Source: https://www.legislation.gov.au/Details/F2016L01394
Timestamp: 2020-07-03 09:14:49
Document Index: 416237195

Matched Legal Cases: ['art 1', 'art 2', 'art 3', 'art 4', 'art 5', 'art 6', 'art 7', 'art 8', 'art 9', 'art 10']

Financial Sector (Collection of Data) (reporting standard) determination No. 22 of 2016 - HRS 601.0 Statistical Data by State
Details: F2016L01394
- F2016L01394
No. 22 of 2016 Determinations/Financial (Other) as made
This instrument determines Reporting Standard HRS 601.0 Statistical Data by State.
F2016L01394
Financial Sector (Collection of Data) (reporting standard) determination No. 22 of 2016
Reporting Standard HRS 601.0 Statistical Data by State
I, Steven John Davies, delegate of APRA, under paragraph 13(1)(a) of the Financial Sector (Collection of Data) Act 2001 (the Act) and subsection 33(3) of the Acts Interpretation Act 1901
· REVOKE Financial Sector (Collection of Data) (reporting standard) determination No. 31 of 2015, including Reporting Standard HRS 601.0 Statistical Data by State made under that Determination; and
· DETERMINE Reporting Standard HRS 601.0 Statistical Data by State, in the form set out in the Schedule, which applies to the financial sector entities to the extent provided in paragraph 3 of the reporting standard.
Under section 15 of the Act, I DECLARE that the reporting standard shall begin to apply to those financial sector entities, and the revoked reporting standard shall cease to apply, on the date of registration on the Federal Register of Legislation.
Reporting Standard HRS 601.0 Statistical Data by State comprises the 74 pages commencing on the following page.
Reporting Standard HRS 601.0
Statistical Data by State
This Reporting Standard sets out the requirements for the provision of information to APRA allowing for the calculation of the risk equalisation special account and calculation of levies in respect of private health insurers, administered by APRA.
It includes Form HRF 601.1 Statistical Data – Cover Page, Form HRF 601.1 Statistical Data - by State and associated specific instructions.
2. Information collected under this Reporting Standard, as set out in Form HRF 601.1 Statistical Data - by State, is used by APRA for prudential supervision, risk equalisation purposes and for publication.
3. This Reporting Standard applies to all private health insurers.
4. This Reporting Standard applies for reporting periods ending on or after
5. A private health insurer must provide APRA with the information required by Form HRF 601.1 Statistical Data - by State in respect of each reporting period.
6. The information required by this Reporting Standard must be provided for:
(a) each health benefits fund of the private health insurer; and
(b) in relation to Form HRF 601.1 Statistical Data - by State, each risk equalisation jurisdiction of the health benefits fund[1].
7. The information required by this Reporting Standard must be lodged as electronic data via a D2A Form, or an alternate method notified by APRA, in writing, prior to submission.
8. A private health insurer to which this Reporting Standard applies must provide the information required by this Reporting Standard for each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June).
9. The information required by this Reporting Standard must be provided to APRA within 28 calendar days after the end of the reporting period to which the information relates.[2]
10. APRA may, in writing, grant a private health insurer an extension of a due date, in which case the new due date for the provision of the information will be the date on the notice of extension.
11. 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.
12. By 30 September each year, a private health insurer must give to APRA an auditor’s report relating to:
(a) the information provided by the private health insurer under this Reporting Standard for each quarter in the year ending 30 June of that year; or
(b) if the private health insurer provides an amended quarterly return to replace a return referred to in paragraph (a) — the amended quarterly return.
13. The auditor providing the report to a private health insurer must not be an Officer of, or employed by, the private health insurer.
14. For the purposes of paragraph 12, the auditor’s report must be addressed to APRA and must set out the auditor’s opinion as to whether:
(a) the records for the health benefits fund contain the information required to be kept by this Reporting Standard and the Private Health Insurance Risk Equalisation (Administration) Rules 2015;
(b) the submitted information for the purposes of this Reporting Standard, accurately reflects the information contained in the records of the health benefits fund; and
(c) the records of the health benefits fund have been accurately compiled so as to permit the private health insurer to fairly state the information required by this Reporting Standard.
15. If a private health insurer received a qualified auditor’s report for a health benefits fund 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.
16. 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.
17. A person who submits the information required under this Reporting Standard must be suitably authorised by an officer of the private health insurer.
18. APRA may, in writing, vary the reporting requirements of this Reporting Standard in relation to a private health insurer.
19. Any approval, determination or other exercise of discretion, made prior to the commencement of this reporting standard by:
(a) PHIAC in relation to the PHIAC 1 return; or
(b) APRA in relation to Reporting Standard HRS 601.0 Statistical Data by State made on 26 June 2015
will continue to have effect after the commencement of this reporting standard, as if made under this reporting standard, until revoked by APRA.
