital And Hospital Substitute Treatment Type | Y | All private health insurers | Medical ServicesOtherMedical Devices Or Human Tissue ProductsHospital Cover Travel And AccommodationNot Applicable | Report the hospital and hospital substitute treatment type. |\n| 8 | Psychiatric Care Indicator | Y | All private health insurers | YesNo | Report whether psychiatric care has been provided. |\n| 9 | Risk Equalisation Jurisdiction (Geography) | Y | All private health insurers | NSWVICQLDSAWATASACTNT | Report the relevant risk equalisation jurisdiction. |\n| 10 | Admission Type | Y | All private health insurers | First AdmissionSubsequent AdmissionNot Applicable | Report the admission type. |\n| 11 | Hospital Type | Y | All private health insurers | Public HospitalPrivate HospitalHospital SubstituteNot Hospital | Report the hospital type. |\n| 12 | Private Hospital Type | Y | All private health insurers | DayNot DayNot Applicable | Report the private hospital type. |\n| 13 | Length Of Treatment Type | Y | All private health insurers | OvernightDayNot Applicable | Report the length of treatment type. |\n| 14 | Psychiatric Care Waiting Period Exemption Type | Y | All private health insurers | UsedNot UsedNot Applicable | Report whether a psychiatric care waiting period exemption has been used. |","sortOrder":23}],"analysis":{"kimi_summary":{"_metrics":{"completionTokens":442},"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"The legislation remains tightly focused on its original purpose: collecting quarterly data from private health insurers to monitor the 2017 reforms. No significant scope creep is evident."},"complexity_factors":["47+ defined terms across multiple definition tables","Four separate data tables with 8-14 fields each, many with constrained valid values","Complex cross-referencing to other legislation (PHI Act, Prudential Standards, Complying Product Rules)","Detailed apportionment rules for age-based reporting when treatment spans a birthday","Nested conditional logic for psychiatric care waiting period exemptions","Transitional provisions requiring dual reporting under old and new standards"],"plain_english_summary":"This standard requires every Australian private health insurer (by fund) to submit detailed quarterly data to APRA tracking how the 2017 private health insurance reforms are being implemented. \n\nReports—submitted electronically and subject to annual audit and internal quality controls—cover membership movements, policy and cover mix, demographics and hospital service activity so the Department of Health can monitor reform rollout and APRA can supervise insurer performance and compliance."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":false,"description":"This Determination does not materially expand the statutory scope of who must report or the categories of insurers covered: it applies to all private health insurers, as prior reporting standards did (paragraph 3). It primarily introduces or reissues a specific reporting form (HRF 605.0), sets an effective start date (reporting periods ending on or after 31 March 2024) (paragraph 4), and specifies procedural and quality-control requirements (audit and internal controls) and transitional arrangements for reports straddling the revocation of the prior standard (paragraphs 12–13, 17). In substance the instrument standardises and details the data items to be collected and the processes for submission and auditing rather than broaden the class of reporting entities or the fundamental policy aim. The more significant change for affected firms is increased granularity and formalisation of audit and control obligations rather than an expansion of the population required to report."},"complexity_factors":["Extensive field-level instruction guide with four named tables (Persons movements, Insured persons, Policies, Hospital services) and many individual data items to report (Tables 1–4).","Large number of defined terms in the instruction guide (approximately 60–80 distinct definitions and permitted value lists, including product tiers, policy cover types, movement reasons, treatment types and psychiatric-care definitions).","Detailed rules and exceptions for data apportionment (e.g. episode apportionment across birthdays, psychiatric waiting-period exemption rules) that require non-trivial data processing logic.","Cross-references to external instruments and standards (Prudential Standard HPS 310, Private Health Insurance Act 2007 and its Rules, Private Health Insurance (Prudential Supervision) Act 2015) creating dependency on other texts for full meaning (paragraph 12 and definitions).","Discretionary powers and conditional rules (APRA may vary frequency for particular insurers, grant extensions, and make minor variations to forms) which add branches to implementation and compliance pathways (paragraphs 10–11, 15–16).","Transitional provisions that require tracking of which reporting periods fall under the old standard versus the new standard (paragraph 17).","Audit requirement that systems/processes be reviewed by the external auditor 'as set out in HPS 310', with annual or more frequent testing which introduces timing and evidentiary complexity (paragraph 12).","Electronic submission mandate with APRA-specific electronic methods (paragraph 7) — operational dependency on APRA’s portal and potential for technical/formatting changes.","Repetition and duplication of guidance text in the published instrument (multiple repeated sections), which increases reading time and risk of user confusion."],"plain_english_summary":"**What this instrument does (mechanically)\n\n- Requires every private health insurer to submit a new standardised data return called HRF 605.0 (Private Health Insurance Reform Data Collection) to APRA (the Australian Prudential Regulation Authority) for each health benefits fund (paragraphs 5–6). \n- Applies to reporting periods ending on or after 31 March 2024 and, by default, requires quarterly reporting (periods ending 30 Sep, 31 Dec, 31 Mar, 30 Jun) (paragraphs 4, 8). \n- Mandates electronic submission by methods available on APRA’s website (paragraph 7), with a default due date of 28 calendar days after each quarter end (paragraph 9). \n- Gives APRA the written power to change reporting frequency for a particular insurer (more often or less often) after considering insurer circumstances, prudential needs and Department of Health requirements (paragraph 10). \n- Requires that all reported information be produced by systems and controls subject to review and testing by the insurer’s appointed external auditor under Prudential Standard HPS 310, and be subject to the insurer’s own internal review and authorisation processes (paragraphs 12–13). \n- Requires that a person who submits the data be authorised in writing by an officer of the insurer (paragraph 14). \n- Allows APRA to make minor technical changes to forms and instructions without changing substantive requirements, and to notify insurers of such changes (paragraphs 15–16). \n- Contains transitional rules that preserve reporting under the previous standard for certain reporting periods that straddle the revocation of the old standard (paragraph 17). \n\nWhat specific information is being collected\n\n- The Instruction Guide (Reporting Form HRF 605.0) sets out the exact fields insurers must report. Key categories include: counts and movements of insured persons and policies; demographic breakdowns (sex, age); product characteristics (policy cover type, product tier: Basic/Bronze/Silver/Gold; excess amounts; age-based discounts); service-level data (hospital services, benefits paid, fees charged, treatment days, episodes); psychiatric-care waiting-period exemption use; and risk equalisation jurisdiction (full detail in the form tables). The Guide defines many reporting conventions (e.g. how to apportion episodes that cross birthdays) and permissible values for each field.