Accrued premium

This refers to accrued premium as defined in HPS 001.

Report this item net of any reinsurance, for the purpose of this Reporting Standard.

Accrued premium (AES) amount

This is the forecast value of accrued premium after the Adverse Event Stress (AES), as defined in HPS 115, for that month.

Accrued premium (CE) amount

This is the central estimate (CE) forecast of accrued premium for that month.

Accrued premium (MA) amount

The insurer is required to report this item for months 10, 11 and 12 only. For health insurance business (HIB), this is to be determined by adjusting accrued premium (AES) amount for management actions (MA), as defined in HPS 115. For health-related insurance business (HRIB), this is to be reported as the accrued premium (CE) after allowing for management actions, as defined in HPS 115.

Accrued premium (MA) must reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer’s expectations and not be limited to the extent that these result in insurance profits. This constraint will be applied separately in insurance profits forecast after management actions amount.

For months 1 to 9 inclusive, this is a derived item.

For HIB, this is equal to accrued premium (AES) amount. For HRIB, this is equal to accrued premium (CE) amount.

Benefits incurred (AES) amount

This is a derived item.

 For hospital treatment, this item is calculated as the sum of:

• claims incurred (AES) amount;
• calculated deficit (AES) amount; and
• state levies (AES) amount.

Less:

• gross deficit (AES) amount.

For general treatment, this item is equal to claims incurred (AES) amount.

Benefits incurred (CE) amount

This is a derived item.

For hospital treatment, this item is calculated as the sum of:

• claims incurred (CE) amount;
• calculated deficit (CE) amount; and
• state levies (CE) amount.

Less:

• gross deficit (CE) amount.

For general treatment and health-related insurance business, this item is equal to claims incurred (CE) amount.

Benefits incurred (MA) amount

This is a derived item.

 For hospital treatment, this item is calculated as the sum of:

• claims incurred (MA) amount;
• calculated deficit (MA) amount; and
• state levies (MA) amount.

Less:

• gross deficit (MA) amount.

For general treatment and health-related insurance business, this item is equal to claims incurred (MA) amount.

Benefits incurred (pre-MA) amount

This is a derived item, which provides an approximation of benefits incurred, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115.

For hospital treatment and general treatment, this item is calculated as:

Where:

A equals Benefits incurred (AES) amount

B equals HIB stress %

For health-related insurance business, this item is calculated as:

A equals Benefits incurred (CE) amount

B equals HRIB stress %

For general treatment and health-related insurance business, this item is also equal to claims incurred (pre-MA) amount.

Billed Risk Equalisation Special Account liability amount

Billed Risk Equalisation Special Account liability amount means the amount of Risk Equalisation Special Account payments, on the relevant day, for which an invoice from the APRA has been received by the insurer but that have not yet been paid by the insurer.

Risk Equalisation Special Account has the same meaning as in the Act.

Calculated deficit (AES) amount

This is a derived item and is calculated as:

Where:

A equals Calculated deficit (CE) amount

B equals Single Equivalent Units (CE) count

C equals Single Equivalent Units (AES) count.

Calculated deficit (CE) amount

This is the central estimate forecast of the calculated deficit for that month.

The calculated deficit is the total amount that is expected to be payable by the private health insurer should each single equivalent unit (SEU) be entitled to the average amount as defined in sub-rule 11(1) of the Private Health Insurance (Risk Equalisation Policy) Rules 2015 or its replacement.

Calculated deficit (MA) amount

This is a derived item.

For months 1-9, this is calculated identically to calculated deficit (AES) amount.

For months 10-12, this item is calculated as:

Where:

A equals Calculated deficit (AES) amount

B equals Single Equivalent Units (AES) count

C equals Single Equivalent Units (MA) count.

Central estimate of OCL

This is a derived item and is calculated as the sum of:

• claims component - OCL amount;
• claims handling expenses - OCL amount;
• risk equalisation component - OCL amount; and
• settled but not paid claims - OCL amount

Less the sum of:

• reinsurance recoverables - OCL amount;
• non-reinsurance recoveries - OCL amount; and
• discount on OCL amount.

