Document ID: chunk:federal_register_of_legislation:F2015L01039:body:0:p2
Version: federal_register_of_legislation:F2015L01039
Segment Type: other
Provision Reference: 
Character Range: 2689–5785

quarterly return means a return required under the Financial Sector (Collection of Data) Act 2001 relating to risk equalisation information.
Risk Equalisation Policy Rules means the Private Health Insurance (Risk Equalisation Policy) Rules 2007 made under the Act.
(2)          In these Rules, a category of policy is to be identified as follows:
(a)           for a policy under which only one person is insured – as 'single';
(b)          for a policy under which 2 adults are insured (and no‑one else) – as 'couple';
(c)          for a policy under which 2 or more people are insured, none of whom is an adult – as '2 + persons, no adults';
(d)          a policy under which 2 or more people are insured, only one of whom is an adult – as 'single parent';
(e)          a policy under which 3 or more people are insured, only 2 of whom are adults – as 'family';
(f)           a policy under which 3 or more adults are insured – as '3 + adults'.
(3)          In these Rules, the following terms relevant to the high cost claimants pool have the same meaning as in the Risk Equalisation Policy Rules:
age based pool (ABP)
designated threshold
high cost claimants pool (HCCP)
gross benefit.
Part 2 – Requirement for records to be kept

4.             General records
For each fund conducted by an insurer, the insurer must keep records that contain the following details about each policy of the fund:
       (a)          the name, date of birth, age and principal place of residence of each person covered by the policy; and
       (b)          which of the following the policy covers:
(i)            hospital treatment;
(ii)         hospital-substitute treatment;
(iii)       chronic disease management programs;
(iv)        ambulance service;
(v)          other general treatment; and
       (c)          whether the policy includes any excesses or co‑payments payable; and
       (d)          the category of policy by reference to the number of adults and dependent children covered; and
Note:   Subrule 3 (2) deals with the identification of 'categories of policies'.
       (e)          for each benefit that is paid to or on behalf of an insured person:
           (i)            the name of the insured person to whom the benefit relates; and

           (ii)         the medical or health speciality for which the benefit was paid; and

           (iii)       whether the benefit was paid for:

              (A)        hospital treatment; or

              (B)        hospital-substitute treatment; or

              (C)        chronic disease management program treatment; or

              (D)        ambulance services; or

              (E)         other general treatment; and

           (iv)        if the treatment was provided in accordance with a chronic disease management program, the type of disease for which the program was provided and whether the treatment was provided as hospital treatment or general treatment; and

           (v)          the gross benefits paid; and

           (vi)        the date of treatment; and

           (vii)     the date of