Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p24
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 24/38)
Character Range: 107102–111440

policy).

Transferring to another policy     Means policies and insured persons transferring to another policy treatment type. Policy types being "Hospital Treatment Only", "Hospital Treatment and General Treatment" or "General Treatment Only".

Transferring from another policy   Means policies and insured persons transferring from another policy treatment type. Policy types being "Hospital Treatment Only", "Hospital Treatment and General Treatment" or "General Treatment Only".

Discontinued                       Means policies and insured persons leaving. Represents the balancing item for the aggregate fund coverage from one quarter to the next.  Included in this category is:

                                        * Deaths (decrease in insured persons, not necessarily policies).
                                        * Suspended policies, where they are not included in the coverage count for risk equalisation purposes.
                                        * Policies with "Hospital and General Treatment" that drop "Hospital Treatment" cover or drop "General Treatment Cover".

End of quarter                     This equals:

                                   policies/insured persons at start of quarter

                                   plus new policies/insured persons joining

                                   plus transfers from another state, fund or policy type

                                   less transfers to another state or policy type

                                   less discontinued coverage.

Types of treatment

Chronic Disease Management Program (CDMP)  See Page 33

Hospital treatment                         Meaning of hospital treatment

hospital treatment                           (1)  Hospital treatment is treatment (including the provision of goods and services) that:
                                           (a)   is intended to manage a disease, injury or condition; and
                                           (b)   is provided to a person:
                                                  (i)      by a person who is authorised by a hospital to provide the treatment; or
                                                  (ii)     under the management or control of such a person;
                                           (c)    either:
                                                  (i)      is provided at a hospital; or
                                                  (ii)     is provided, or arranged, with the direct involvement of a hospital.

                                           (Division 121, Private Health Insurance Act 2007)

                                           Definition for Hospital see page 28

Hospital-substitute Treatment              Means general treatment that:

hospital-substitute treatment                 (a)        substitutes for an episode of hospital treatment; and
                                              (b)       is any of, or any combination of, nursing, medical, surgical, podiatric surgical, diagnostic, therapeutic, medical device or human tissue product, pharmacological, pathology or other services or goods intended to manage a disease, injury or condition; and
                                              (c)        is not specified in the Private Health Insurance (Complying Product) Rules as a treatment that is excluded from this definition.

                                           (Division 69, Private Health Insurance Act 2007)

                                           Note: In the Act the Coverage Requirements do not permit a general treatment policy only to include hospital-substitute treatment.  Policies that include hospital-substitute treatment must also include hospital treatment.

General Treatment                          See page 37

General Treatment Only Policies            Means policies that cover specified treatments that are general treatment but none that are hospital or 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