Document ID: chunk:federal_register_of_legislation:F2023L00723:front:0:p9
Version: federal_register_of_legislation:F2023L00723
Segment Type: other
Provision Reference: 
Character Range: 26428–30337

with Part 2, Rule 11(1)(a) of the Private Health Insurance (Risk Equalisation Policy) Rules 2015.
Gross deficit (AES) amount          This is the forecast of the gross deficit after the Adverse Event Stress, as defined in HPS 115, for that month.
Gross deficit (CE) amount           This is the central estimate forecast of gross deficit for that month.
Gross deficit (MA) amount           The insurer is required to report this item for months 10, 11 and 12 only. This is to be determined by adjusting the gross deficit (pre-MA) for management actions as defined in HPS 115.

                                    Gross deficit (MA) must only reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer's expectations and not be limited to the extent that these result in an insurance profit. This constraint will be applied separately in insurance profits forecast after management actions amount.

                                    For months 1 to 9 inclusive this is a derived item and is equal to gross deficit (pre-MA) amount.
Gross deficit (pre-MA) amount       This is a derived item, which provides an approximation of gross deficit, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115. This derived item provides a basis from which management actions can be taken in determining gross deficit (MA) amount.

                                    Gross deficit (pre-MA) is calculated as:

                                      *

                                    where:
                                    A equals Claims incurred (pre-MA) amount
                                    B equals Gross deficit (AES) amount
                                    C equals Claims incurred (AES) amount.
Gross margin (AES) amount           This is a derived item. For hospital treatment and general treatment it is calculated as:

                                         * accrued premium (AES) amount
                                    less:
                                         * benefits incurred (AES) amount.
Gross margin (CE) amount            This is a derived item and is calculated as:

                                         * accrued premium (CE) amount
                                    less:
                                         * benefits incurred (CE) amount.
Gross margin (MA) amount            This is a derived item and is calculated as:

                                         * accrued premium (MA) amount
                                    less:
                                         * benefits incurred (MA) amount.
Gross margin (pre-MA) amount        This is a derived item, which provides an approximation of gross margin, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115.

                                    Gross margin (pre-MA) amount is calculated as:

                                         * accrued premium (pre-MA) amount
                                    less:
                                         * benefits incurred (pre-MA) amount.

H
Health benefits fund                                      Health benefits fund has the same meaning as in the Act.
(Private health insurer fund type)
Health insurance business                                 Health insurance business (HIB) has the same meaning as in the Act.
(Private health insurer   business type)

Health insurance business membership reporting period     Health insurance business membership is the hospital treatment SEUs as at the relevant date for each health benefits fund. The applicable options are:
                                                                * as at the current reporting date;
                                                                * one year