Central estimate of PL

This is a derived item and is calculated as the sum of:

• claims component - PL amount;
• claims handling expenses - PL amount;
• policy administration expenses – PL amount; and
• risk equalisation component - PL amount

Less the sum of:

• expected reinsurance recoveries - PL amount;
• non-reinsurance recoveries - PL amount; and
• discount on PL amount.

Claims component - OCL amount

This is the value, as at the relevant date, of the claims component of the central estimate of OCL, determined in accordance with HPS 340. This includes claims payable for:

• claims that have been reported, but are not yet settled at balance date;
• claims that have been incurred, but not yet reported; and
• claims that have been administratively settled, but which may be reopened.

This should not include any other unpaid amounts which are certain, including those that have been settled but not paid. These amounts are to be reported separately.      

This is to be reported gross of any recoveries and discounting, which are reported separately.

Claims component - PL amount

This is the value, as at the relevant date, of the claims component of the central estimate of PL, determined in accordance with HPS 340.

This is to be reported gross of any Risk Equalisation or reinsurance recoveries and discounting, which are reported separately.

Claims handling expenses - OCL amount

This is the value, as at the relevant date, of the claims handling expenses associated with those claims included within the central estimate of OCL, determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on OCL amount.

Claims handling expenses - PL amount

This is the value, as at the relevant date, of the claims handling expenses associated with those claims included within the central estimate of PL, determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on PL amount.

Claims incurred

This refers to the relevant forecast of claims incurred, as defined in HPS 001.

Report this item net of any reinsurance for the purpose of this reporting standard.

Claims incurred (AES) amount

This is the forecast of claims incurred after the Adverse Event Stress, as defined in HPS 115, for that month.

For general treatment, this item is also equal to benefits incurred (AES) amount.

Claims incurred (CE) amount

This is the central estimate forecast of claims incurred for that month.

For general treatment and health-related insurance business, this item is also equal to benefits incurred (CE) amount.

Claims incurred (MA) amount

The insurer is required to report this item for months 10, 11 and 12 only. This is to be determined by adjusting the claims incurred (pre-MA) for management actions, as defined in HPS 115.

Claims incurred (MA) must only reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer’s expectations and not be limited to the extent that these result in an insurance profit. This constraint will be applied separately in insurance profits forecast after management actions amount.

For months 1 to 9 inclusive, this is a derived item and is equal to claims incurred (pre-MA) amount.

For general treatment and health-related insurance business, this item is equal to benefits incurred (MA) amount.

Claims incurred (pre-MA) amount

This is a derived item, which provides an approximation of claims incurred, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115. This derived item provides a basis from which management actions can be taken in determining claims incurred (MA) amount.

For hospital treatment, this item is calculated as:

Where:

A equals Claims incurred (AES) amount

B equals Benefits incurred (pre-MA) amount

C equals Benefits incurred (AES) amount

D equals State Levies (pre-MA) amount

E equals State Levies (AES) amount

F equals Gross deficit (AES) amount

G equals Claims incurred (AES) amount

For general treatment and health-related insurance business, this item is equal to benefits incurred (pre-MA) amount.

Class of business

Relates to insurance business only. This can be:

• hospital treatment;
• general treatment; or
• health-related insurance business (HRIB).

Deferred Claims Liability (DCL) aggregation benefit

The DCL aggregation benefit makes an explicit allowance for diversification between the DCL and all other components of insurance risks, as defined in HPS 115 at the 99.5 percent probability of adequacy.

DCL at 75th probability of adequacy (POA) amount

This is the value of claims deferred due to COVID – 19 related disruptions or other circumstances as defined by APRA. This is calculated at the 75 percent probability of adequacy (POA), as at the relevant date, determined in accordance with HPS 340.

DCL at 99.5th probability of adequacy (POA) amount

This is the value of claims deferred due to COVID – 19 related disruptions or other circumstances as defined by APRA. This is calculated at the 99.5 percent probability of adequacy (POA), as at the relevant date, in accordance with HPS 340.

