Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p11
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 11/38)
Character Range: 69649–72407

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 of a person with Hospital-linked Ambulance Treatment and the person is not included in this part.

           ii)            Note that health management programs are reported in each quarter that benefits are paid for the program. The commencement date of the program, and thus the 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. Note that the program would be deemed to be ceased in the case where the participant leaves the program (for example, by choice or other reason such as death). Note that 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. If a member participates in more than one program, each program they participate in is counted.

           iii)          Programs that are similar to, but do not satisfy the criteria for, CDMPs should be reported under Part 9 General Treatment.

Part 7 Total Hospital Treatment Policies by Type of Cover

The intention of Part 7 is to determine contributors by their level of excess.

The data in this part is to be reported as at the end of the quarter being reported.

    20.         Excess relates to the maximum excess that could be payable in any one year. (An excess may also be referred to as a Front End Deductible.) For consistency in reporting from health insurers it should be noted that the $500/$1,000 relates to the Australian Taxation cut-off, above which there is a Medicare Levy surcharge.

    21.         Full Cover records the coverage that has no restriction on benefits paid after 12 months of the policy commencing. This could be regarded as a 100 per cent product, with no exclusions. Coverage with a co-payment (and no other restriction) is not defined as having reduced cover. Where a fixed percentage is paid (e.g. 85 per cent benefit of contract fee) the 15 per cent payable by the policy holder should be regarded as a moiety or co-payment, and not reduced cover. Products that pay, for example, 100 per cent on contracted hospitals but a fixed benefit on non-contract hospitals should be regarded as full cover. A Full Cover product may have policies reported at all levels of co-payments.

    22.         Reduced cover refers to policies that restrict benefits paid after 12 months of membership, e.g. provides some form of default benefits for a period of time. This