Financial Sector (Collection of Data) (reporting standard) determination No. 105 of 2023
RepealedCTH
This Act has been repealed and is no longer in force. It is retained for historical reference.
Jurisdiction
Commonwealth
Collection
legislative instrument
Plain English Summary
8/10 complexity
This APRA reporting standard requires all Australian private health insurers to submit quarterly and audited annual electronic returns detailing the insurance risk charge—the capital buffer held against unexpected claim spikes. Reports cover outstanding and future claims, risk‑equalisation, deferred claims and membership measures, calculated under central, adverse‑event and management‑action scenarios.
Timely submissions let APRA monitor solvency, spot emerging stress, and ensure insurers hold sufficient capital to protect policyholders during crises.
This Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s insurance risk charge.
It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 115 Capital Adequacy: Insurance Risk Charge (HPS 115) and Prudential Standard HPS 340 Insurance Liability Valuation (HPS 340).
Authority
This Reporting Standard is made under section 13 of the Financial Sector (Collection of Data) Act 2001.
Purpose
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.
Application and commencement
This Reporting Standard applies to all private health insurers. This Reporting Standard applies for reporting periods ending on or after 1 July 2023.
Information required
A private health insurer must provide APRA with the information required by this Reporting Standard for each reporting period.
Method of submission
The information required by this Reporting Standard must be given to APRA:
(a) in electronic format using an electronic method available on APRA’s website; or
(b) by a method notified by APRA prior to submission.
Reporting periods and due dates
Subject to paragraph 7, a private health insurer must provide the information required by this Reporting Standard:
(a) in respect of each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June); and
(b) in respect of each year ending 30 June.
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.
The information required by this Reporting Standard must be provided to APRA:
(a) in the case of quarterly information, within 28 calendar days after the end of the reporting period to which the information relates;
(b) in the case of annual information, by 30 September each year; or
(c) in the case of information provided in accordance with paragraph 7, within the time specified by notice in writing.
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.
Note: 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.
Quality control
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.
Annual audit requirements
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.
Audit certification and opinion must be provided to APRA by 30 September each year.
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 year previous to the year for which the report is provided, the report for the year for which the report is provided 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.
The auditor’s report must:
(a) state details of the program adopted to carry out the audit; and
(b) include the name of, and be signed by, the auditor who takes responsibility for the accuracy of the report.
Authorisation
A person who submits the information required under this Reporting Standard must be suitably authorised by an officer of the private health insurer.
Variations
APRA may, in writing, vary the reporting requirements of this Reporting Standard in relation to a private health insurer.
Interpretation
In this Reporting Standard:
(a) unless the contrary intention appears, words and expressions have the meanings given to them in Prudential Standard HPS 001 Definitions (HPS 001); and
(b) the following definitions are applicable:
APRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998;
capital standards means the prudential standards which relate to capital adequacy, as defined in HPS 001;
officer has the same meaning as in the Act;
private health insurer has the same meaning as in the Act;
reporting period means a period mentioned in paragraph 6 or, if applicable, paragraph 7; and
the Act means the Private Health Insurance (Prudential Supervision) Act 2015.
18. 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.
This Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s insurance risk charge.
It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 115 Capital Adequacy: Insurance Risk Charge (HPS 115) and Prudential Standard HPS 340 Insurance Liability Valuation (HPS 340).
Authority
This Reporting Standard is made under section 13 of the Financial Sector (Collection of Data) Act 2001.
Purpose
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.
Application and commencement
This Reporting Standard applies to all private health insurers. This Reporting Standard applies for reporting periods ending on or after 1 July 2023.
Information required
A private health insurer must provide APRA with the information required by this Reporting Standard for each reporting period.
Method of submission
The information required by this Reporting Standard must be given to APRA:
(a) in electronic format using an electronic method available on APRA’s website; or
(b) by a method notified by APRA prior to submission.
Reporting periods and due dates
Subject to paragraph 7, a private health insurer must provide the information required by this Reporting Standard:
(a) in respect of each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June); and
(b) in respect of each year ending 30 June.
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.
The information required by this Reporting Standard must be provided to APRA:
(a) in the case of quarterly information, within 28 calendar days after the end of the reporting period to which the information relates;
(b) in the case of annual information, by 30 September each year; or
(c) in the case of information provided in accordance with paragraph 7, within the time specified by notice in writing.
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.
Note: 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.
Quality control
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.
Annual audit requirements
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.
Audit certification and opinion must be provided to APRA by 30 September each year.
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 year previous to the year for which the report is provided, the report for the year for which the report is provided 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.
The auditor’s report must:
(a) state details of the program adopted to carry out the audit; and
(b) include the name of, and be signed by, the auditor who takes responsibility for the accuracy of the report.
Authorisation
A person who submits the information required under this Reporting Standard must be suitably authorised by an officer of the private health insurer.
Variations
APRA may, in writing, vary the reporting requirements of this Reporting Standard in relation to a private health insurer.
