Get a plain-English read of Table 9: Insurance Claims - Hospital Cat
Turn the raw legal text into a practical explanation grounded in Financial Sector (Collection of Data) (reporting standard) determination No. 20 of 2025.
This table applies to health benefits funds and the general fund.
Units of measurement
Report values in whole Australian dollars.
Name
Valid values
Description
1
Private Health Insurer Fund Type
Health benefits fundGeneral fund
Report the private health insurer fund type.
2
Private Health Insurer Fund Name
Free text
Report the name of the private health insurer fund type. This is in the event a private health insurer has multiple health benefits funds.In the event a private health insurer has only one health benefits fund, its name should be the same as the private health insurer.For the general fund, report the same name as the private health insurer.
Report the gains/losses on investments amount.Report gains on investments as a positive value.Report losses on investments as a negative value.
Table 8: Insurance Claims - HIB by state
Reporting basis
This table applies to health benefits funds only.
Units of measurement
Report values in whole Australian dollars.
Name
Valid values
Description
1
Private Health Insurer Fund Name
Free text
Report the name of the private health insurer fund type. This is in the event a private health insurer has multiple health benefits funds.In the event a private health insurer has only one health benefits fund, its name should be the same as the private health insurer.
2
State And Territory Of Australia
NSWVICQLDSAWATASACTNT
Report by state and territory of Australia.
3
Hospital Treatment Claims Incurred Amount
Whole dollars
Report the claims incurred amount for hospital treatment only.
4
Net RESA Amount
Whole dollars
Report the net RESA amount.Report net RESA amount as a positive value where RESA is a net payable.Report net RESA amount as a negative value where RESA is a net receipt.Although NSW and ACT are in the same RESA jurisdiction, the total net RESA in that jurisdiction should be apportioned between NSW and ACT according to the split of the residency of the health benefit fund’s hospital SEUs as at the reporting date.
5
State Ambulance Levies Amount
Whole dollars
Report the state ambulance levies amount.
6
General Treatment Claims Incurred Amount
Whole dollars
Report the claims incurred amount for general treatment only.
Table 9: Insurance Claims - Hospital Category
Reporting basis
This table applies to health benefits funds only.
Units of measurement
Report values in whole Australian dollars.
Name
Valid values
Description
1
Private Health Insurer Fund Name
Free text
Report the name of the private health insurer fund type. This is in the event a private health insurer has multiple health benefits funds.In the event a private health insurer has only one health benefits fund, its name should be the same as the private health insurer.
2
Hospital Category
GoldSilver +SilverBronze +BronzeBasic +Basic
Report the hospital category.
3
Hospital Treatment Claims Incurred Amount
Whole dollars
Report the claims incurred amount for hospital treatment.Private health insurers may use approximate methods and take into account overall materiality in apportioning this item by hospital category.
4
Net RESA Amount
Whole dollars
Report the net RESA amount.Private health insurers may use approximate methods and take into account overall materiality in apportioning this item by hospital category.Report net RESA amount as a positive value where RESA is a net payable.Report net RESA amount as a negative value where RESA is a net receipt.
5
State Ambulance Levies Amount
Whole dollars
Report the state ambulance levies amount.Private health insurers may use approximate methods and take into account overall materiality in apportioning this item by hospital category.
Table 10: Insurance Claims – HRIB
Reporting basis
This table applies to health benefits funds and the general fund.
Units of measurement
Report values in whole Australian dollars.
Name
Valid values
Description
1
Private Health Insurer Fund Type
Health benefits fundGeneral fund
Report the private health insurer fund type.
2
Private Health Insurer Fund Name
Free text
Report the name of the private health insurer fund type. This is in the event a private health insurer has multiple health benefits funds.In the event a private health insurer has only one health benefits fund, its name should be the same as the private health insurer.For the general fund, report the same name as the private health insurer.
3
Health-Related Insurance Business Type
Overseas visitor coverOverseas student health cover
Report the health-related insurance business type.
4
Gross Claims Incurred Amount
Whole dollars
Report the gross claims incurred amount.
5
Reinsurance Recoveries Amount
Whole dollars
Report the reinsurance recoveries amount.
Table 11: Other Business Expenses
Reporting basis
This table applies to health benefits funds and the general fund.
Units of measurement
Report values in whole Australian dollars.
Name
Valid values
Description
1
Private Health Insurer Fund Type
Health benefits fundGeneral fund
Report the private health insurer fund type.
2
Private Health Insurer Fund Name
Free text
Report the name of the private health insurer fund type. This is in the event a private health insurer has multiple health benefits funds.In the event a private health insurer has only one health benefits fund, its name should be the same as the private health insurer.For the general fund, report the same name as the private health insurer.
3
Private Health Insurer Business Type
Health insurance businessHealth-related insurance businessHealth-related business – non-insurance
Report the private health insurer business type.Health insurance business does not apply where the private health insurer fund type is general fund.
4
Other Business Expenses Type
Commissions & feesMarketing and publicityEmployee costsOperations & administrationShare of corporate overheadsOther expensesCosts of goods/services: Optical businessCosts of goods/services: Dental businessCosts of goods/services: Hospitals & Medical CentresCosts of goods/services: Other
Report the other business expenses type.Only the following items apply where the private health insurer business type is health insurance business or health-related insurance business:Commissions & feesMarketing and publicityEmployee costsOperations & administrationShare of corporate overheadsOther expensesAll items apply where the private health insurer business type is health-related business – non-insurance.
5
Other Business Expenses Amount
Whole dollars
Report the other business expenses amount.
Table 12: Other Business Expenses – Claims Handling Expenses
Reporting basis
This table applies to health benefits funds and the general fund.
Units of measurement
Report values in whole Australian dollars.
Name
Valid values
Description
1
Private Health Insurer Fund Type
Health benefits fundGeneral fund
Report the private health insurer fund type.
2
Private Health Insurer Fund Name
Free text
Report the name of the private health insurer fund type. This is in the event a private health insurer has multiple health benefits funds.In the event a private health insurer has only one health benefits fund, its name should be the same as the private health insurer.For the general fund, report the same name as the private health insurer.
3
Private Health Insurer Business Type
Health insurance businessHealth-related insurance business
Report the private health insurer business type.Health insurance business does not apply where the private health insurer fund type is general fund.
4
Claims Handling Expenses Amount
Whole dollars
Report the claims handling expenses amount.
Table 13: Retained Earnings at the end of the Reporting Period
Reporting basis
This table applies to health benefits funds and the general fund.
Units of measurement
Report values in whole Australian dollars.
Name
Valid values
Description
1
Private Health Insurer Fund Type
Health benefits fundGeneral fund
Report the private health insurer fund type.
2
Private Health Insurer Fund Name
Free text
Report the name of the private health insurer fund type. This is in the event a private health insurer has multiple health benefits funds.In the event a private health insurer has only one health benefits fund, its name should be the same as the private health insurer.For the general fund, report the same name as the private health insurer.
3
Retained Earnings Item Type
Retained earnings at the beginning of the reporting periodProfit / loss after income tax attributable to members of the companyAdjustments to retained earnings due to change in accounting policies / standardsReduction in retained earnings on share buy backTransfers to / from reservesTransfers to / from parent entityDividends declared or paidTransfers to / from other fundsOther retained earnings movements
Report the retained earnings item type.
4
Retained Earnings Amount
Whole dollars
Report the retained earnings amount.Report decreases to retained earnings item types as negative values.Report increases to retained earnings item types as positive values.