20. Information that would have been required to be submitted to PHIAC on the PHIAC 1 return in respect of the quarter ending 30 June 2015 must instead be submitted to APRA as though it was required under this Reporting Standard.
21. Information that had previously been required to be submitted to PHIAC on the PHIAC 1 return relating to a period ending before 30 June 2015, but which had not been submitted to PHIAC by the end of 30 June 2015, must be submitted to APRA.
22. If, at the end of 30 June 2015, a private health insurer was under an obligation to submit an amended quarterly return, to replace a quarterly return that the private health insurer submitted to PHIAC prior to 1 July 2015, the private health insurer must submit the amended quarterly return to APRA as soon as practicable.
23. If APRA, acting reasonably, is satisfied that information submitted by a private health insurer to PHIAC on the PHIAC 1 return prior to 1 July 2015 is inaccurate, APRA may, by notifying the private health insurer in writing of the basis of APRA’s concern, require resubmission of that information in a way that corrects the inaccuracy.
24. 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) APRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998;
officer has the meaning in the Private Health Insurance (Prudential Supervision) Act 2015;
PHIAC means the Private Health Insurance Administration Council continued in existence under subsection 264-1(1) of the Private Health Insurance Act 2007, as it existed immediately prior to the commencement of the Private Health Insurance (Prudential Supervision) Act 2015;
PHIAC 1 return means the form titled PHIAC 1 return issued under Division 310 of the Private Health Insurance Act 2007, as it existed immediately prior to the commencement of the Private Health Insurance (Prudential Supervision) Act 2015;
PHIAC Extranet was an environment (based on SharePoint) used for secure (user ID and password required) sharing of documents via the internet;
Private Health Insurance (Health Insurance Business) Rules 2016 means the Private Health Insurance (Health Insurance Business) Rules 2016 dated 31 March 2016 or any Private Health Insurance (Health Insurance Business) Rules subsequently made by the Minister under section 333-20 of the Private Health Insurance Act 2007;
Private Health Insurance (Prostheses) Rules 2016 (No. 2) means the Private Health Insurance (Prostheses) Rules 2016 (No. 2) dated 23 March 2016 or any Private Health Insurance (Prostheses) Rules subsequently made by the Minister under section 333-20 of the Private Health Insurance Act 2007;
private health insurer has the meaning in the Private Health Insurance (Prudential Supervision) Act 2015;
reporting period means a period mentioned in paragraph 8;
risk equalisation jurisdiction means the risk equalisation jurisdiction as defined in the Private Health Insurance (Prudential Supervision) Act 2015; and
risk equalisation special account means the risk equalisation special account as defined in the Private Health Insurance (Prudential Supervision) Act 2015.
HRF_601_1: Statistical Data - by State
Whole dollars to two decimal places
Part 1 Policies and insured persons
2+ persons no adults
1. Total hospital treatment (includes hospital treatment only and hospital treatment and general treatment combined)
1.1. Policies
1.1.1. Exclusionary policies
1.1.1.1. Excess & co-payments
1.1.1.2. No excess & no co-payments
1.1.1.3. Total exclusionary policies
1.1.2. Non-exclusionary policies
1.1.2.1. Excess & co-payments
1.1.2.2. No excess & no co-payments
1.1.2.3. Total non-exclusionary policies
1.2. Total policies
1.3. Insured persons
1.3.1. Exclusionary policies
1.3.1.1. Excess & co-payments
1.3.1.2. No excess & no co-payments
1.3.1.3. Total exclusionary policies
1.3.2. Non-exclusionary policies
1.3.2.1. Excess & co-payments
1.3.2.2. No excess & no co-payments
1.3.2.3. Total non-exclusionary policies
1.4. Total insured persons
2. Hospital treatment only
2.1. Policies
2.1.1. Exclusionary policies
2.1.1.1. Excess & co-payments
2.1.1.2. No excess & no co-payments
2.1.1.3. Total exclusionary policies
2.1.2. Non-exclusionary policies
2.1.2.1. Excess & co-payments
2.1.2.2. No excess & no co-payments
2.1.2.3. Total non-exclusionary policies
2.2. Total policies
2.3. Insured persons
2.3.1. Exclusionary policies
2.3.1.1. Excess & co-payments
2.3.1.2. No excess & no co-payments
2.3.1.3. Total exclusionary policies
2.3.2. Non-exclusionary policies
2.3.2.1. Excess & co-payments
2.3.2.2. No excess & no co-payments
2.3.2.3. Total non-exclusionary policies
2.4. Total insured persons
3. Hospital treatment and general treatment combined
3.1. Policies
3.1.1. Exclusionary policies