Interpretation
In this Reporting Standard:
(a) unless the contrary intention appears, words and expressions have the meanings given to them in Prudential Standard HPS 001 Definitions (HPS 001); and
(b) the following definitions are applicable:
APRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998;
capital standards means the prudential standards which relate to capital adequacy, as defined in HPS 001;
officer has the same meaning as in the Act;
private health insurer has the same meaning as in the Act;
reporting period means a period mentioned in paragraph 6 or, if applicable, paragraph 7; and
the Act means the Private Health Insurance (Prudential Supervision) Act 2015.
18. 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.
Objective of this Reporting Standard
Objective of this Reporting Standard
Objective of this Reporting Standard
This Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s insurance risk charge.
It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 115 Capital Adequacy: Insurance Risk Charge (HPS 115) and Prudential Standard HPS 340 Insurance Liability Valuation (HPS 340).
Authority
Authority
Authority
This Reporting Standard is made under section 13 of the Financial Sector (Collection of Data) Act 2001.
Purpose
Purpose
Purpose
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.
Application and commencement
Application and commencement
Application and commencement
This Reporting Standard applies to all private health insurers. This Reporting Standard applies for reporting periods ending on or after 1 July 2023.
Information required
Information required
Information required
A private health insurer must provide APRA with the information required by this Reporting Standard for each reporting period.
Method of submission
Method of submission
Method of submission
The information required by this Reporting Standard must be given to APRA:
(a) in electronic format using an electronic method available on APRA’s website; or
(b) by a method notified by APRA prior to submission.
Reporting periods and due dates
Reporting periods and due dates
Reporting periods and due dates
Subject to paragraph 7, a private health insurer must provide the information required by this Reporting Standard:
(a) in respect of each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June); and
(b) in respect of each year ending 30 June.
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.
The information required by this Reporting Standard must be provided to APRA:
(a) in the case of quarterly information, within 28 calendar days after the end of the reporting period to which the information relates;
(b) in the case of annual information, by 30 September each year; or
(c) in the case of information provided in accordance with paragraph 7, within the time specified by notice in writing.
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.
Note: 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.
Quality control
Quality control
Quality control
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.
Annual audit requirements
Annual audit requirements
Annual audit requirements
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.
Audit certification and opinion must be provided to APRA by 30 September each year.
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 year previous to the year for which the report is provided, the report for the year for which the report is provided 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.
The auditor’s report must:
(a) state details of the program adopted to carry out the audit; and
(b) include the name of, and be signed by, the auditor who takes responsibility for the accuracy of the report.
Authorisation
Authorisation
Authorisation
A person who submits the information required under this Reporting Standard must be suitably authorised by an officer of the private health insurer.
Variations
Variations
Variations
APRA may, in writing, vary the reporting requirements of this Reporting Standard in relation to a private health insurer.
Interpretation
Interpretation
Interpretation
In this Reporting Standard:
(a) unless the contrary intention appears, words and expressions have the meanings given to them in Prudential Standard HPS 001 Definitions (HPS 001); and
(b) the following definitions are applicable:
APRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998;
capital standards means the prudential standards which relate to capital adequacy, as defined in HPS 001;
officer has the same meaning as in the Act;
private health insurer has the same meaning as in the Act;
reporting period means a period mentioned in paragraph 6 or, if applicable, paragraph 7; and
the Act means the Private Health Insurance (Prudential Supervision) Act 2015.
18. 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.
General instructions
General instructions
Reporting Standard HRS 115.0
Insurance Risk Charge
General instructions
Reporting tables
Tables 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.
Any specific combination of values in a table must not appear on more than one row in that table when reported.
Definitions
Terms highlighted in bold italics indicate that the definition is provided in these instructions.
A
Accrued premium
This refers to accrued premium as defined in HPS 001.Report this item net of any reinsurance, for the purpose of this Reporting Standard.
Accrued premium (AES) amount
This is the forecast value of accrued premium after the Adverse Event Stress (AES), as defined in HPS 115, for that month.
Accrued premium (CE) amount
This is the central estimate (CE) forecast of accrued premium for that month.
Accrued premium (MA) amount
The insurer is required to report this item for months 10, 11 and 12 only. For health insurance business (HIB), this is to be determined by adjusting accrued premium (AES) amount for management actions (MA), as defined in HPS 115. For health-related insurance business (HRIB), this is to be reported as the accrued premium (CE) after allowing for management actions, as defined in HPS 115.Accrued premium (MA) must reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer’s expectations and not be limited to the extent that these result in insurance profits. This constraint will be applied separately in insurance profits forecast after management actions amount.For months 1 to 9 inclusive, this is a derived item.For HIB, this is equal to accrued premium (AES) amount. For HRIB, this is equal to accrued premium (CE) amount.
B
Benefits incurred (AES) amount
This is a derived item.For hospital treatment, this item is calculated as the sum of:claims incurred (AES) amount;calculated deficit (AES) amount; andstate levies (AES) amount.Less:gross deficit (AES) amount.For general treatment, this item is equal to claims incurred (AES) amount.
