Document ID: chunk:federal_register_of_legislation:F2023L00723:front:0:p5
Version: federal_register_of_legislation:F2023L00723
Segment Type: other
Provision Reference: 
Character Range: 12747–17221

%

                                                           For health-related insurance business, this item is calculated as:

                                                             *
                                                           A equals Benefits incurred (CE) amount
                                                           B equals HRIB stress %
                                                           For general treatment and health-related insurance business, this item is also equal to claims incurred (pre-MA) amount.
Billed Risk Equalisation Special Account liability amount  Billed Risk Equalisation Special Account liability amount means the amount of Risk Equalisation Special Account payments, on the relevant day, for which an invoice from the APRA has been received by the insurer but that have not yet been paid by the insurer.

                                                           Risk Equalisation Special Account has the same meaning as in the Act.

C
Calculated deficit (AES) amount        This is a derived item and is calculated as:

                                            *

                                       Where:
                                       A equals Calculated deficit (CE) amount
                                       B equals Single Equivalent Units (CE) count
                                       C equals Single Equivalent Units (AES) count.
Calculated deficit (CE) amount         This is the central estimate forecast of the calculated deficit for that month.

                                       The calculated deficit is the total amount that is expected to be payable by the private health insurer should each single equivalent unit (SEU) be entitled to the average amount as defined in sub-rule 11(1) of the Private Health Insurance (Risk Equalisation Policy) Rules 2015 or its replacement.
Calculated deficit (MA) amount         This is a derived item.

                                       For months 1-9, this is calculated identically to calculated deficit (AES) amount.

                                       For months 10-12, this item is calculated as:

                                         *

                                       Where:
                                       A equals Calculated deficit (AES) amount
                                       B equals Single Equivalent Units (AES) count
                                       C equals Single Equivalent Units (MA) count.
Central estimate of OCL                This is a derived item and is calculated as the sum of:
                                            * claims component - OCL amount;
                                            * claims handling expenses - OCL amount;
                                            * risk equalisation component - OCL amount; and
                                            * settled but not paid claims - OCL amount
                                       Less the sum of:
                                            * reinsurance recoverables - OCL amount;
                                            * non-reinsurance recoveries - OCL amount; and
                                            * discount on OCL amount.
Central estimate of PL                 This is a derived item and is calculated as the sum of:
                                            * claims component - PL amount;
                                            * claims handling expenses - PL amount;
                                            * policy administration expenses – PL amount; and
                                            * risk equalisation component - PL amount
                                       Less the sum of:
                                            * expected reinsurance recoveries - PL amount;
                                            * non-reinsurance recoveries - PL amount; and
                                            * discount on PL amount.
Claims component - OCL amount          This is the value, as at the relevant date, of the claims component of the central estimate of OCL, determined in accordance with HPS 340. This includes claims payable for:
                                            * claims that have been reported, but are not yet settled at balance date;
                                            * claims that have been incurred, but not yet reported; and
                                            * claims