Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p29
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 29/38)
Character Range: 123587–127204

the following:

                                      * planning and coordination services for CDMP;
                                      * allied health services which are provided as part of a CDMP;
                                      * hospital-substitute treatment; and
                                      * hospital treatment.

                                 (Part 1, Private Health Insurance (Risk Equalisation Policy) Rules 2015)

Ineligible Benefits              Includes other benefits paid by an insurer that are not eligible.

Fees Charged                     Is the known or invoiced fee charged by the provider for general treatment.

Benefits                         In parts 3 and 4 means benefits paid for hospital treatment or hospital-substitute treatment. It does not include Medical, medical devices or human tissue products and Ineligible benefits.

Total Benefits                   Means benefits plus Medical and medical devices or human tissue products benefits. It does not include Ineligible benefits.

Part 7 Total Hospital Treatment Policies by Type of Cover

Excess/Co-Payments                                  See page 22

                                                    In this section Excess refers to the maximum Excess that could be payable in any one year for a policy.

                                                    Any policies that commenced cover before 24 May 2000 and are exempt from the Medicare Levy Surcharge should be reported in the categories "Nil" or "<=$500/$1,000".

Full Cover                                          Means policies that have no restriction on benefits paid after 12 months of cover. This could be regarded as a 100% product, with no exclusions.

                                                    Policies with a co-payment and no other restriction are defined as having full cover.

                                                    Where a fixed percentage of benefits is paid (e.g. 85 per cent benefit of contract fee) the 15 per cent payable by the member should be regarded as a moiety or co-payment, and therefore full cover.

                                                    Products that pay, for example, 100 per cent on contracted hospitals but a fixed benefit on non-contract hospitals should be regarded as full cover.

                                                    A Full Cover product may have members reported at all levels of co-payments.

Reduced cover                                       Means policies that restrict benefits paid after 12 months of cover. Products that have a fixed benefit regardless of the fees charged are included in the reduced benefits category. A product that pays fixed benefits will have a nil Excess/Co-payment unless a moiety is attached to the product.

Some Lifetime Exclusions                            Means policies that provide no benefits for certain treatments for the life of the membership. (Note that an exclusionary product excludes certain treatments in all settings. For example, a product that does not pay benefits for certain treatment in a private hospital but does pay benefits for that treatment in a public hospital is not regarded as exclusionary).

General Treatment claims processing                 This data item shows the percent of General Treatment claims (excluding hospital-substitute and CDMP) that were processed within five working days in the current quarter.

(excluding hospital-substitute treatment and CDMP)

Retention index - Hospital Treatment policies       The retention index is designed to provide a performance indicator