{"id":"F2023L00576","name":"Financial Sector (Collection of Data) (reporting standard) determination No. 99 of 2023","slug":"financial-sector-collection-of-data-reporting-standard-determination-no-99-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":104215,"registerId":"commonwealth-F2023L00576-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Reporting Standard HRS 109.0","sectionType":"part","heading":"Reporting Standard HRS 109.0","content":"![Commonwealth Coat of Arms of Australia](image.001.png)\n\n# Reporting Standard HRS 109.0\n\n# Claims\n\n## Objective of this Reporting Standard\n\nThis Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s claims.\n\nIt includes associated specific instructions.\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. The information reported to APRA under this Reporting Standard is used by APRA for the purpose of prudential supervision including assessing compliance with capital standards.\n\n### Application and commencement\n\n3. This Reporting Standard applies to all private health insurers. This Reporting Standard applies for reporting periods ending on or after 1 July 2023.\n\n### Information required\n\n4. A private health insurer must provide APRA with the information required by this Reporting Standard for each reporting period.\n\n### Method of submission\n\n5. 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; or\n (b) by a method notified by APRA prior to submission.\n\n### Reporting periods and due dates\n\n6. Subject to paragraph 7, a private health insurer must provide the information required by this Reporting Standard:\n\n (a) in respect of each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June); and\n (b) in respect of each year ending 30 June.\n\n7. If, having regard to the particular circumstances of a private health insurer, APRA considers it necessary or desirable to obtain information more or less frequently than as provided by subparagraph 6(a) or 6(b), APRA may, by notice in writing, change the reporting periods, or specify reporting periods, for the particular private health insurer.\n\n8. The information required by this Reporting Standard must be provided to APRA:\n\n(a) in the case of quarterly information, within 28 calendar days after the end of the reporting period to which the information relates;\n\n(b) in the case of annual information, by 30 September each year; or\n\n(c) in the case of information provided in accordance with paragraph 7, within the time specified by notice in writing.\n\n9. 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 on 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\n10. 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\n### Annual audit requirements\n\n11. The information submitted for the purposes of paragraph 8(b) is to be subject to external audit to ensure consistency with the private health insurer’s statutory financial accounts and faithful application of the capital standards.\n\n12. Audit certification and opinion must be provided to APRA by 30 September each year.\n\n13. If a private health insurer received a qualified auditor’s report for a health benefits fund, the general fund, or the private health insurer for the previous year (previous report), the current year’s auditor’s report must state whether the auditor has examined the issues identified and is satisfied that the private health insurer has taken the appropriate steps to rectify the matters raised in the previous report.\n\n14. The auditor’s report must:\n\n (a) state details of the program adopted to carry out the audit; and\n (b) include the name of, and be signed by, the auditor who takes responsibility for the accuracy of the report.\n\n### Authorisation\n\n15. A person who submits the information required under this Reporting Standard must be suitably authorised by an officer of the private health insurer.\n\n### Variations\n\n16. APRA may, in writing, vary the reporting requirements of this Reporting Standard in relation to a private health insurer.\n\n### Interpretation\n\n17. In this Reporting Standard:\n\n(a) unless the contrary intention appears, words and expressions have the meanings given to them in Prudential Standard HPS 001 Definitions (HPS 001); and\n\n(b) the following definitions are applicable:\n\n APRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998;\n capital standards means the prudential standards which relate to capital adequacy, as defined in HPS 001;\n\nofficer has the same meaning as in the Act;\n\nprivate health insurer has the same meaning as in the Act;\n\nreporting period means a period mentioned in paragraph 6 or, if applicable, paragraph 7; and\n\n the Act means the Private Health Insurance (Prudential Supervision) Act 2015.