Document ID: chunk:federal_register_of_legislation:F2016C00820:body:0:p4
Version: federal_register_of_legislation:F2016C00820
Segment Type: other
Provision Reference: 
Character Range: 8196–11266

of a chronic disease management program:
(i)                     the planning and coordination services described in paragraphs (b) and (c) of the definition of chronic disease management program in the Business Rules; and
(ii)                   allied health services, as defined in the Business Rules, which are provided as part of the chronic disease management program;
(b)                    hospital-substitute treatment;
(c)                    hospital treatment, other than treatment provided as part of a chronic disease management program, or a program of a similar type in respect of a person with a chronic disease, except as mentioned in paragraph (d); and
(d)                    the following components of hospital treatment that are part of a chronic disease management program that is intended to reduce complications in a person with a diagnosed chronic disease:
(i)                     the planning and coordination services described in paragraphs (b) and (c) of the definition of chronic disease management program in the Business Rules; and
(ii)                   allied health services, as defined in the Business Rules, which are provided as part of the chronic disease management program.
           Note: Policy means a complying health insurance policy―see subrule 3 (1).
(2)        In this rule, the following terms have the same meaning as in the Business Rules:
      chronic disease management program
      chronic disease
      risk factors for chronic disease
           Note1 : The Business Rules exclude some classes of treatment from the definition of hospital treatment.
           Note 2: Health insurance benefits are not payable for any treatment for chronic disease management for which a medicare benefit is payable―see section 121-10 of the Act.
(3)        For the avoidance of doubt, benefits not covered by paragraphs (1) (a) and (1) (d) include benefits paid for any other treatment as part of a chronic disease management program including, but not limited, to:
(a)                    diagnosis of chronic disease;
(b)                    the identification of risk factors.

          Part 2 Calculation of levy

6.                      Purpose of this Part
For paragraph 318-10 (2) (c) of the Act, this Part specifies the method for working out the amount to be paid, for crediting to the Special Account, by insurers as risk equalisation levy.

7.                      Matters to be taken into account
(1)        The matters mentioned in this rule are to be taken into account on a State-by-State basis consistently with the information provided by the insurer in its quarterly return for a health benefits fund for a State.
(2)        The amount of levy for a quarter for an insurer, for each health benefits fund of that insurer, is to be worked out having regard to:
(a)                    the age of each insured person in respect of whom an eligible benefit is paid in that quarter; and
(b)                    the mean number for that quarter of single equivalent units for that fund, being the number determined by