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Financial Sector (Collection of Data) (reporting standard) determination No. 1 of 2024
Part 7Total Hospital Treatment Policies by Type of Cover
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Part 7 Total Hospital Treatment Policies by Type of Cover
| Excess/Co-Payments | See page 22In this section Excess refers to the maximum Excess that could be payable in any one year for a policy.Any policies that commenced cover before 24 May 2000 and are exempt from the Medicare Levy Surcharge should be reported in the categories “Nil” or “<=$500/$1,000”. |
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| Full Cover | Means policies that have no restriction on benefits paid after 12 months of cover. This could be regarded as a 100% product, with no exclusions.Policies with a co-payment and no other restriction are defined as having full cover.Where a fixed percentage of benefits is paid (e.g. 85 per cent benefit of contract fee) the 15 per cent payable by the member should be regarded as a moiety or co-payment, and therefore full 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 members reported at all levels of co-payments. |
| Reduced cover | Means policies that restrict benefits paid after 12 months of cover. Products that have a fixed benefit regardless of the fees charged are included in the reduced benefits category. A product that pays fixed benefits will have a nil Excess/Co-payment unless a moiety is attached to the product. |
| Some Lifetime Exclusions | Means policies that provide no benefits for certain treatments for the life of the membership. (Note that an exclusionary product excludes certain treatments in all settings. For example, a product that does not pay benefits for certain treatment in a private hospital but does pay benefits for that treatment in a public hospital is not regarded as exclusionary). |
| General Treatment claims processing(excluding hospital-substitute treatment and CDMP) | This data item shows the percent of General Treatment claims (excluding hospital-substitute and CDMP) that were processed within five working days in the current quarter. |
| Retention index - Hospital Treatment policies | The retention index is designed to provide a performance indicator by showing the percent of policies that have remained active hospital treatment policies of the same fund for two years or more, over all states. |