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Prudential and Reporting Standards for Private health insurance

Capital

  • 100

    Solvency Standard

    HPS
    100
    Prudential Standards (1)
    In Force
    In effect from 26 June 2015
    The purpose of this Prudential Standard is to ensure as far as practicable that at any time the financial position of a health benefits fund conducted by a private health insurer is such that the private health insurer will be able to meet, out of the fund’s assets, all liabilities that are referrable to the fund, as those liabilities become due. This Prudential Standard requires the private health insurer to demonstrate that it will be able to meet the liabilities of its health benefits fund, allowing for adverse circumstances.
  • 110

    Capital Adequacy

    HPS
    110
    Prudential Standards (1)
    In Force
    In effect from 26 June 2015
    The purpose of this Prudential Standard is to ensure, as far as practicable, that there are sufficient assets in a health benefits fund conducted by a private health insurer to provide adequate capital for the conduct of the health benefits fund in accordance with the Act and in the interests of the policy holders of the fund. This Prudential Standard requires the private health insurer to demonstrate that the assets of its health benefits fund will be able to meet the liabilities of the fund after a 12 month period, allowing for the future business plans of the fund and adverse circumstances.

Financial statements

Governance

  • 310

    Audit and related matters

    HPS
    310
    Prudential Standards (1)
    In Force
    In effect from 1 July 2019
    This Prudential Standard establishes requirements for the provision, to the Board and senior management of a private health insurer, of independent advice in relation to the operations, financial position and risk controls of the business operations of the private health insurer. This independent advice is designed to assist the Board and senior management in carrying out their responsibilities for the sound and prudent management of the business operations of the private health insurer.
  • 320

    Actuarial and Related Matters

    CPS
    320
    CPG
    320
    Prudential Standards (1)
    In Force
    In effect from 1 July 2019
    This Prudential Standard aims to ensure that a general insurer, life company or private health insurer has access to appropriate actuarial advice to assist in the sound and prudent operation of its business. It sets out the requirements for insurers to appoint an Appointed Actuary and to establish a framework for the provision of actuarial advice. It also sets out the functions of the Appointed Actuary role.
    Guidance (1)
    Current
    In effect from 1 July 2019
    This prudential practice guide was developed to support insurers and actuaries in fulfilling their responsibilities to comply with the requirements contained in CPS 320. Not all practices outlined in this guide will be relevant for every insurer, and some aspects may vary depending upon the size, business mix and complexity of the insurer’s business operations.  |  File type: PDF  |  File size: 503.62 KB
  • 510

    Governance

    CPS
    510
    Prudential Standards (1)
    In Force
    Governance
    This Prudential Standard sets out minimum foundations for good governance of an APRA-regulated institution in the deposit-taking, general insurance, life insurance and private health insurance industries, and of a Head of a group. Its objective is to ensure that an institution and group is managed soundly and prudently by a competent Board (or equivalent), which can make reasonable and impartial business judgements in the best interests of the institution and group and which duly considers the impact of its decisions on depositors and/or policyholders.
    Related resources (1)
  • 510

    Governance

    HPG
    510
    Guidance (1)
    Current
    July 2019
    Prudential Standard CPS 510 Governance (CPS 510) sets out APRA’s requirements in relation to the governance of authorised deposit takers, general insurers, life companies, private health insurers, and Level 2 and Level 3 groups, collectively referred to as regulated institutions. This PPG aims to assist regulated institutions to comply with those requirements and, more generally, to outline prudent practices in relation to certain governance matters.   |  File type: PDF  |  File size: 234.94 KB
  • 520

    Fit and Proper

    CPS
    520
    CRF
    520
    Prudential Standards (1)
    In Force
    In effect from 1 July 2019
    This Prudential Standard sets out minimum requirements for APRA-regulated institutions in determining the fitness and propriety of individuals to hold positions of responsibility. Its objective is to ensure that an institution prudently manages the risks that persons acting in responsible person positions who are not fit and proper pose to the institution’s business and financial standing.
    Guidance (0)
    Reporting Forms (1)
    In Force
    May 2013
    In order to assist entities in complying with the requirement to ensure that information provided to APRA remains correct for all responsible persons, the form can be submitted at any time, however it will be provided on an annual basis to all entities submitting annual returns via D2A. Entities can use the annual form to correct and update the information they have provided to APRA throughout the year.  |  File type: PDF  |  File size: 130.35 KB
  • 520

    Fit and Proper

    HPG
    520
    HRF
    520.0
    Guidance (1)
    Current
    July 2019
    Prudential Standard CPS 520 Fit and Proper (CPS 520) sets out APRA’s requirements in relation to assessing the fitness and propriety of responsible persons of authorised deposit taking institutions, general insurers, life companies and private health insurers, collectively referred to as APRA-regulated institutions. This PPG aims to assist private health insurers in complying with those requirements and, more generally, to outline prudent practices in relation to fitness and propriety.  |  File type: PDF  |  File size: 243.64 KB
    Reporting Forms (1)
    Current
    September 2019
    Responsible Persons - Changes to the responsible persons (CEO, directors, senior managers, Appointed Actuary or Appointed Auditor) of the Insurer should be submitted using this form.  |  File type: PDF  |  File size: 117.99 KB

Other requirements

  • 001

    Definitions

    HPS
    1
    Prudential Standards (1)
    In Force
    In effect from 1 July 2019
    This Prudential Standard defines key terms referred to in other prudential standards which are applicable to private health insurers. All prudential standards applicable to private health insurers must be read in conjunction with this Prudential Standard.
    Reporting Standards (0)
    Reporting Forms (0)
  • 350

    Disclosure to APRA

    HPS
    350
    Prudential Standards (1)
    Not in force
    In effect until 14 September 2018
    This Prudential Standard sets out minimum requirements for circumstances where a private health insurer must make disclosures to APRA.

Risk management

  • 220

    Risk Management

    CPS
    220
    CPG
    220
    Prudential Standards (1)
    In Force
    In effect from 1 July 2019
    This Prudential Standard requires an APRA-regulated institution and a Head of a group to have systems for identifying, measuring, evaluating, monitoring, reporting, and controlling or mitigating material risks that may affect its ability, or the ability of the group it heads, to meet its obligations to depositors and/or policyholders. These systems, together with the structures, policies, processes and people supporting them, comprise an institution’s or group’s risk management framework.
    Guidance (1)
    Current
    April 2018
    This PPG aims to assist APRA-regulated institutions in complying with Prudential Standard CPS 220 Risk Management (CPS 220) and, more generally, to outline prudent practices in relation to risk management.  |  File type: PDF  |  File size: 675.49 KB
  • 231

    Outsourcing

    HPS
    231
    Prudential Standards (1)
    In Force
    In effect from 26 June 2015
    This Prudential Standard sets out minimum requirements for outsourcing of a private health insurer’s business activities.
    Related resources (1)
  • 234

    Information Security

    CPS
    234
    CPG
    234
    Prudential Standards (1)
    In Force
    In effect from 1 July 2019
    This Prudential Standard aims to ensure that an APRA-regulated entity takes measures to be resilient against information security incidents (including cyber-attacks) by maintaining an information security capability commensurate with information security vulnerabilities and threats.
    Guidance (1)
    Current
    June 2019
    This PPG aims to assist regulated entities in maintaining information security. It is designed to provide guidance to Boards, senior management, risk management and information security specialists (management and operational).  |  File type: PDF  |  File size: 837.05 KB
    Related resources (2)