Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p25
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 25/38)
Character Range: 111060–114837

hospital-substitute treatment.

                                           General Treatment Ambulance Only is included in Total General Treatment Only.

General Treatment Ambulance Only Policies  Means policies that cover ambulance services but does not cover any other hospital or general treatment.

                                           A subset of General Treatment Only Policies, covering only ambulance services. Ambulance services associated with the provision of treatment to an insured person are specified as included in General Treatment for the purposes of subsection 121-10 (2) of the Private Health Insurance Act 2007.

Hospital Treatment Only Policies           Means policies that specify only treatments that are hospital treatment.

Hospital and General Treatment Combined    Means policies that specify treatments that are hospital treatment and specify treatments that are general treatment.

Part 2 Total Benefits Paid for Hospital Treatment and General Treatment

episode/s                                                Means for a particular type of treatment or place where the treatment was provided:

                                                           (a)   for hospital treatment provided at a hospital, the period between the insured person's admission to the hospital and discharge from that hospital, including leave periods, is one episode; and
                                                           (b)  for:
                                                             (i)     hospital-substitute treatment; and
                                                             (ii)    hospital treatment that is provided, or arranged, with the direct involvement of a hospital, the continuous period between the commencement and cessation of the treatment is one episode, and
                                                           (c)   an episode for which a benefit has been paid is to be counted (unless an incomplete episode).

                                                         Note: episodes are not reported until the episode is complete.

incomplete episode                                       If an episode is not completed within a quarter but a benefit has been paid in relation to the treatment because of an interim billing arrangement, the episode is reported as one episode only and only in the quarter in which the episode is completed.

Days - Hospital Treatment                                Means day/s on which a policy holder or insured person is a patient of a public or private hospital for hospital treatment.

                                                         Days must reflect the total days related to each episode, including days when no private health insurance benefits are paid.  Where a hospital stay includes leave days, those days are not reported in HRF 601.1.

Days - Hospital-substitute 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.

Benefits Paid Chronic Disease Management Program (CDMP)  Means benefits paid for services covered by Chronic Disease Management Programs.

Benefits Paid General Treatment                          Means benefits paid for services covered by general treatment.

Benefits Paid Hospital Benefits                          Means benefits paid 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