Part 9Benefits Paid for General Treatment

Part 9 Benefits Paid for General Treatment

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

33. Report the number of services, benefits paid and fees charged for General Treatment excluding Hospital-Substitute Treatment and CDMP.

34. Include, for example, payments for ambulance, ex-gratia payments and payment for travel in this part under General Treatment. Do not include them as “ineligible hospital benefits”.

(a) Services benefits and fees on behalf of a person with Hospital-linked Ambulance Treatment should be included in this part, even in those cases where the person is not included in Part 6.
(b) Note that health management programs are reported in each quarter that benefits are paid for the program. The commencement date of the program, and thus the first quarter in which the program is deemed to have commenced, should be taken as the date on which benefits were first paid for under the program. Note that the program would be deemed to be ceased in the case where the participant leaves the program (for example, by choice or other reason such as death). Note that number of programs does not refer to the particular programs offered by the health insurer, but refers to the number of persons participating in a program. If a member participates in more than one program, each program they participate in is counted.
(c) Programs that are similar to, but do not satisfy the criteria for, CDMPs should be reported under Part 9 General Treatment.