3.1.1.1. Excess & co-payments
3.1.1.2. No excess & no co-payments
3.1.1.3. Total exclusionary policies
3.1.2. Non-exclusionary policies
3.1.2.1. Excess & co-payments
3.1.2.2. No excess & no co-payments
3.1.2.3. Total non-exclusionary policies
3.2. Total policies
3.3. Insured persons
3.3.1. Exclusionary policies
3.3.1.1. Excess & co-payments
3.3.1.2. No excess & no co-payments
3.3.1.3. Total exclusionary policies
3.3.2. Non-exclusionary policies
3.3.2.1. Excess & co-payments
3.3.2.2. No excess & no co-payments
3.3.2.3. Total non-exclusionary policies
3.4. Total insured persons
4. General treatment ambulance only
4.1.1. Policies
4.1.2. Insured persons
5. Total general treatment only
5.1.1. Policies
5.1.2. Insured persons
6. General treatment excluding hospital-substitute, CD MP and hospital-linked ambulance treatment
6.1.1. Policies
6.1.2. Insured persons
7. Total general treatment
7.1.1. Policies
7.1.2. Insured persons
Changes during the quarter
Hospital treatment only
Hospital treatment and general treatment
General treatment only
8. Start of quarter
9. New policies/persons
10. Transferring from another state
11. Transferring to another state
12. Transferring from another fund
13. Transferring from another policy
14. Transferring to another policy
15. Discontinued
16. End of quarter
Part 2 Total benefits paid for hospital treatment and hospital-substitute treatment
Total benefits for hospital treatment and hospital-substitute treatment
17. Day hospital
18. Public hospitals
18.1. Day only
18.2. Overnight
19.1. Day only
19.2. Overnight
20. Hospital-substitute day only
21. Treatment greater than one day
23. Nursing home type patients
23.1. Public hospitals
23.2. Private hospitals
23.3. Total nursing home type patients
24. Medical benefits
25. Prostheses benefits
26. Total Chronic Disease Management Programs
27. Total benefits paid for general treatment
28. Ineligible hospital benefits
29. Total benefits paid for hospital treatment and general treatment
High Cost Claimants Pool
30. Number of HCCP claimants (current quarter)
31. Gross benefits for current and preceding 3 quarters (for current quarter HCCP claimants)
32. Net benefits for current and preceding 3 quarters for HCCP claimants - after ABP
33. Net benefits above threshold for current and preceding 3 quarters (for current quarter HCCP claimants)
34. Total benefits to be included in HCCP (current quarter)
Part 3 Hospital treatment by age category
Hospital treatment by age category
35. Males
Other HT benefits
Fees excluding Medicare benefit
35.1. Total males
36. Females
36.1. Total females
Part 4 Hospital-substitute treatment by age category
Hospital-substitute treatment by age category
37. Males
Other H-ST benefits
37.1. Total males
38. Females
38.1. Total females
Part 5 Chronic Disease Management Program by age category
Chronic Disease Management Program by age category
39. Males
Ineligible benefits
39.1. Total males
40. Females
40.1. Total females
Part 6 General treatment excluding hospital-substitute, CDMP and hospital-linked ambulance treatment
General treatment by age category
41. Males
41.1. Total males
42. Females
42.1. Total females
Part 7 Total hospital treatment policies by type of cover
Total hospital treatment policies
43. Number of policies
Reduced cover but no lifetime exclusions
Reduced cover and some lifetime exclusions
Some lifetime exclusions but no reduced cover
43.1. Excess & co-payments
<= $500/$1,000 (*)
> $500/$1,000 (*)
43.2. Total
(*) Excess <= $500 per policy covering only one person and excess <=$1,000 for all other policies
(**) Excess > $500 per policy covering only one person and excess > $1,000 for all other policies
General treatment claims processing for the state (excluding hospital-substitute treatment and CDMP)
44. Percent of claims processed within five working days
National retention index - hospital treatment policy holders
45. Percent of policies existing two years or more that are still in force
Part 8 Benefits paid for Chronic Disease Management Programs
46. Benefits paid for CDMPs
CDMP deliverables
46.1. Total CDMPs
47. Benefits paid by program type
Type of CDMP
47.1. Total by program type
Part 9 Benefits paid for general treatment (excluding hospital-substitute treatment and CDMP)
48. Type of treatment by service type
Accidental Death / Funeral Expenses
Community, Home, District Nursing
Preventative Health Products/Health Management Program
Orthoptics (Eye Therapy)
Prostheses, Aids and Appliances
Psych/Group Therapy
48.1. Other (please specify)
48.2. Total general treatment
Part 10 Lifetime Health Cover
49. Number of adults with hospital cover
Certified age at entry
Male LHC loading removed
Female LHC loading removed
LHC Loading %