Benefits incurred (CE) amount
This is a derived item.For hospital treatment, this item is calculated as the sum of:claims incurred (CE) amount;calculated deficit (CE) amount; andstate levies (CE) amount.Less:gross deficit (CE) amount.For general treatment and health-related insurance business, this item is equal to claims incurred (CE) amount.
Benefits incurred (MA) amount
This is a derived item.For hospital treatment, this item is calculated as the sum of:claims incurred (MA) amount;calculated deficit (MA) amount; andstate levies (MA) amount.Less:gross deficit (MA) amount.For general treatment and health-related insurance business, this item is equal to claims incurred (MA) amount.
Benefits incurred (pre-MA) amount
This is a derived item, which provides an approximation of benefits incurred, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115.For hospital treatment and general treatment, this item is calculated as:Where:A equals Benefits incurred (AES) amountB equals HIB stress %For health-related insurance business, this item is calculated as:A equals Benefits incurred (CE) amountB equals HRIB stress %For general treatment and health-related insurance business, this item is also equal to claims incurred (pre-MA) amount.
Billed Risk Equalisation Special Account liability amount
Billed Risk Equalisation Special Account liability amount means the amount of Risk Equalisation Special Account payments, on the relevant day, for which an invoice from the APRA has been received by the insurer but that have not yet been paid by the insurer.Risk Equalisation Special Account has the same meaning as in the Act.
C
Calculated deficit (AES) amount
This is a derived item and is calculated as:Where:A equals Calculated deficit (CE) amountB equals Single Equivalent Units (CE) countC equals Single Equivalent Units (AES) count.
Calculated deficit (CE) amount
This is the central estimate forecast of the calculated deficit for that month.The calculated deficit is the total amount that is expected to be payable by the private health insurer should each single equivalent unit (SEU) be entitled to the average amount as defined in sub-rule 11(1) of the Private Health Insurance (Risk Equalisation Policy) Rules 2015 or its replacement.
Calculated deficit (MA) amount
This is a derived item.For months 1-9, this is calculated identically to calculated deficit (AES) amount.For months 10-12, this item is calculated as:Where:A equals Calculated deficit (AES) amountB equals Single Equivalent Units (AES) countC equals Single Equivalent Units (MA) count.
Central estimate of OCL
This is a derived item and is calculated as the sum of:claims component - OCL amount;claims handling expenses - OCL amount;risk equalisation component - OCL amount; andsettled but not paid claims - OCL amountLess the sum of:reinsurance recoverables - OCL amount;non-reinsurance recoveries - OCL amount; anddiscount on OCL amount.
Central estimate of PL
This is a derived item and is calculated as the sum of:claims component - PL amount;claims handling expenses - PL amount;policy administration expenses – PL amount; andrisk equalisation component - PL amountLess the sum of:expected reinsurance recoveries - PL amount;non-reinsurance recoveries - PL amount; anddiscount on PL amount.
Claims component - OCL amount
This is the value, as at the relevant date, of the claims component of the central estimate of OCL, determined in accordance with HPS 340. This includes claims payable for:claims that have been reported, but are not yet settled at balance date;claims that have been incurred, but not yet reported; andclaims that have been administratively settled, but which may be reopened.This should not include any other unpaid amounts which are certain, including those that have been settled but not paid. These amounts are to be reported separately.This is to be reported gross of any recoveries and discounting, which are reported separately.
Claims component - PL amount
This is the value, as at the relevant date, of the claims component of the central estimate of PL, determined in accordance with HPS 340.This is to be reported gross of any Risk Equalisation or reinsurance recoveries and discounting, which are reported separately.
Claims handling expenses - OCL amount
This is the value, as at the relevant date, of the claims handling expenses associated with those claims included within the central estimate of OCL, determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on OCL amount.
Claims handling expenses - PL amount
This is the value, as at the relevant date, of the claims handling expenses associated with those claims included within the central estimate of PL, determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on PL amount.
Claims incurred
This refers to the relevant forecast of claims incurred, as defined in HPS 001.Report this item net of any reinsurance for the purpose of this reporting standard.
Claims incurred (AES) amount
This is the forecast of claims incurred after the Adverse Event Stress, as defined in HPS 115, for that month.For general treatment, this item is also equal to benefits incurred (AES) amount.
Claims incurred (CE) amount
This is the central estimate forecast of claims incurred for that month.For general treatment and health-related insurance business, this item is also equal to benefits incurred (CE) amount.
Claims incurred (MA) amount
The insurer is required to report this item for months 10, 11 and 12 only. This is to be determined by adjusting the claims incurred (pre-MA) for management actions, as defined in HPS 115.Claims incurred (MA) must only reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer’s expectations and not be limited to the extent that these result in an insurance profit. This constraint will be applied separately in insurance profits forecast after management actions amount.For months 1 to 9 inclusive, this is a derived item and is equal to claims incurred (pre-MA) amount.For general treatment and health-related insurance business, this item is equal to benefits incurred (MA) amount.