DCL Risk Charge

The DCL Risk Charge relates to the risk that the value of the DCL will be greater than the value determined in accordance with HPS 340.

This is a derived item and is calculated as:

• DCL at 99.5th POA amount; less
• DCL at 75th POA amount; less
• DCL aggregation benefit.

Discount on Future Exposure Risk Charge (FERC) (MA) amount

This is the value of discounting the future cashflows associated with the future exposure risk charge. This is value of cashflows post management actions after the exclusion of any insurance profits forecast after management actions, in accordance with HPS 115.

Discount on Outstanding Claims Liability (OCL) amount

This is the value of discounting on the HPS 340 outstanding claims liability. This includes the impact of discounting on the net actuarial central estimate of outstanding claims.

Discount on Premium Liability (PL) amount

This is the value of discounting on the HPS 340 premium liability.

Expected reinsurance recoveries - PL amount

This is the value of expected reinsurance recoveries receivable by the health benefits fund or general fund associated with the PL, gross of any provisions for depreciation or impairment. It is determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on PL amount.

Future Exposure Risk Charge

This is a derived item and is calculated as the sum of:

• Future Exposure Risk Charge - HIB; and
• Future Exposure Risk Charge - HRIB.

Future Exposure Risk Charge - HIB

This is a derived item and is calculated as:

where:

A equals HIB net margin (MA) amount total

B equals Insurance profits forecast after management actions amount for HIB

C equals Discount on Future Exposure Risk Charge amount for HIB

Future Exposure Risk Charge - HRIB

This is a derived item and is calculated as:

where:

A equals HRIB net margin (MA) amount total

B equals Insurance profits forecast after management actions amount for HRIB

C equals Discount on Future Exposure Risk Charge amount for HRIB

Future Exposure Risk Charge period

This is the month of the forecast period, and ranges from the month following the reporting date to the month concluding on the 12th month following the reporting date.

General fund

(Private health insurer fund type)

This refers to the portion of the insurer referred to as the general fund as defined in HPS 001.

General treatment

(Class of Business)

General treatment has the same meaning as in the Private Health Insurance Act 2007 (PHI Act).

Gross deficit

Gross deficit means the sum of the eligible benefits notionally allocated to the aged-based pool and the high cost claimants pool, calculated for each risk equalisation jurisdiction, in accordance with Part 2, Rule 11(1)(a) of the Private Health Insurance (Risk Equalisation Policy) Rules 2015.

Gross deficit (AES) amount

This is the forecast of the gross deficit after the Adverse Event Stress, as defined in HPS 115, for that month.

Gross deficit (CE) amount

This is the central estimate forecast of gross deficit for that month.

Gross deficit (MA) amount

The insurer is required to report this item for months 10, 11 and 12 only. This is to be determined by adjusting the gross deficit (pre-MA) for management actions as defined in HPS 115.

Gross deficit (MA) must only reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer’s expectations and not be limited to the extent that these result in an insurance profit. This constraint will be applied separately in insurance profits forecast after management actions amount.

For months 1 to 9 inclusive this is a derived item and is equal to gross deficit (pre-MA) amount.

Gross deficit (pre-MA) amount

This is a derived item, which provides an approximation of gross deficit, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115. This derived item provides a basis from which management actions can be taken in determining gross deficit (MA) amount.

Gross deficit (pre-MA) is calculated as:  

where:

A equals Claims incurred (pre-MA) amount

B equals Gross deficit (AES) amount

C equals Claims incurred (AES) amount.

Gross margin (AES) amount

This is a derived item. For hospital treatment and general treatment it is calculated as:

• accrued premium (AES) amount

less:

• benefits incurred (AES) amount.

Gross margin (CE) amount

This is a derived item and is calculated as:

• accrued premium (CE) amount

less:

• benefits incurred (CE) amount.

Gross margin (MA) amount

This is a derived item and is calculated as:

• accrued premium (MA) amount

less:

• benefits incurred (MA) amount.

Gross margin (pre-MA) amount

This is a derived item, which provides an approximation of gross margin, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115.

