Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p1
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 1/38)
Character Range: 39093–42964

65                                                                                                                                                                                                                                                                                                   70%
Total                                                                                                                                                                                                                                                                                                0%

Part 11 Total hospital treatment medical services statistics

                                                                                                                       Amount charged                        Medicare benefit                           Fund benefit                                 Gap                                             Number of services     % of services                                       Amount charged % of MBS
                                                                                                                       (1)                                   (2)                                        (3)                                          (4)                                             (5)                    (6)                                                 (7)
50. No-gap agreement
<= MBS fee
>MBS to 125% MBS fee
>125% to 150% MBS fee
>150% to 200% MBS fee
>200% MBS fee
50.1. Total no-gap agreement

51. Known gap agreement
>MBS to 125% MBS fee
>125% to 150% MBS fee
>150% to 200% MBS fee
>200% MBS fee
51.1. Total known gap agreement
52. Total agreement

53. No agreement
<= MBS fee
>MBS to 125% MBS fee
>125% to 150% MBS fee
>150% to 200% MBS fee
>200% MBS fee
54. Total no agreement

55. Grand total
55.1. Total services with no gap
55.2. Total services with no or known gap

Reporting Form HRF 601.1 series

Statistical Data by State

Explanatory notes

The HRF 601.1 series includes 9 iterations of Form HRF 601.1 Statistical Data - by State (HRF 601.1) that collect statistical data on a State or Territory basis. The HRF 601.1 series must be completed for each health benefits fund of the private health insurer.

Disclaimer

In the case of any contradiction between these reporting instructions and the relevant legislation, the legislation should be deemed to be the correct interpretation.

Definitions

Definitions for terms used in these reporting instructions can be found in the Attachment to these reporting instructions.

'The Act' refers the Private Health Insurance (Prudential Supervision) Act 2015.

Units of measurement

All financial values, quantities and percentages must be reported to no more than two decimal places.

Financial values must be reported in Australian dollars.

Instructions for specific items

The header for HRF 601.1 includes the name of the private health insurer, their Australian business number and the quarter for which the HRF 601.1 series is being submitted.

Note that APRA processing requires the entire file with all states to be submitted. If there are no persons resident in a state, a nil return for that state is required.

Templates are issued with a default setting of zero (0) in all fields, this is a nil return. Funds must fill in all (white) fields before submitting to APRA. Some fields are automatically calculated, these fields are in grey.

The reporting forms are preset for each Risk Equalisation Jurisdiction (state). Policies and insured persons are reported in the state of their principal place of residence as at the end of the quarter[3]. State amounts as zero if there are no such persons in the jurisdiction. If a benefit is paid[4] to or on behalf of an insured person during a quarter and the person changes his or her