\n\n18. Unless the contrary intention appears, a reference to an Act, Prudential Standard, Reporting Standard, Australian Accounting or Auditing Standard is a reference to the instrument as in force from time to time.","sortOrder":0},{"sectionNumber":"Claims","sectionType":"part","heading":"Claims","content":"![Commonwealth Coat of Arms of Australia](image.001.png)\n\n# Reporting Standard HRS 109.0\n\n# Claims\n\n## Objective of this Reporting Standard\n\nThis Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s claims.\n\nIt includes associated specific instructions.\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. The information reported to APRA under this Reporting Standard is used by APRA for the purpose of prudential supervision including assessing compliance with capital standards.\n\n### Application and commencement\n\n3. This Reporting Standard applies to all private health insurers. This Reporting Standard applies for reporting periods ending on or after 1 July 2023.\n\n### Information required\n\n4. A private health insurer must provide APRA with the information required by this Reporting Standard for each reporting period.\n\n### Method of submission\n\n5. 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; or\n (b) by a method notified by APRA prior to submission.\n\n### Reporting periods and due dates\n\n6. Subject to paragraph 7, a private health insurer must provide the information required by this Reporting Standard:\n\n (a) in respect of each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June); and\n (b) in respect of each year ending 30 June.\n\n7. If, having regard to the particular circumstances of a private health insurer, APRA considers it necessary or desirable to obtain information more or less frequently than as provided by subparagraph 6(a) or 6(b), APRA may, by notice in writing, change the reporting periods, or specify reporting periods, for the particular private health insurer.\n\n8. The information required by this Reporting Standard must be provided to APRA:\n\n(a) in the case of quarterly information, within 28 calendar days after the end of the reporting period to which the information relates;\n\n(b) in the case of annual information, by 30 September each year; or\n\n(c) in the case of information provided in accordance with paragraph 7, within the time specified by notice in writing.\n\n9. 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 on 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\n10. 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\n### Annual audit requirements\n\n11. The information submitted for the purposes of paragraph 8(b) is to be subject to external audit to ensure consistency with the private health insurer’s statutory financial accounts and faithful application of the capital standards.\n\n12. Audit certification and opinion must be provided to APRA by 30 September each year.\n\n13. If a private health insurer received a qualified auditor’s report for a health benefits fund, the general fund, or the private health insurer for the previous year (previous report), the current year’s auditor’s report must state whether the auditor has examined the issues identified and is satisfied that the private health insurer has taken the appropriate steps to rectify the matters raised in the previous report.\n\n14. The auditor’s report must:\n\n (a) state details of the program adopted to carry out the audit; and\n (b) include the name of, and be signed by, the auditor who takes responsibility for the accuracy of the report.\n\n### Authorisation\n\n15. A person who submits the information required under this Reporting Standard must be suitably authorised by an officer of the private health insurer.\n\n### Variations\n\n16. APRA may, in writing, vary the reporting requirements of this Reporting Standard in relation to a private health insurer.\n\n### Interpretation\n\n17. In this Reporting Standard:\n\n(a) unless the contrary intention appears, words and expressions have the meanings given to them in Prudential Standard HPS 001 Definitions (HPS 001); and\n\n(b) the following definitions are applicable:\n\n APRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998;\n capital standards means the prudential standards which relate to capital adequacy, as defined in HPS 001;\n\nofficer has the same meaning as in the Act;\n\nprivate health insurer has the same meaning as in the Act;\n\nreporting period means a period mentioned in paragraph 6 or, if applicable, paragraph 7; and\n\n the Act means the Private Health Insurance (Prudential Supervision) Act 2015.\n\n18. Unless the contrary intention appears, a reference to an Act, Prudential Standard, Reporting Standard, Australian Accounting or Auditing Standard is a reference to the instrument as in force from time to time.","sortOrder":1},{"sectionNumber":"Objective of this Reporting Standard","sectionType":"part","heading":"Objective of this Reporting Standard","content":"## Objective of this Reporting Standard\n\nThis Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s claims.