Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p5
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 5/38)
Character Range: 53860–57010

double counted if entered under both headings. It is to be entered:

           i)              under the policy they are leaving report under Transferring to another state; and

           ii)            under the policy they are entering report under Transferring from another policy.

       (d)          Transfers to and from another policy refers to transfers between the treatment types of "Hospital Treatment Only", "Hospital Treatment and General Treatment" and "General Treatment Only". Note that a change in the type of cover (e.g. single to couple) does not constitute a change in treatment policy for the purposes of this section.

       (e)          With the introduction of Lifetime Health Cover and the need for tracking the transferring members to maintain their certified age, health funds are required to report whether a member is joining from another health fund. This should enable funds to split out new membership into new members in the industry as opposed to new members from other funds.

       (f)           Discontinued represents the balancing item for the aggregate fund policies/persons from one quarter to the next. Included in this category is: deaths (decrease in persons, not necessarily policies) and suspended policies/persons, where they are not included in the count for Risk Equalisation purposes.

       (g)          End of quarter policies/persons should equal corresponding totals as reported in Part 1 of the return.

Part 2 Total Benefits Paid for Hospital Treatment and General Treatment

The data in this part is to be reported as cumulative totals over the quarter being reported.

    5.             Report the number of episodes, days and total benefits paid in each hospital category.

    6.             Report number of and total benefits paid for medical services, medical devices or human tissue products items and CDMP.

    7.             Report total ineligible hospital benefits. The category Ineligible Benefits is for hospital benefits that are not eligible for Risk Equalisation. They are not reported in any other part of the form.

    8.             General guidance

       (a)          Episodes are reported in each category (place where the treatment was provided) in the quarter in which the treatment ceased, this excludes incomplete episodes, see (d). Episodes are to be determined as:

         i)       hospital treatment provided at a hospital, the period between the insured person's admission to the hospital and discharge from that hospital, including leave periods, as one episode

       For:

           ii)            hospital-substitute treatment, and

           iii)          hospital treatment that is provided, or arranged, with the direct involvement of a hospital, the continuous period between the commencement and cessation of the treatment as one episode.

       (b)          Days must reflect the total days related to each episode, including days when no fund benefit is paid.

       (c)          Leave days from a hospital stay are excluded from reporting days.

       (d)          Where an episode has not been completed in a quarter (an incomplete