Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p26
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 26/38)
Character Range: 114486–117745

for services covered by hospital treatment.

Day Hospital Facilities                                  Means a private hospital that is not licensed or otherwise permitted to provide treatment that includes part of an overnight stay at the hospital.

                                                         Note: Day hospital facilities are those that were a day hospital facility within the meaning of the National Health Act 1953, and are taken to be private hospitals for the purpose of the Private Health Insurance Act 2007.

Day Only                                                 Means a day on which a policy holder or insured person is accommodated as a patient in a public or private hospital for day treatment.

leave periods/leave days                                 Means a temporary absence from hospital treatment with medical approval for a period no greater than seven consecutive days.

Private Hospitals                                        Means a hospital in respect of which there is in force a statement under subsection 121-5(8) of the Private Health Insurance Act 2007 that the hospital is a private hospital.

Public Hospitals                                         Means a hospital in respect of which there is in force a statement under subsection 121-5(8) of the Private Health Insurance Act 2007 that the hospital is a public hospital.

Overnight                                                Means days on which a policy holder or insured person is a patient of a public or private hospital for hospital treatment for a period of time.

Hospital-Substitute Treatment                            See page 26

Treatment greater than one day                           For hospital-substitute treatment an episode is to be counted as the continuous period between commencement and cessation of treatment.  While there may be no accommodation benefits involved in hospital-substitute there will be days involved in the care.  Either one day only or more than one day.  The intent is to collect data on the length of care involved in hospital-substitute.

Nursing Home Type Patients                               Means a patient in the hospital who has been provided with accommodation and nursing care, as an end in itself, for a continuous period exceeding 35 days.

Medical benefits                                         Means benefits paid under all policies of the fund for services provided as part of hospital treatment or hospital-substitute treatment if a Medicare benefit is payable for the service.

Medical devices or human tissue products benefits        Means benefits paid under all policies of the fund for medical devices or human tissue products of the kinds listed in the Private Health Insurance (Medical Devices and Human Tissue Products) Rules (No. 1) 2023 made under the Act, but only where those Rules provide that there must be a benefit for the provision of the medical devices or human tissue products in the circumstances specified.

Ineligible benefits                                      See page 31

Risk Equalisation

Age Based Pool (ABP)             The Age Based Pool (ABP) equalises benefits for the Risk Equalisation Levy. Pooling is based on adding a proportion of applicable benefits,