Part 7Total Hospital Treatment Policies by Type of Cover

Part 7 Total Hospital Treatment Policies by Type of Cover

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

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 includes excesses, both day and amount. 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 there is an additional moiety attached to the product.
23. Some Lifetime Exclusions refers to polices that provide no benefits for certain occurrences for the life of the membership. (Note that an exclusionary product excludes certain treatments in all settings, for example hip replacement, but does not include the exclusion of services not covered by Medicare, for example cosmetic surgery).
24. Excess relate to the maximum Excess that could be payable in any one year.
25. In the category >$500/$1,000 the intention is for funds to report those policies that are subject to the Medicare Levy Surcharge due to the size of their Excess. Policies that are not subject to the Medicare Levy Surcharge should not be reported on this line.

Part 7 General Treatment claims processing for the state

(excluding Hospital-Substitute Treatment and CDMP)

26. General Treatment claims processing (excluding Hospital-Substitute Treatment and CDMP) - Report the percentage of General Treatment claims processed within five working days. General Treatment claims processing cannot be greater than 100 per cent.

Part 7 National retention index – Hospital Treatment policy holders

27. Retention Index – Hospital Treatment policy holders. The retention index is designed to provide a performance indicator by showing the percentage of policies that have remained active hospital policies of the same fund for two years or more, over all states.
28. If a policy holder changes their coverage from hospital treatment, or hospital treatment and general treatment combined, to general treatment only then they would not be regarded as having retained their hospital treatment policy. A policy which is suspended at the quarter end date is not included in the totals in HRF 601.1. They should not be included in the retention index. If they are re-instated they would then be included as if there had been no lapse in their coverage. The retention index is calculated based on policies as: \[Policies at end of reporting quarter less policies joining over the previous eight quarters including the reporting quarter\] divided by \[policies at end of the quarter nine quarters previously\]. The retention index should be reported correct to two decimal points.