Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p19
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 19/38)
Character Range: 90740–95370

(Risk Equalisation Policy) Rules 2015.

                                                                                                   Note: health management programs are not included (these are to be included in Part 6 and 9).

                                                                                              Total benefits – sum of eligible plus ineligible benefits paid for CDMPs in the quarter.

                                                                                              Fees excluding Medicare benefit – report fees charged by providers, as health insurers are precluded from paying benefits for out-of-hospital services for which a Medicare benefit is payable (except in the circumstances outlined in General treatment – services for which Medicare benefit is payable of the Private Health Insurance (Health Insurance Business) Rules 2018.

6.    General Treatment by age category                                                           Note: information on health management programs is reported here.

8.    Benefits paid for CDMPs                                                                 Definitions of planning, coordination and allied health services for the delivery of CDMPs are provided in the Private Health Insurance (Health Insurance Business) Rules 2018.

                                                                                              Services – the total number of goods and services that benefits were paid for in the quarter.

                                                                                              Benefits – the total amount of benefits paid for goods and services in the quarter.

                                                                                              Fees charged – the total amount of fees charged by providers for goods and services in the quarter.

      Benefits paid by Program Type                                                           This is a breakdown of the types of CDMPs that benefits were paid for during the quarter.

                                                                                              Programs – the number of insured persons commencing CDMPs that during the quarter. If one person commenced in two CDMPs, this should be reported as two.

                                                                                              Benefits – the total amount of benefits paid for goods and services in the quarter.

                                                                                              Fees charged – the total amount of fees charged by providers for goods and services in the quarter.

9.    Benefits paid for General Treatment (excluding Hospital-Substitute Treatment and CDMP)      Note: information on health management programs is reported here.

Attachment – HRF 601.0 series Data Dictionary

Table of contents

About the Data Dictionary.............................................19

Part 1 Policies and insured persons.......................................20
  Type of cover.....................................................22
  Types of Policies...................................................22
  Changes during the quarter...........................................23
  Types of treatment.................................................25

Part 2 Total Benefits Paid for Hospital Treatment and General Treatment........26
  Risk Equalisation..................................................28

Parts 3-6 Collections by Type of Product and Age Category...................31

Part 7 Total Hospital Treatment Policies by Type of Cover....................31

Part 8 Benefits Paid for Chronic Disease Management Programs...............32
  Types of Allied Health Professionals...................................34

Part 9 Benefits Paid for General Treatment................................36
  General Treatment categories ........................................37

Part 10 Lifetime Health Cover..........................................40

Part 11 Total Hospital Treatment Medical Services Statistics..................41

Index..............................................................43

About the Data Dictionary

This dictionary is a compilation of definitions for terms used or associated with the HRF 601.0 series in the order in which they appear in the template.

All definitions that come from current legislation are cited underneath.

Applicable legislation includes:

       * Private Health Insurance Act 2007;

       * Private Health Insurance (Health Insurance Business) Rules