\n\nWho this affects and who pays\n\n- Who reports: All private health insurers and, for multi-fund insurers, reporting is required for each health benefits fund (paragraphs 3, 6). \n- Who pays (compliance burden): insurers bear the direct costs of collecting and submitting the data, maintaining systems and controls, and paying external auditors to review and test the reporting processes in line with HPS 310 (paragraph 12). Smaller insurers are likely to face proportionally higher compliance costs because the return is detailed and includes many granular fields. \n\nWhy the data is being collected (stated purpose) and how APRA/DoH will use it\n\n- The stated purpose is to enable APRA to assist the Department of Health in performing its functions; APRA may also use the data for prudential supervision and for publication purposes (paragraph 2). That is, the dataset supports health policy administration (Department of Health) and APRA’s supervisory and public reporting activities.\n\nHow the instrument changes behaviour and the likely trade-offs\n\n- Systems and process changes: Insurers must maintain or upgrade their IT, data mapping and internal-control processes to produce HRF 605.0-compliant outputs, and engage auditors to review those systems regularly (paragraphs 12–13). \n- Timing and operational impact: Quarterly reporting on a 28-day timetable creates recurring operational deadlines. APRA can require more frequent reporting for particular insurers, which raises potential additional burden for those entities (paragraph 10). \n- Transparency and publication: Because APRA may publish the data (paragraph 2), insurers face a potential reputational and commercial signalling effect from reported details (product mix, benefits paid, fees charged). This can change competitive dynamics or product design decisions. \n- Costs vs monitoring benefits: The instrument tightens monitoring and standardises data for government and prudential purposes at the cost of increased compliance, audit and data‑management expense. The trade-off is improved regulatory visibility of product and claims behaviour versus the time and money insurers must devote to reporting.\n\nKey discretionary powers and implementation risks\n\n- APRA discretion: APRA can change reporting frequency for individual insurers (paragraph 10), grant extensions in writing (paragraph 11), and make minor technical variations to forms/instructions (paragraphs 15–16). Those are administrative levers that affect timing and detail of compliance. The instrument requires APRA exercise powers in writing (paragraph 20). \n- Implementation risks: mapping legacy policy and claims systems to the form’s many defined fields (for example age‑apportionment rules and psychiatric waiting period indicators) creates data-integration risk; transitional reporting (paragraph 17) can create overlap or duplication if not coordinated. Audit timing (annual or more frequent where required) may create timing/cost unpredictability (paragraph 12).\n\nPractical effects on markets, competition and private choice (mechanisms, not judgments)\n\n- Competition and product design: The form collects product-level attributes (tier, cover type, excess levels, age-based discounts). If APRA or the Department publishes these data, insurers may change product features or pricing in response to public or regulatory scrutiny. \n- Costs concentrated vs diffuse: Compliance costs fall directly on insurers (concentrated) and may be proportionally heavier on smaller insurers. Benefits of the data (policy evaluation, better supervision) are diffuse across regulators and the public. \n- Contract freedom and operation of independent firms: The reporting obligations do not directly limit insurers’ contractual freedom, but increased disclosure and auditing requirements can shape commercial behaviour (e.g. recordkeeping, product definitions, claims handling) and increase operating costs for independent funds.\n\nCompliance burden and monitoring\n\n- Reporting is detailed and prescriptive (multiple tables and field‑level definitions in the Instruction Guide). Insurers must maintain audited systems and internal controls and ensure authorised sign-off on submissions (paragraphs 12–14). Failure to meet the rules’ form or timing would expose insurers to administrative follow-up by APRA.\n\nNotes on purpose-claims and testing them against costs and incentives\n\n- The instrument explicitly claims the data is to help APRA assist the Department of Health and for APRA’s prudential/publication uses (paragraph 2). That purpose is consistent with collecting detailed product, utilisation and demographic data. \n- Costs and incentives: producing this level of granular data requires investment in data systems and external audit. Those costs create an incentive for insurers to streamline internal reporting and may discourage small‑scale product experiments if the reporting overhead outweighs expected returns. APRA’s authority to vary frequency (paragraph 10) can tailor burden to risk, but it also creates ongoing compliance uncertainty for insurers. \n\nImmediate actionable points for an insurer reading this\n\n- Map existing policy, membership and claims data to the HRF 605.0 field definitions and validate apportionment rules (Instruction Guide). \n- Budget for quarterly submission cycles and auditor review in line with HPS 310 (paragraph 12). \n- Ensure there is an authorised officer-ready signatory and written delegation in place for submissions (paragraph 14). \n- Monitor APRA notifications for any minor form changes and any written notices altering reporting frequency or due dates (paragraphs 10, 11, 15–16)."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-3-of-2024","history":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-3-of-2024/history","analysis":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-3-of-2024/analysis","conflicts":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-3-of-2024/conflicts","importantCases":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-3-of-2024/important-cases","documents":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-3-of-2024/documents"}}