Claims incurred (pre-MA) amount
This is a derived item, which provides an approximation of claims incurred, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115. This derived item provides a basis from which management actions can be taken in determining claims incurred (MA) amount.For hospital treatment, this item is calculated as:Where:A equals Claims incurred (AES) amountB equals Benefits incurred (pre-MA) amountC equals Benefits incurred (AES) amountD equals State Levies (pre-MA) amountE equals State Levies (AES) amountF equals Gross deficit (AES) amountG equals Claims incurred (AES) amountFor general treatment and health-related insurance business, this item is equal to benefits incurred (pre-MA) amount.
Class of business
Relates to insurance business only. This can be:hospital treatment;general treatment; orhealth-related insurance business (HRIB).
The DCL aggregation benefit makes an explicit allowance for diversification between the DCL and all other components of insurance risks, as defined in HPS 115 at the 99.5 percent probability of adequacy.
DCL at 75th probability of adequacy (POA) amount
This is the value of claims deferred due to COVID – 19 related disruptions or other circumstances as defined by APRA. This is calculated at the 75 percent probability of adequacy (POA), as at the relevant date, determined in accordance with HPS 340.
DCL at 99.5th probability of adequacy (POA) amount
This is the value of claims deferred due to COVID – 19 related disruptions or other circumstances as defined by APRA. This is calculated at the 99.5 percent probability of adequacy (POA), as at the relevant date, in accordance with HPS 340.
DCL Risk Charge
The DCL Risk Charge relates to the risk that the value of the DCL will be greater than the value determined in accordance with HPS 340.This is a derived item and is calculated as:DCL at 99.5th POA amount; lessDCL at 75th POA amount; lessDCL aggregation benefit.
Discount on Future Exposure Risk Charge (FERC) (MA) amount
This is the value of discounting the future cashflows associated with the future exposure risk charge. This is value of cashflows post management actions after the exclusion of any insurance profits forecast after management actions, in accordance with HPS 115.
Discount on Outstanding Claims Liability (OCL) amount
This is the value of discounting on the HPS 340 outstanding claims liability. This includes the impact of discounting on the net actuarial central estimate of outstanding claims.
Discount on Premium Liability (PL) amount
This is the value of discounting on the HPS 340 premium liability.
E
Expected reinsurance recoveries - PL amount
This is the value of expected reinsurance recoveries receivable by the health benefits fund or general fund associated with the PL, gross of any provisions for depreciation or impairment. It is determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on PL amount.
F
Future Exposure Risk Charge
This is a derived item and is calculated as the sum of:Future Exposure Risk Charge - HIB; andFuture Exposure Risk Charge - HRIB.
Future Exposure Risk Charge - HIB
This is a derived item and is calculated as:where:A equals HIB net margin (MA) amount totalB equals Insurance profits forecast after management actions amount for HIBC equals Discount on Future Exposure Risk Charge amount for HIB
Future Exposure Risk Charge - HRIB
This is a derived item and is calculated as:where:A equals HRIB net margin (MA) amount totalB equals Insurance profits forecast after management actions amount for HRIBC equals Discount on Future Exposure Risk Charge amount for HRIB
Future Exposure Risk Charge period
This is the month of the forecast period, and ranges from the month following the reporting date to the month concluding on the 12th month following the reporting date.
G
General fund(Private health insurer fund type)
This refers to the portion of the insurer referred to as the general fund as defined in HPS 001.
General treatment(Class of Business)
General treatment has the same meaning as in the Private Health Insurance Act 2007 (PHI Act).
Gross deficit
Gross deficit means the sum of the eligible benefits notionally allocated to the aged-based pool and the high cost claimants pool, calculated for each risk equalisation jurisdiction, in accordance with Part 2, Rule 11(1)(a) of the Private Health Insurance (Risk Equalisation Policy) Rules 2015.
Gross deficit (AES) amount
This is the forecast of the gross deficit after the Adverse Event Stress, as defined in HPS 115, for that month.
Gross deficit (CE) amount
This is the central estimate forecast of gross deficit for that month.
Gross deficit (MA) amount
The insurer is required to report this item for months 10, 11 and 12 only. This is to be determined by adjusting the gross deficit (pre-MA) for management actions as defined in HPS 115.Gross deficit (MA) must only reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer’s expectations and not be limited to the extent that these result in an insurance profit. This constraint will be applied separately in insurance profits forecast after management actions amount.For months 1 to 9 inclusive this is a derived item and is equal to gross deficit (pre-MA) amount.
Gross deficit (pre-MA) amount
This is a derived item, which provides an approximation of gross deficit, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115. This derived item provides a basis from which management actions can be taken in determining gross deficit (MA) amount.Gross deficit (pre-MA) is calculated as:where:A equals Claims incurred (pre-MA) amountB equals Gross deficit (AES) amountC equals Claims incurred (AES) amount.
