Consultation Paper on Private Health Insurance (PHI) Default Benefit Arrangements

Closed 23 Sep 2022

Opened 12 Aug 2022


Informing the Private Health Insurance Default Benefits Arrangement study

Ernst & Young (EY) has been contracted by the Department of Health and Aged Care (the Department) to undertake a study of private health insurance (PHI) default benefit arrangements (the PHI default benefits).

PHI default benefits include ‘minimum’ and ‘second-tier default’ benefits, both of which are defined in the Private Health Insurance (Benefit Requirements) Rules 2011 and are regulated by the Commonwealth. They are paid by health insurers to eligible hospitals for the treatment of privately-insured inpatients in specific circumstances where there is not an agreed contract in place between the health insurer and the hospital.

An aim of PHI default benefits is that they support improvements in accessibility and efficiency of privately insured hospital services for healthcare consumers.

This Consultation Paper (as below) has been prepared by EY to inform the study, which includes consideration of potential reform options for PHI default benefits and how can they influence contracting arrangements between hospitals and health insurers.

The study is scheduled for finalisation by the end of 2022.

Why your views matter

The purpose of this consultation paper is to seek stakeholder and community feedback on:

1.            The current state of minimum and second-tier default benefits

2.            Potential reform options.

The diverse perspectives, experiences and knowledge of all stakeholders and interested members of the community are valued and respected and will contribute to the study.

How to respond

The Consultation Paper (including associated questions) can be found under the 'Give us your views' heading below.

Please submit your response via email to by close-of-business, Friday 23 September 2022.

When responding, please indicate whether you are contributing to the consultation process as a healthcare adviser, healthcare provider, representative body, business representative, member of the public, or in any other capacity

What happens next

The feedback received as part of this consultation process will contribute to a study report including reform options. The study is scheduled for finalisation by the end of 2022.


  • Anyone from any background


  • Hospitals
  • e-Health
  • Health technology
  • Medicare
  • Legislation
  • Pharmaceutical benefits
  • Health insurance
  • Rural health services
  • Regulatory policy
  • Women's health
  • Children's health
  • Learning and development
  • Management review
  • Administration
  • Capability
  • Information Technology
  • Strategic Policy
  • Policy Development