\n\nIt includes associated specific instructions.","sortOrder":2},{"sectionNumber":"Authority","sectionType":"division","heading":"Authority","content":"### Authority\n\n1. This Reporting Standard is made under section 13 of the Financial Sector (Collection of Data) Act 2001.","sortOrder":3},{"sectionNumber":"Purpose","sectionType":"division","heading":"Purpose","content":"### Purpose\n\n2. The information reported to APRA under this Reporting Standard is used by APRA for the purpose of prudential supervision including assessing compliance with capital standards.","sortOrder":4},{"sectionNumber":"Application and commencement","sectionType":"division","heading":"Application and commencement","content":"### Application and commencement\n\n3. This Reporting Standard applies to all private health insurers. This Reporting Standard applies for reporting periods ending on or after 1 July 2023.","sortOrder":5},{"sectionNumber":"Information required","sectionType":"division","heading":"Information required","content":"### Information required\n\n4. A private health insurer must provide APRA with the information required by this Reporting Standard for each reporting period.","sortOrder":6},{"sectionNumber":"Method of submission","sectionType":"division","heading":"Method of submission","content":"### Method of submission\n\n5. 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; or\n (b) by a method notified by APRA prior to submission.","sortOrder":7},{"sectionNumber":"Reporting periods and due dates","sectionType":"division","heading":"Reporting periods and due dates","content":"### Reporting periods and due dates\n\n6. Subject to paragraph 7, a private health insurer must provide the information required by this Reporting Standard:\n\n (a) in respect of each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June); and\n (b) in respect of each year ending 30 June.\n\n7. If, having regard to the particular circumstances of a private health insurer, APRA considers it necessary or desirable to obtain information more or less frequently than as provided by subparagraph 6(a) or 6(b), APRA may, by notice in writing, change the reporting periods, or specify reporting periods, for the particular private health insurer.\n\n8. The information required by this Reporting Standard must be provided to APRA:\n\n(a) in the case of quarterly information, within 28 calendar days after the end of the reporting period to which the information relates;\n\n(b) in the case of annual information, by 30 September each year; or\n\n(c) in the case of information provided in accordance with paragraph 7, within the time specified by notice in writing.\n\n9. 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 on 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":8},{"sectionNumber":"Quality control","sectionType":"division","heading":"Quality control","content":"### Quality control\n\n10. 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.","sortOrder":9},{"sectionNumber":"Annual audit requirements","sectionType":"division","heading":"Annual audit requirements","content":"### Annual audit requirements\n\n11. The information submitted for the purposes of paragraph 8(b) is to be subject to external audit to ensure consistency with the private health insurer’s statutory financial accounts and faithful application of the capital standards.\n\n12. Audit certification and opinion must be provided to APRA by 30 September each year.\n\n13. If a private health insurer received a qualified auditor’s report for a health benefits fund, the general fund, or the private health insurer for the previous year (previous report), the current year’s auditor’s report must state whether the auditor has examined the issues identified and is satisfied that the private health insurer has taken the appropriate steps to rectify the matters raised in the previous report.\n\n14. The auditor’s report must:\n\n (a) state details of the program adopted to carry out the audit; and\n (b) include the name of, and be signed by, the auditor who takes responsibility for the accuracy of the report.","sortOrder":10},{"sectionNumber":"Authorisation","sectionType":"division","heading":"Authorisation","content":"### Authorisation\n\n15. A person who submits the information required under this Reporting Standard must be suitably authorised by an officer of the private health insurer.","sortOrder":11},{"sectionNumber":"Variations","sectionType":"division","heading":"Variations","content":"### Variations\n\n16. APRA may, in writing, vary the reporting requirements of this Reporting Standard in relation to a private health insurer.","sortOrder":12},{"sectionNumber":"Interpretation","sectionType":"division","heading":"Interpretation","content":"### Interpretation\n\n17. In this Reporting Standard:\n\n(a) unless the contrary intention appears, words and expressions have the meanings given to them in Prudential Standard HPS 001 Definitions (HPS 001); and\n\n(b) the following definitions are applicable:\n\n APRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998;\n capital standards means the prudential standards which relate to capital adequacy, as defined in HPS 001;\n\nofficer has the same meaning as in the Act;\n\nprivate health insurer has the same meaning as in the Act;\n\nreporting period means a period mentioned in paragraph 6 or, if applicable, paragraph 7; and\n\n the Act means the Private Health Insurance (Prudential Supervision) Act 2015.