Gross margin (AES) amount
This is a derived item. For hospital treatment and general treatment it is calculated as:accrued premium (AES) amountless:benefits incurred (AES) amount.
Gross margin (CE) amount
This is a derived item and is calculated as:accrued premium (CE) amountless:benefits incurred (CE) amount.
Gross margin (MA) amount
This is a derived item and is calculated as:accrued premium (MA) amountless:benefits incurred (MA) amount.
Gross margin (pre-MA) amount
This is a derived item, which provides an approximation of gross margin, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115.Gross margin (pre-MA) amount is calculated as:accrued premium (pre-MA) amountless:benefits incurred (pre-MA) amount.
H
Health benefits fund(Private health insurer fund type)
Health benefits fund has the same meaning as in the Act.
Health insurance business(Private health insurer business type)
Health insurance business (HIB) has the same meaning as in the Act.
Health insurance business membership reporting period
Health insurance business membership is the hospital treatment SEUs as at the relevant date for each health benefits fund. The applicable options are:as at the current reporting date;one year prior to the reporting date;two years prior to the reporting date; andthree years prior to the reporting date.
Health-related insurance business (HRIB)(Private health insurer business type)(Class of business)
This is as defined in HPS 001.
Health-related insurance business accrued premium amount
This is the value of accrued premium for health-related insurance business for the 12 months up to the reporting date.
HIB stress %
This is the health insurance business stress, as a percentage, determined in accordance with HPS 115.
Hospital treatment(Class of business)
Hospital treatment has the same meaning as in the PHI Act.
HRIB stress %
This is the health-related insurance business stress, as a percentage, determined in accordance with HPS 115.
I
Individual other insurance liability at 75th POA amount
This is the value of each other insurance liability, as defined by HPS340.
Individual other insurance liability at 99.5th POA amount
This is the value of each other insurance liability, as defined by HPS340, valued at a 99.5 per cent level of sufficiency, in accordance with HPS 115.
Individual other insurance liability description
This is the name of the each other insurance liability as defined by HPS340. This name will be used to identify the liability and should reflect its nature and the reason the liability has arisen.
Insurance Liability Risk Charge
This is a derived item and is calculated as the sum of:OCL Risk Charge;PL Risk Charge;RE Risk Charge; andOther Insurance Liabilities Risk Charge.
Insurance profits forecast after management actions amount
This is the private health insurer’s estimate of insurance profits forecast after management actions amount. This will be deducted from the sum of net margin (MA) amount. This reflects the constraint outlined in HPS 115, that any insurance profits forecast after management actions cannot offset prior losses.The insurance profit offset to be reported is to be determined as:Where:A equals The sum of net margin (MA) amount for the months including and after management actions take effect.Insurance profits forecast after management actions amount is to be reported separately for HIB and HRIB.
Insurance Risk Charge
This is a derived item and is calculated as the sum of:Insurance Liability Risk Charge;Future Exposure Risk Charge; andDCL Risk Charge
M
Management expenses
This refers to the relevant forecast of management expenses as defined in HPS 001.
Management expenses (AES) amount
This is the forecast management expenses after the Adverse Event Stress, as defined in HPS 115, for that month.
Management expenses (CE) amount
This is the central estimate forecast of management expenses for that month.
Management expenses (MA) amount
The insurer is required to report this item for months 10, 11 and 12 only. This is to be determined by adjusting management expenses (pre-MA) amount for management Actions as defined in HPS 115.Management expenses (MA) must only reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer’s expectations and not be limited to the extent that these result in an insurance profit. This constraint will be applied separately in insurance profits forecast after management actions amount.For months 1 to 9 inclusive, this is a derived item and is equal to management expenses (pre-MA) amount.
Management expenses (pre-MA) amount
This is a derived item, which provides an approximation of management expenses, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115. This derived item provides a basis from which management actions can be taken in determining management expenses (MA) amount.For HIB, it is calculated as:where:A equals Management expenses (AES) amountB equals HIB stress %For HRIB, it is calculated as:where:A equals Management expenses (CE) amountB equals HRIB stress %
N
Net margin (AES) amount
This is a derived item. It is calculated as:gross margin (AES) amountless:management expenses (AES) amount.
Net margin (CE) amount
This is a derived item. It is calculated as:gross margin (CE) amountless:management expenses (CE) amount,
Net margin (MA) amount
This is a derived item. It is calculated as:gross margin (MA) amountless:management expenses (MA) amount.
Non-reinsurance recoveries - OCL amount
This includes the value of recoveries under arrangements, other than reinsurance and risk equalisation arrangements, receivable by the health benefits fund or general fund associated with the OCL, net of any provisions for depreciation or impairment. It is determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on OCL amount.
Non-reinsurance recoveries - PL amount
This includes the value of recoveries under arrangements, other than reinsurance arrangements, receivable by the health benefits fund or general fund associated with the PL, gross of any provisions for depreciation or impairment. It is determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on PL amount.
