Commonwealth Coat of Arms of Australia

Reporting Standard HRS 104.0

Forecasts and Targets

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 forecasts and targets.

It includes associated specific instructions and should be read in conjunction with Prudential Standard HPS 110 Capital Adequacy (HPS 110).

Authority

1. This Reporting Standard is made under section 13 of the Financial Sector (Collection of Data) Act 2001.

Purpose

2. 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

3. This Reporting Standard applies to all private health insurers. This Reporting Standard applies for reporting periods ending on or after:

(a) 1 July 2023 for significant financial institutions and any private health insurer that is classified as a non-significant financial institution but is subject to an APRA determination under paragraph 53(b) of HPS 110; and

(b) 1 July 2025 for all private health insurers that are classified as a non-significant financial institution and are not subject to an APRA determination under paragraph 53(b) of HPS 110.

Information required

4. A private health insurer must provide APRA with the information required by this Reporting Standard for each reporting period.

Method of submission

5. 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

6. Subject to paragraph 7, a private health insurer must provide the information required by this Reporting Standard in respect of each year ending 30 June.

7. 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 paragraph 6, APRA may, by notice in writing, change the reporting periods, or specify reporting periods, for the particular private health insurer.

8. The information required by this Reporting Standard must be provided to APRA:

(a) in the case of annual information, by 30 September each year; or

(b) in the case of information provided in accordance with paragraph 7, within the time specified by notice in writing.

9. 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

10. 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

11. The information submitted for the purposes of paragraph 8(a) 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.

12. Audit certification and opinion must be provided to by 30 September each year.

13. 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.

14. 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

15. A person who submits the information required under this Reporting Standard must be suitably authorised by an officer of the private health insurer.

Variations

16. APRA may, in writing, vary the reporting requirements of this Reporting Standard in relation to a private health insurer.

Interpretation

17. In this Reporting Standard:

(a) unless the contrary intention appears, words and expressions have the meanings given to them in 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;

non-significant financial institution has the same meaning as 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;

significant financial institution has the same meaning as in HPS 001; 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.