Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p8
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 8/38)
Character Range: 61870–64563

HCCP after ABP for the current and the preceding three quarters.

Circular 08/04 of 25 January 2008 provides detailed information to assist health insurers complete the high cost claimants section of the HRF 601.1, with a spreadsheet example attached to the circular.

Parts 3 to 6 Collections by Type of Product and Age Category

The data in these parts is to be reported by age and gender:

     * for insured persons in the age cohort that they are in at the end of the quarter; and
     * for all other headings as cumulative totals over the quarter being reported.

    10.         Part 3 and 4 - "Other HT Benefits" and "Other H-ST Benefits" refers to benefits paid for hospital treatment or hospital-substitute treatment respectively and includes hospital charges such as accommodation and theatre fees. Do not include Medical, Medical devices or human tissue products and Ineligible Benefits under this heading.

    11.         Part 3 and 4 - Total benefits for Part 3 are the sum of "Other HT Benefits", "Medical benefits", and "Medical devices or human tissue products benefits". Total benefits for Part 4 are the sum of "Other H-ST Benefits", "Medical benefits", and "Medical devices or human tissue products benefits". Benefits should be reported:

       (a)          in the quarter in which they are paid;

       (b)          against the age of the person as at the date of treatment; and

       (c)          reversals in benefits should be reported against the age of the person as at the date of treatment if possible, but may be reported against the age of the person as at the time of the reversal.

    12.         Part 3, 4 and 6 - Services and Episodes are reported under the age at the date of treatment.

    13.         Part 3 and 4 - Requirements for reporting episodes, days and benefits are the same as reporting requirements in Part 2 (see Part 2 general guidance).

    14.         All parts - Where an insured person changes age cohort during an episode:

       (a)          the episode is to be reported in the age cohort that the episode was finalised;

       (b)          the days and benefits are to be reported for the age cohort in which they were incurred (e.g. a 20 day episode with an accommodation cost of $200 per day, where the insured person turned 50 on day four, is reported as: 1 episode under 50-54, 3 days under 45-49 and 17 days under 50-54, $600 under 45-49 and $3,400 under 50-54). Note that apportionment of benefits by the number of days in each age cohort only relates to the case where the treatment covers more than one age cohort, for example an invoice is received for accommodation for a period where the person had a number of