O
OCL at 75th probability of adequacy
This is a derived item and is calculated as the sum of:central estimate of OCL; andrisk margin at 75th probability of adequacy - OCL amount.
OCL Risk Charge
This is a derived item and is the Insurance Liability Risk Charge in respect of outstanding claims risk, which relates to the risk that the value of OCL is greater than the value determined in accordance with HPS 340. It is calculated as: (OCL at 75th probability of adequacy minus settled but not paid claims - OCL amount) multiplied by outstanding claims risk size margin, as defined by HPS 115.
Other Insurance Liabilities Risk Charge
This is a derived item and is the Insurance Liability Risk Charge in respect of other insurance liabilities, which relates to the risk that the value of other insurance liabilities is less than the value determined in accordance with HPS 340. It is the sum of each individual other insurance liability at 99.5th POA minus the sum of each individual other insurance liability at 75th POA.
P
PL at 75th probability of adequacy
This is a derived item and is calculated as the sum of:central estimate of PL; andrisk margin at 75th probability of adequacy - PL amount.
PL Risk Charge
This is a derived item and is the Insurance Liability Risk Charge in respect of premiums liabilities risk, which relates to the risk that the value of PL is greater than the value determined in accordance with HPS 340.For HIB, this is calculated as PL at 75th probability of adequacy for HIB multiplied by HIB stress %.For HRIB, this is calculated as PL at 75th probability of adequacy for HRIB multiplied by HRIB stress %.The PL Risk Charge is the sum of HIB and HRIB.
Policy administration expenses - PL amount
This is the value, as at the relevant date, of the policy administration expenses associated with those claims included within the central estimate of PL determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on PL amount.
Private health insurer business type
This is either health insurance business or health-related insurance business.
Private health insurer fund type
This is either a health benefits fund or general fund.
R
RE Risk Charge
This is a derived item and is the Insurance Liability Risk Charge in respect of risk equalisation, which relates to the risk that the value of risk equalisation transfers are less favourable than the value determined in accordance with HPS 340. It is calculated as unbilled calculated deficit amount multiplied by the risk equalisation charge factor of 4%, as set out in HPS 115.
Reinsurance recoverables - OCL amount
This is the value of reinsurance recoverables, being amounts due to the health benefits fund or general fund under a reinsurance arrangement, that arise from the recognition of the central estimate of the OCL. The value must be reported net of any provisions for doubtful debts and in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on OCL amount.
Risk equalisation component - OCL amount
This is the value, as at the relevant date, of any amount estimated to be payable or receivable under the Risk Equalisation Special Account arising from claims incurred and included within the central estimate of OCL determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on OCL amount.
Risk equalisation component - PL amount
This is the value, as at the relevant date, of any amount estimated to be payable or receivable under the Risk Equalisation Special Account arising from claims included within the central estimate of PL determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on PL amount.
Risk margin at 75th POA - OCL amount
This is the value, as at the relevant date, of the risk margin component of OCL, net of recoveries, determined in accordance with HPS 340. The risk margin is that which has been applied to the Outstanding Claims Liabilities for HIB and HRIB, and may include diversification across the insurance portfolio within the health benefits fund or general fund.
Risk margin at 75th POA - PL amount
This is the value, as at the relevant date, of the risk margin component of PL, net of recoveries, determined in accordance with HPS 340. The risk margin is that which has been applied to the Premium Liabilities for HIB and HRIB, and may include diversification across the insurance portfolio within the health benefits fund or general fund.
Risk margin at 75th POA – risk equalisation transfers amount
This is the value, as at the relevant date, of the risk margin component of risk equalisation transfers, determined in accordance with HPS 340.
S
Settled but not paid claims - OCL amount
This is the value, as at the relevant date, of unpaid claims amounts where the value has been determined. This includes claims that have been settled but not paid and included within the central estimate of OCL determined in accordance with HPS 340. These items should be disclosed as OCL instead of current liabilities or trade creditors. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on OCL amount.
Single Equivalent Units (AES) count
This is the value of forecast Single Equivalent Units after the Adverse Event Stress, as defined in HPS 115, for that month.
Single Equivalent Units (CE) count
This is the central estimate forecast of Single Equivalent Units for that month.
Single Equivalent Units (fund) count
This is the value, at the health insurance business membership reporting period, of the SEUs for the health benefits fund.The value of SEUs should be consistent with that calculated from the relevant HRS 601 return.
Single Equivalent Units (MA) count
The is to be reported for months 10, 11 and 12 only. This is to be determined by adjusting Single Equivalent Units (AES) count for management actions as defined in HPS 115.Single Equivalent Units (MA) must only reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer’s expectations and not be limited to the extent that these result in an insurance profit. This constraint will be applied separately in insurance profits forecast after management actions amount.For months 1 to 9 inclusive this is a derived item and is equal to Single Equivalent Units (AES) count.
