Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p10
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 10/38)
Character Range: 66813–69948

first quarter in which the program is deemed to have commenced, should be taken as the date on which benefits were first paid for under the program. The commencement date of the program may be hard to determine due to the different ways benefits can be paid, as well as delays in this information being relayed to health insurers. The first quarter that benefits are paid for a CDMP should be taken as the quarter in which the program commences.

           ii)            Benefits and fees charged are reported in the quarter in which they are paid in the age category of the participant. Where an insured person changes age cohort during a program, services are reported against the age of the participant at the date benefits were paid for the treatment.

           iii)          The number of programs does not refer to the particular programs offered by the health insurer, but refers to the number of persons participating in a program.

           iv)          If a person participates in more than one program, each program they participate in is counted separately.

           v)             Where an insured person changes age cohort during a program, services are reported against the age of the participant at the date of treatment.

       (b)          Eligible benefits are reported as the benefit paid for any of the following components of general and/or hospital treatment provided as part of a chronic disease management program:

           i)              the planning and coordination services described in the definition of chronic disease management program in the Private Health Insurance (Health Insurance Business) Rules 2018 and

           ii)            allied health services, as defined in the Private Health Insurance (Health Insurance Business) Rules 2018, which are provided as part of the chronic disease management program.

       (c)          Ineligible benefits report all benefits paid that are not eligible benefits.

       (d)          Fees excluding Medicare benefits: as health insurers are precluded from paying benefits for out-of-hospital services for which a Medicare benefit is payable (except in the circumstances outlined in General Treatment- services for which Medicare benefit is payable in the Private Health Insurance (Health Insurance Business) Rules 2018 this should be interpreted as "fees" only as no Medicare benefits are payable.

    19.         Part 6 - General Treatment excluding Hospital-Substitute, CDMP and Hospital-linked Ambulance Treatment

       (a)          Report the number of persons by age with General Treatment coverage excluding those with Hospital-Substitute, CDMP and Hospital-linked Ambulance Treatment. These persons are those with ancillary or extras cover.

       (b)          Report the number of General Treatment services, benefits and fees excluding Hospital-Substitute and CDMP.

       (c)          Services, benefits and fees reported in Part 6 should reconcile with services, benefits and fees reported in Part 9.

           i)              Services, benefits and fees should include those for ambulance even where these are on behalf