Licensing guidelines for private health insurers

Make sure you read APRA’s Licensing Process in conjunction with the information on this page.

Who needs a private health insurance licence?

Under the Private Health Insurance (Prudential Supervision) Act 2015 (the PHIPS Act), a person must not provide health insurance unless they are registered to do so. If your business intends to conduct any business that can be classed as health insurance business, you need a licence from APRA registering you to conduct health insurance business in Australia.

Health insurance business is defined in sub-section 121-1 of the Private Health Insurance Act 2007 as business that consists of undertaking liability by way of insurance, or an employee health benefit scheme, that relates to hospital or general treatment. There are some exclusions, such as accident and sickness business, as this is covered under the Insurance Act 1973.

The PHIPS Act only allows corporations to carry out health insurance business in Australia, which means APRA cannot consider applications from partnerships or unincorporated entities.

Application guidelines

Information on APRA’s licensing process, including how and when to contact APRA, is available here.

For more information on the licensing of private health insurers see the ‘Instruction Guide – registration as a private health insurer’. The guide outlines APRA’s registration process for private health insurers, including the minimum criteria to be addressed by applicants and the necessary information and documents to be lodged with an application.

Before you lodge your application for a private health insurer licence, ensure you have read and are familiar with the prudential framework for private health insurers, including relevant legislation, APRA rules, prudential standards and prudential practice guides. You can find all of this information on private health insurance supervision page.

Application form

The applicable approved form should be completed and lodged with APRA with the required supporting information and applicable additional attachments. The form must be lodged with APRA at least 90 days before the date specified in the application as the day on which the applicant proposes to become registered as a private health insurer.

Additional attachments for private health application form:

Change of details

Where an application has been lodged with APRA and changes have been made to the composition of the board before APRA has ruled on the application, you must notify APRA on the changes using the above additional attachments to the approved form.