Single equivalent units (SEUs)
This refers to the relevant forecast of Single Equivalent Units as defined in HPS 001.
Single Equivalent Units (transferor funds) count
This is the value, at the health insurance business membership reporting period, of the SEUs for all health benefits funds which have since transferred into the health benefits fund.That is, where another health benefits fund/s has been transferred into this health benefits fund, the Single Equivalent Units (transferor funds) count is the total SEUs from all transferor health benefits funds at the relevant period. This may include from before the transfer took place.For example, where fund A has been transferred into the reporting health benefits fund by the end of the reporting period, the SEUs of fund A should be reported for previous health insurance business membership reporting periods.For periods after the transfer has occurred, the value for the transferor/s Single Equivalent Units (transferor funds) count is to be reported as zero.
State levies
State levies are all state ambulance levies payable by the health benefits fund.
State levies (AES) amount
This is the forecast of state levies after the Adverse Event Stress, as defined in HPS 115, for that month.
State levies (CE) amount
This is the central estimate forecast of state levies for that month.
State levies (MA) amount
The insurer is required to report this item for months 10, 11 and 12 only. This is to be determined by adjusting the state levies amount for management actions as defined in HPS 115.State levies (MA) amount must only reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer’s expectations and not be limited to the extent that these result in an insurance profit. This constraint will be applied separately in insurance profits forecast after management actions amount.For months 1 to 9 inclusive this is a derived item and is equal to state levies (pre-MA) amount.
State levies (pre-MA) amount
This is a derived item, which provides an approximation of state levies, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115. This derived item provides a basis from which management actions can be taken in determining state levies (MA) amount.State levies (pre-MA) amount is calculated as:Where:A equals State Levies (AES) amountB equals HIB stress %
U
Unbilled calculated deficit amount
Unbilled calculated deficit means the central estimate of the total amount that would have been payable by the insurer should each SEU been entitled to the average amount as defined in rule 11(1)(e) of the Private Health Insurance (Risk Equalisation Policy) Rules 2015 or its replacement, and under the following conditions:over the period up to the reporting date;where the risk equalisation levy has accrued but has not yet been paid; andwhere an invoice, notice or receipt from APRA has not yet been received by the private health insurer, for that period.
Unbilled gross deficit amount
Unbilled gross deficit means the sum of the eligible benefits notionally allocated to the aged-based pool and the high cost claimants pool, calculated for each risk equalisation jurisdiction, in accordance with Part 2, rule 11(1)(a) of the Private Health Insurance (Risk Equalisation Policy) Rules 2015 and under the following conditions:over the period up to the reporting date;where the risk equalisation levy has accrued but has not yet been paid; andwhere an invoice, notice or receipt from APRA has not yet been received by the private health insurer, for that period.
Reporting tables
Reporting tables
Reporting tables
Tables 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.
Any specific combination of values in a table must not appear on more than one row in that table when reported.
More sections below
Source text: opening excerpt
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
Reporting Standard HRS 115.0 Reporting Standard HRS 115.0
Reporting Standard HRS 115.0
Insurance Risk Charge
Objective of this Reporting Standard
This Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s insurance risk charge.
It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 115 Capital Adequacy: Insurance Risk Charge (HPS 115) and Prudential Standard HPS 340 Insurance Liability Valuation (HPS 340).
Authority
This Reporting Standard is made under section 13 of the Financial Sector (Collection of Data) Act 2001.
Purpose
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.
Application and commencement
This Reporting Standard applies to all private health insurers. This Reporting Standard applies for reporting periods ending on or after 1 July 2023.
Information required
A private health insurer must provide APRA with the information required by this Reporting Standard for each reporting period.
Method of submission
The information required by this Reporting Standard must be given to APRA:
(a) in electronic format using an electronic method available on APRA’s website; or
(b) by a method notified by APRA prior to submission.
Reporting periods and due dates
Subject to paragraph 7, a private health insurer must provide the information required by this Reporting Standard:
(a) in respect of each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June); and
(b) in respect of each year ending 30 June.
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.
The information required by this Reporting Standard must be provided to APRA:
(a) in the case of quarterly information, within 28 calendar days after the end of the reporting period to which the information relates;
(b) in the case of annual information, by 30 September each year; or
(c) in the case of information provided in accordance with paragraph 7, within the time specified by notice in writing.
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.
Note: 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.
Quality control
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.
Annual audit requirements
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.
Audit certification and opinion must be provided to APRA by 30 September each year.
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 year previous to the year for which the report is provided, the report for the year for which the report is provided 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.
The auditor’s report must:
(a) state details of the program adopted to carry out the audit; and
(b) include the name of, and be signed by, the auditor who takes responsibility for the accuracy of the report.
Authorisation
A person who submits the information required under this Reporting Standard must be suitably authorised by an officer of the private health insurer.
Variations
APRA may, in writing, vary the reporting requirements of this Reporting Standard in relation to a private health insurer.