\n\n18. Unless the contrary intention appears, a reference to an Act, Prudential Standard, Reporting Standard, Australian Accounting or Auditing Standard is a reference to the instrument as in force from time to time.","sortOrder":13},{"sectionNumber":"General instructions","sectionType":"part","heading":"General instructions","content":"# Reporting Standard HRS 109.0\n\n# Claims\n\n## General instructions\n\n### Reporting tables\n\nTables described in this reporting standard list each of the data fields required to be reported. The data fields are listed sequentially in the column order that they will appear in the reported data set. Constraints on the data that can be reported for each field have also been provided.\n\nAny specific combination of values in a table must not appear on more than one row in that table when reported.\n\n#### Definitions\n\nTerms highlighted in bold italics indicate that the definition is provided in these instructions.\n\nC\n\n| Claim payment | Means the benefit paid to the policy holder (gross of risk equalisation trust fund payments/receipts). |\n| ------------- | ------------------------------------------------------------------------------------------------------ |\n\nH\n\n| Health benefits fund | Has the same meaning as in the Act. |\n| -------------------- | ----------------------------------- |","sortOrder":16},{"sectionNumber":"Reporting tables","sectionType":"division","heading":"Reporting tables","content":"### Reporting tables\n\nTables described in this reporting standard list each of the data fields required to be reported. The data fields are listed sequentially in the column order that they will appear in the reported data set. Constraints on the data that can be reported for each field have also been provided.\n\nAny specific combination of values in a table must not appear on more than one row in that table when reported.","sortOrder":17},{"sectionNumber":"Definitions","sectionType":"subdivision","heading":"Definitions","content":"#### Definitions\n\nTerms highlighted in bold italics indicate that the definition is provided in these instructions.\n\nC\n\n| Claim payment | Means the benefit paid to the policy holder (gross of risk equalisation trust fund payments/receipts). |\n| ------------- | ------------------------------------------------------------------------------------------------------ |\n\nH\n\n| Health benefits fund | Has the same meaning as in the Act. |\n| -------------------- | ----------------------------------- |","sortOrder":18},{"sectionNumber":"Specific instructions","sectionType":"part","heading":"Specific instructions","content":"## Specific instructions\n\n### Table 1: HIB Claim Payments\n\n#### Reporting basis\n\nReport values on a cash flow basis.\n\nThis table applies to health benefits funds only.\n\nThis table applies to claim payments for health insurance business only, where health insurance business has the same meaning as in the Act.\n\n#### Units of measurement\n\nReport values in whole Australian dollars (no decimal places).\n\n| | Name | Valid values | Description |\n| --- | -------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| 1 | Private Health Insurer Fund Name | Free text | Report the name of the private health insurer fund. This is in the event an insurer has multiple health benefits funds.In the event an insurer has only one health benefits fund, its name should be the same as the insurer. |\n| 2 | Month Claim Incurred | 48 Months Prior47 Months Prior46 Months Prior45 Months Prior44 Months Prior43 Months Prior42 Months Prior41 Months Prior40 Months Prior39 Months Prior38 Months Prior37 Months Prior36 Months Prior35 Months Prior34 Months Prior33 Months Prior32 Months Prior31 Months Prior30 Months Prior29 Months Prior28 Months Prior27 Months Prior26 Months Prior25 Months Prior24 Months Prior23 Months Prior22 Months Prior21 Months Prior20 Months Prior19 Months Prior18 Months Prior17 Months Prior16 Months Prior15 Months Prior14 Months Prior13 Months Prior12 Months Prior11 Months Prior10 Months Prior9 Months Prior8 Months Prior7 Months Prior6 Months Prior5 Months Prior4 Months Prior3 Months Prior2 Months Prior1 Month PriorSame Month | Report the month the claim was incurred, using the reporting date as the current date. |\n| 3 | Month Claim Paid | 2 months prior1 month priorSame month | Report the month the claim was paid, using the reporting date as the current date. |\n| 4 | Claim Payment Amount | Whole dollars | Report the claim payment amount. |","sortOrder":19},{"sectionNumber":"Table 1: HIB Claim Payments","sectionType":"division","heading":"Table 1: HIB Claim Payments","content":"## Specific instructions\n\n### Table 1: HIB Claim Payments\n\n#### Reporting basis\n\nReport values on a cash flow basis.