Gross margin (pre-MA) amount is calculated as:

• accrued premium (pre-MA) amount

less:

• benefits incurred (pre-MA) amount.

Health benefits fund

(Private health insurer fund type)

Health benefits fund has the same meaning as in the Act.

Health insurance business

(Private health insurer   business type)

Health insurance business (HIB) has the same meaning as in the Act.

Health insurance business membership reporting period

Health insurance business membership is the hospital treatment SEUs as at the relevant date for each health benefits fund. The applicable options are:

• as at the current reporting date;
• one year prior to the reporting date;
• two years prior to the reporting date; and
• three years prior to the reporting date.

Health-related insurance business (HRIB)

(Private health insurer   business type)

(Class of business)

This is as defined in HPS 001.

Health-related insurance business accrued premium amount

This is the value of accrued premium for health-related insurance business for the 12 months up to the reporting date.

HIB stress %

This is the health insurance business stress, as a percentage, determined in accordance with HPS 115.

Hospital treatment

(Class of business)

Hospital treatment has the same meaning as in the PHI Act.

HRIB stress %

This is the health-related insurance business stress, as a percentage, determined in accordance with HPS 115.

Individual other insurance liability at 75th POA amount

This is the value of each other insurance liability, as defined by HPS340.

Individual other insurance liability at 99.5th POA amount

This is the value of each other insurance liability, as defined by HPS340, valued at a 99.5 per cent level of sufficiency, in accordance with HPS 115.

Individual other insurance liability description

This is the name of the each other insurance liability as defined by HPS340. This name will be used to identify the liability and should reflect its nature and the reason the liability has arisen.

Insurance Liability Risk Charge

This is a derived item and is calculated as the sum of:

• OCL Risk Charge;
• PL Risk Charge;
• RE Risk Charge; and
• Other Insurance Liabilities Risk Charge.

Insurance profits forecast after management actions amount

This is the private health insurer’s estimate of insurance profits forecast after management actions amount. This will be deducted from the sum of net margin (MA) amount. This reflects the constraint outlined in HPS 115, that any insurance profits forecast after management actions cannot offset prior losses.

The insurance profit offset to be reported is to be determined as:

Where:

A equals The sum of net margin (MA) amount for the months including and after management actions take effect.

Insurance profits forecast after management actions amount is to be reported separately for HIB and HRIB.

Insurance Risk Charge

This is a derived item and is calculated as the sum of:

• Insurance Liability Risk Charge;
• Future Exposure Risk Charge; and
• DCL Risk Charge

Management expenses

This refers to the relevant forecast of management expenses as defined in HPS 001.

Management expenses (AES) amount

This is the forecast management expenses after the Adverse Event Stress, as defined in HPS 115, for that month.

Management expenses (CE) amount

This is the central estimate forecast of management expenses for that month.

Management expenses (MA) amount

The insurer is required to report this item for months 10, 11 and 12 only. This is to be determined by adjusting management expenses (pre-MA) amount for management Actions as defined in HPS 115.

Management expenses (MA) must only reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer’s expectations and not be limited to the extent that these result in an insurance profit. This constraint will be applied separately in insurance profits forecast after management actions amount.

For months 1 to 9 inclusive, this is a derived item and is equal to management expenses (pre-MA) amount.

Management expenses (pre-MA) amount

This is a derived item, which provides an approximation of management expenses, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115. This derived item provides a basis from which management actions can be taken in determining management expenses (MA) amount.

For HIB, it is calculated as:

where:

A equals Management expenses (AES) amount

B equals HIB stress %

For HRIB, it is calculated as:

where:

A equals Management expenses (CE) amount

B equals HRIB stress %

Net margin (AES) amount

This is a derived item. It is calculated as:

• gross margin (AES) amount

less:

• management expenses (AES) amount.

Net margin (CE) amount

This is a derived item. It is calculated as:

• gross margin (CE) amount

less:

• management expenses (CE) amount,

Net margin (MA) amount

This is a derived item. It is calculated as:

• gross margin (MA) amount

less:

• management expenses (MA) amount.