Interpretation
In this Reporting Standard:
(a) unless the contrary intention appears, words and expressions have the meanings given to them in Prudential Standard HPS 001 Definitions (HPS 001); and
(b) the following definitions are applicable:
APRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998;
capital standards means the prudential standards which relate to capital adequacy, as defined in HPS 001;
officer has the same meaning as in the Act;
private health insurer has the same meaning as in the Act;
reporting period means a period mentioned in paragraph 6 or, if applicable, paragraph 7; and
the Act means the Private Health Insurance (Prudential Supervision) Act 2015.
18. 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.
Insurance Risk Charge Insurance Risk Charge
Reporting Standard HRS 115.0
Insurance Risk Charge
Objective of this Reporting Standard
This Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s insurance risk charge.
It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 115 Capital Adequacy: Insurance Risk Charge (HPS 115) and Prudential Standard HPS 340 Insurance Liability Valuation (HPS 340).
Authority
This Reporting Standard is made under section 13 of the Financial Sector (Collection of Data) Act 2001.
Purpose
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.
Application and commencement
This Reporting Standard applies to all private health insurers. This Reporting Standard applies for reporting periods ending on or after 1 July 2023.
Information required
A private health insurer must provide APRA with the information required by this Reporting Standard for each reporting period.
Method of submission
The information required by this Reporting Standard must be given to APRA:
(a) in electronic format using an electronic method available on APRA’s website; or
(b) by a method notified by APRA prior to submission.
Reporting periods and due dates
Subject to paragraph 7, a private health insurer must provide the information required by this Reporting Standard:
(a) in respect of each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June); and
(b) in respect of each year ending 30 June.
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.
The information required by this Reporting Standard must be provided to APRA:
(a) in the case of quarterly information, within 28 calendar days after the end of the reporting period to which the information relates;
(b) in the case of annual information, by 30 September each year; or
(c) in the case of information provided in accordance with paragraph 7, within the time specified by notice in writing.
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.
Note: 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.
Quality control
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.
Annual audit requirements
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.
Audit certification and opinion must be provided to APRA by 30 September each year.
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 year previous to the year for which the report is provided, the report for the year for which the report is provided 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.
The auditor’s report must:
(a) state details of the program adopted to carry out the audit; and
(b) include the name of, and be signed by, the auditor who takes responsibility for the accuracy of the report.
Authorisation
A person who submits the information required under this Reporting Standard must be suitably authorised by an officer of the private health insurer.
Variations
APRA may, in writing, vary the reporting requirements of this Reporting Standard in relation to a private health insurer.
Interpretation
In this Reporting Standard:
(a) unless the contrary intention appears, words and expressions have the meanings given to them in Prudential Standard HPS 001 Definitions (HPS 001); and
(b) the following definitions are applicable:
APRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998;
capital standards means the prudential standards which relate to capital adequacy, as defined in HPS 001;
officer has the same meaning as in the Act;
private health insurer has the same meaning as in the Act;
reporting period means a period mentioned in paragraph 6 or, if applicable, paragraph 7; and
the Act means the Private Health Insurance (Prudential Supervision) Act 2015.
18. 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.
Objective of this Reporting Standard Objective of this Reporting Standard
Objective of this Reporting Standard
This Reporting Standard sets out requirements for the provision of information to APRA relating to a private health insurer’s insurance risk charge.
It includes associated specific instructions and must be read in conjunction with Prudential Standard HPS 115 Capital Adequacy: Insurance Risk Charge (HPS 115) and Prudential Standard HPS 340 Insurance Liability Valuation (HPS 340).
Authority Authority
Authority
This Reporting Standard is made under section 13 of the Financial Sector (Collection of Data) Act 2001.
Purpose Purpose
Purpose
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.
Application and commencement Application and commencement
Application and commencement
This Reporting Standard applies to all private health insurers. This Reporting Standard applies for reporting periods ending on or after 1 July 2023.
Information required Information required
Information required
A private health insurer must provide APRA with the information required by this Reporting Standard for each reporting period.
Method of submission Method of submission
Method of submission
The information required by this Reporting Standard must be given to APRA:
(a) in electronic format using an electronic method available on APRA’s website; or
(b) by a method notified by APRA prior to submission.
Reporting periods and due dates Reporting periods and due dates
Reporting periods and due dates
Subject to paragraph 7, a private health insurer must provide the information required by this Reporting Standard:
(a) in respect of each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June); and
(b) in respect of each year ending 30 June.
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.
The information required by this Reporting Standard must be provided to APRA:
(a) in the case of quarterly information, within 28 calendar days after the end of the reporting period to which the information relates;
(b) in the case of annual information, by 30 September each year; or
(c) in the case of information provided in accordance with paragraph 7, within the time specified by notice in writing.
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.
Note: 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.
Quality control Quality control
Quality control
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.
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.
Audit certification and opinion must be provided to APRA by 30 September each year.
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 year previous to the year for which the repor
This is an opening excerpt, not the complete document.