\n\nThis table applies to health benefits funds only.\n\nThis table applies to claim payments for health insurance business only, where health insurance business has the same meaning as in the Act.\n\n#### Units of measurement\n\nReport values in whole Australian dollars (no decimal places).\n\n| | Name | Valid values | Description |\n| --- | -------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| 1 | Private Health Insurer Fund Name | Free text | Report the name of the private health insurer fund. This is in the event an insurer has multiple health benefits funds.In the event an insurer has only one health benefits fund, its name should be the same as the insurer. |\n| 2 | Month Claim Incurred | 48 Months Prior47 Months Prior46 Months Prior45 Months Prior44 Months Prior43 Months Prior42 Months Prior41 Months Prior40 Months Prior39 Months Prior38 Months Prior37 Months Prior36 Months Prior35 Months Prior34 Months Prior33 Months Prior32 Months Prior31 Months Prior30 Months Prior29 Months Prior28 Months Prior27 Months Prior26 Months Prior25 Months Prior24 Months Prior23 Months Prior22 Months Prior21 Months Prior20 Months Prior19 Months Prior18 Months Prior17 Months Prior16 Months Prior15 Months Prior14 Months Prior13 Months Prior12 Months Prior11 Months Prior10 Months Prior9 Months Prior8 Months Prior7 Months Prior6 Months Prior5 Months Prior4 Months Prior3 Months Prior2 Months Prior1 Month PriorSame Month | Report the month the claim was incurred, using the reporting date as the current date. |\n| 3 | Month Claim Paid | 2 months prior1 month priorSame month | Report the month the claim was paid, using the reporting date as the current date. |\n| 4 | Claim Payment Amount | Whole dollars | Report the claim payment amount. |","sortOrder":20},{"sectionNumber":"Reporting basis","sectionType":"subdivision","heading":"Reporting basis","content":"#### Reporting basis\n\nReport values on a cash flow basis.\n\nThis table applies to health benefits funds only.\n\nThis table applies to claim payments for health insurance business only, where health insurance business has the same meaning as in the Act.","sortOrder":21},{"sectionNumber":"Units of measurement","sectionType":"subdivision","heading":"Units of measurement","content":"#### Units of measurement\n\nReport values in whole Australian dollars (no decimal places).\n\n| | Name | Valid values | Description |\n| --- | -------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| 1 | Private Health Insurer Fund Name | Free text | Report the name of the private health insurer fund. This is in the event an insurer has multiple health benefits funds.In the event an insurer has only one health benefits fund, its name should be the same as the insurer. |\n| 2 | Month Claim Incurred | 48 Months Prior47 Months Prior46 Months Prior45 Months Prior44 Months Prior43 Months Prior42 Months Prior41 Months Prior40 Months Prior39 Months Prior38 Months Prior37 Months Prior36 Months Prior35 Months Prior34 Months Prior33 Months Prior32 Months Prior31 Months Prior30 Months Prior29 Months Prior28 Months Prior27 Months Prior26 Months Prior25 Months Prior24 Months Prior23 Months Prior22 Months Prior21 Months Prior20 Months Prior19 Months Prior18 Months Prior17 Months Prior16 Months Prior15 Months Prior14 Months Prior13 Months Prior12 Months Prior11 Months Prior10 Months Prior9 Months Prior8 Months Prior7 Months Prior6 Months Prior5 Months Prior4 Months Prior3 Months Prior2 Months Prior1 Month PriorSame Month | Report the month the claim was incurred, using the reporting date as the current date. |\n| 3 | Month Claim Paid | 2 months prior1 month priorSame month | Report the month the claim was paid, using the reporting date as the current date. |\n| 4 | Claim Payment Amount | Whole dollars | Report the claim payment amount. |","sortOrder":22}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard administrative reporting requirement consistent with APRA's ongoing prudential supervision mandate. The scope remains tightly focused on claims data collection for regulatory oversight, which aligns with the original purpose of the Financial Sector (Collection of Data) Act 2001."