Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p28
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 28/38)
Character Range: 120603–124051

quarters
                                    (c)        T is the designated threshold
                                    (d)       H is the sum of the amounts notionally allocated to the HCCP in the preceding 3 quarters

                                 Subject to a maximum of 82% of gross benefits being included in Risk Equalisation when summing the ABP and HCCP components.

                                 (Part 2, Private Health Insurance (Risk Equalisation Policy) Rules 2015)

HCCP Claimants                   Means the number of insured persons whose total eligible benefits paid by the insurer exceed the threshold after applying ABP.

HCCP Net Benefits                Means applicable benefits, after age based pooling that exceed the threshold. 82% of net benefits in excess of the threshold are to be pooled.

HCCP Threshold                   Means the designated threshold. The designated threshold is $50,000.

Risk Equalisation Levy           To calculate the amount of levy in respect of a current quarter:

                                    (a)        an amount calculated is first to be notionally allocated to the age based pool (ABP).
                                    (b)       if the amount of gross benefit not notionally allocated to the ABP in the current and preceding 3 quarters, is greater than the designated threshold, a second amount is to be notionally allocated to the high cost claimants pool (HCCP).
                                    (c)        If the   for a fund is less than the equivalent state calculation then the insurer must pay into the Risk Equalisation Pool the difference per SEU.
                                    (d)       If the  for a fund is more than the equivalent state calculation then the insurer will receive the difference per SEU from the Risk Equalisation Pool.

                                 (Part 2, Private Health Insurance (Risk Equalisation Policy) Rules 2015)

Parts 3-6 Collections by Type of Product and Age Category

Fees excluding Medicare benefit  The fees excluding Medicare benefit must exclude the Medicare benefit component of the total fee charged. The difference between fees charged and total benefits paid should be the amount that the patient has to pay (gap). In some cases the fund paying the benefits will be unaware of a discount offered by the provider, for example for early payment.  Fees excluding Medicare benefit should be, in cases where the discounted fee is unknown, the invoiced amount less the Medicare benefit.

                                 Fees excluding Medicare benefit should be greater or equal to the sum of benefits, medical benefits and medical devices or human tissue products benefits.

                                 Note: The total fee charged is the total amount the patient and Medicare would have to pay to the provider in the absence of any private health insurance.

Eligible Benefits                Means a benefit paid by an insurer for any of the following:

                                      * planning and coordination services for CDMP;
                                      * allied health services which are provided as part of a CDMP;
                                      * hospital-substitute treatment; and
                                      * hospital treatment.

                                 (Part 1, Private Health Insurance (Risk Equalisation Policy) Rules 2015)

Ineligible Benefits