},"complexity_factors":["Multiple cross-references to external instruments (Prudential Standard HPS 001, Private Health Insurance (Prudential Supervision) Act 2015, Australian Accounting/Auditing Standards)","Conditional reporting timelines with APRA discretion powers (paragraphs 7, 9, 16 allow APRA to modify requirements)","Nested definitions: terms defined by reference to other defined terms (e.g., 'capital standards' defined by reference to HPS 001, which itself defines 'prudential standards')","Temporal complexity: 48-month lookback period for claim incurred dates creates significant data retention requirements","Dual reporting frequencies (quarterly and annual) with different due dates and audit requirements","Specific data validation rules (whole dollars only, unique row constraints in tables)","Audit follow-up requirements for qualified opinions (paragraph 13 creates a continuing obligation based on prior year findings)"],"plain_english_summary":"This APRA reporting standard requires private health insurers to submit detailed claims data — when claims were incurred (up to 48 months), when paid, and amounts — electronically each quarter (within 28 days) and annually (by 30 September), with annual external audit and board/senior-management accountability.\n\nAPRA uses the data to monitor insurers’ financial health and capital adequacy to protect policyholders; APRA can vary deadlines or grant extensions for individual insurers."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"This Reporting Standard implements a focused data collection regime for private health insurers’ claims information and sets accompanying quality control and audit requirements. The instrument’s scope — mandatory claims reporting by private health insurers for prudential supervision and capital assessment — is consistent with the stated purpose (para 2) and does not, on its face, extend beyond that original objective. The principal sources of variability (APRA’s ability to vary frequency or content for particular insurers) permit tailoring of scope for supervisory reasons but do not constitute a fundamental expansion of the instrument’s overall purpose."},"complexity_factors":["Cross‑references to external instruments: relies on definitions in Prudential Standard HPS 001 and other Acts/Standards as 'in force from time to time' (paras 17–18)","Regulator discretion: APRA may vary reporting periods or requirements for particular insurers by written notice (paras 7, 16)","Multiple timing rules and exceptions: quarterly deadlines (28 days), annual deadline (30 Sept), APRA extensions and bespoke periods (paras 8–9)","Mandatory external audit with special rules where prior qualified opinions exist (paras 11–14)","Data formatting and content specifics: Table 1 prescribes cash‑flow basis, units, and particular month‑window fields (Table 1)","Internal control and authorisation obligations assigned to board and senior management (para 10) and authorised submitter requirement (para 15)","Potential operational complexity from APRA‑specified electronic submission method and any future changes (para 5)"],"plain_english_summary":"**What this instrument does (mechanics first)\n\n- Establishes mandatory data‑reporting obligations for all private health insurers about claims. (paras 3–4, Table 1)\n- Requires insurers to submit the data electronically using APRA’s published method, or by any other method APRA notifies. (para 5)\n- Sets standard reporting frequencies: quarterly (periods ending 30 Sep, 31 Dec, 31 Mar, 30 Jun) and annually (year ending 30 Jun). APRA can require different frequencies for particular insurers by written notice. (paras 6–7)\n- Imposes deadlines: quarterly reports within 28 calendar days after period end; annual reports by 30 September; APRA may extend a due date in writing. (paras 8–9)\n- Requires internal controls over reported data (board and senior management responsibility). (para 10)\n- Requires the annual submissions to be externally audited and the audit opinion/certification provided to APRA by 30 September, with additional requirements where the prior year’s auditor issued a qualified opinion. (paras 11–14)\n- Requires that the person submitting data be authorised by an officer of the insurer. (para 15)\n- Gives APRA the power to vary the reporting requirements for a particular insurer in writing. (para 16)\n- Incorporates definitions from Prudential Standard HPS 001 and other instruments as in force. (paras 17–18)\n- Provides a specific data table (Table 1: HIB Claim Payments) with fields and constraints (e.g. fund name, month claim incurred/paid, claim payment amount) and specifies cash‑flow basis and units (whole AUD). (Table 1 instructions)\n\nWhy APRA says this matters\n\n- The stated purpose is to collect information used for prudential supervision, including assessing compliance with capital standards (para 2). That is, APRA will use the data to monitor insurer solvency and adherence to capital rules.\n\nWho this affects and what they must do\n\n- Affected parties: every entity defined as a private health insurer under the Private Health Insurance (Prudential Supervision) Act 2015. (para 3, interpretation)\n- Duties for insurers: implement systems and controls for preparing and authorising the reported data (para 10); compile and submit quarterly and annual claim‑payments data in the format APRA prescribes (paras 4–9, Table 1); obtain an external audit and deliver an auditor’s opinion for annual data (paras 11–14); ensure submissions are made by an authorised person (para 15).\n- Who pays: insurers bear the direct costs of data collection, internal control systems, auditing, and submission. APRA bears data processing and supervisory costs.\n- Who decides: APRA decides the electronic method and may change reporting frequency or timing for particular insurers by written notice; APRA can also vary reporting requirements per insurer (paras 5, 7, 16).\n\nPractical effects, incentives and trade‑offs (test of purpose against costs and risks)\n\n- Compliance burden: insurers must maintain ongoing data capture and reconciliation processes (para 10), prepare quarterly cash‑flow‑based claim payment records (Table 1), and fund annual external audits (paras 11–12). Smaller insurers or funds with multiple discrete funds may face proportionally higher per‑entity costs (Table 1 expects a fund name when multiple funds exist).\n- Incentives: regular, timely reporting increases APRA’s visibility over claims experience and cash outflows, which can lead to more targeted supervisory action or capital interventions where issues are identified (para 2). The power to vary frequency or scope for individual insurers (paras 7, 16) creates an incentive for APRA to intensify reporting for entities it views as higher risk.\n- Bureaucratic discretion and implementation risk: APRA’s ability to change reporting periods and vary requirements in writing (paras 7, 16) gives the regulator significant discretionary control over data demands. That flexibility helps supervisory responsiveness but increases uncertainty for insurers and can require rapid system changes.\n- Data consistency and interpretation risk: the instrument pulls definitions from HPS 001 and allows references to instruments \"as in force from time to time\" (para 17–18). That linkage helps harmonise terminology with prudential rules but means insurers must track changes to external standards and interpret terms consistently for reporting.\n- Opportunity cost and substitution effects: investment in IT, data governance and audit may divert resources from other business activities (product development, claims processing improvements). Where reporting is onerous, insurers may centralise or standardise processes, affecting operational structure and vendor choices.\n- Concentrated benefits vs diffuse costs: the direct, concentrated beneficiary is APRA (and, indirectly, users of prudential oversight) which gains richer data for supervision (para 2). Costs are distributed across all insurers required to comply; the relative burden will be heavier on smaller insurers and those with multiple funds (Table 1).\n- Audit tension: the requirement for external audit and specific auditor statements where prior qualifications existed (paras 11–14) raises the quality of reported data but also increases audit scope and cost. Where auditors identify prior issues, insurers must demonstrate remediation, creating a compliance loop that can surface legacy problems.\n\nOperational notes and edge points to watch\n\n- Reporting format and method are controlled by APRA (para 5). Insurers should confirm APRA’s electronic submission specifications and any transitional guidance.\n- The Table 1 field for \"Month Claim Incurred\" lists a fixed window of months (up to 48 months prior). Insurers must map their claim‑incurred data to this reporting window and the cash‑flow basis required.\n- APRA can give written notice to adjust timing/frequency for a particular insurer (para 7). Insurers should be prepared for bespoke reporting timetables where solvency or risk concerns arise.\n- Where APRA grants extensions, the new due date is the date stated on the extension notice (para 9). Nonbusiness‑day rules do not extend submission obligations (note following para 9).\n\nPrimary legal hooks (for reference)\n\n- Power to make the standard: s.13 Financial Sector (Collection of Data) Act 2001 (Authority heading).\n- Purpose: prudential supervision and capital standards assessment (para 2).\n- Key operational paragraphs: application/commencement (para 3), information required and submission method (paras 4–5), reporting periods and due dates (paras 6–9), quality control (para 10), audit requirements (paras 11–14), APRA variations (para 16), and interpretation (paras 17–18)."},"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-99-of-2023","history":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-99-of-2023/history","analysis":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-99-of-2023/analysis","conflicts":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-99-of-2023/conflicts","importantCases":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-99-of-2023/important-cases","documents":"/api/acts/financial-sector-collection-of-data-reporting-standard-determination-no-99-of-2023/documents"}}