Non-reinsurance recoveries - OCL amount

This includes the value of recoveries under arrangements, other than reinsurance and risk equalisation arrangements, receivable by the health benefits fund or general fund associated with the OCL, net of any provisions for depreciation or impairment. It is determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on OCL amount.

Non-reinsurance recoveries - PL amount

This includes the value of recoveries under arrangements, other than reinsurance arrangements, receivable by the health benefits fund or general fund associated with the PL, gross of any provisions for depreciation or impairment. It is determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on PL amount.

OCL at 75th probability of adequacy

This is a derived item and is calculated as the sum of:

• central estimate of OCL; and
• risk margin at 75th probability of adequacy - OCL amount.

OCL Risk Charge

This is a derived item and is the Insurance Liability Risk Charge in respect of outstanding claims risk, which relates to the risk that the value of OCL is greater than the value determined in accordance with HPS 340. It is calculated as: (OCL at 75th probability of adequacy minus settled but not paid claims - OCL amount) multiplied by outstanding claims risk size margin, as defined by HPS 115.

Other Insurance Liabilities Risk Charge

This is a derived item and is the Insurance Liability Risk Charge in respect of other insurance liabilities, which relates to the risk that the value of other insurance liabilities is less than the value determined in accordance with HPS 340. It is the sum of each individual other insurance liability at 99.5th POA minus the sum of each individual other insurance liability at 75th POA.

PL at 75th probability of adequacy

This is a derived item and is calculated as the sum of:

• central estimate of PL; and
• risk margin at 75th probability of adequacy - PL amount.

PL Risk Charge

This is a derived item and is the Insurance Liability Risk Charge in respect of premiums liabilities risk, which relates to the risk that the value of PL is greater than the value determined in accordance with HPS 340.

For HIB, this is calculated as PL at 75th probability of adequacy for HIB multiplied by HIB stress %.

For HRIB, this is calculated as PL at 75th probability of adequacy for HRIB multiplied by HRIB stress %.

The PL Risk Charge is the sum of HIB and HRIB.

Policy administration expenses - PL amount

This is the value, as at the relevant date, of the policy administration expenses associated with those claims included within the central estimate of PL determined in accordance with HPS 340. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on PL amount.

Private health insurer business type

This is either health insurance business or health-related insurance business.

Private health insurer fund type

This is either a health benefits fund or general fund.

RE Risk Charge

This is a derived item and is the Insurance Liability Risk Charge in respect of risk equalisation, which relates to the risk that the value of risk equalisation transfers are less favourable than the value determined in accordance with HPS 340. It is calculated as unbilled calculated deficit amount multiplied by the risk equalisation charge factor of 4%, as set out in HPS 115.

Reinsurance recoverables - OCL amount

This is the value of reinsurance recoverables, being amounts due to the health benefits fund or general fund under a reinsurance arrangement, that arise from the recognition of the central estimate of the OCL. The value must be reported net of any provisions for doubtful debts and in accordance with HPS 340.  This item is to be reported gross of any discounting, as all discounting is to be reported in discount on OCL amount.

Risk equalisation component - OCL amount

This is the value, as at the relevant date, of any amount estimated to be payable or receivable under the Risk Equalisation Special Account arising from claims incurred and included within the central estimate of OCL determined in accordance with HPS 340.  This item is to be reported gross of any discounting, as all discounting is to be reported in discount on OCL amount.

Risk equalisation component - PL amount

This is the value, as at the relevant date, of any amount estimated to be payable or receivable under the Risk Equalisation Special Account arising from claims included within the central estimate of PL determined in accordance with HPS 340.  This item is to be reported gross of any discounting, as all discounting is to be reported in discount on PL amount.

Risk margin at 75th POA - OCL amount

This is the value, as at the relevant date, of the risk margin component of OCL, net of recoveries, determined in accordance with HPS 340. The risk margin is that which has been applied to the Outstanding Claims Liabilities for HIB and HRIB, and may include diversification across the insurance portfolio within the health benefits fund or general fund.

Risk margin at 75th POA - PL amount

This is the value, as at the relevant date, of the risk margin component of PL, net of recoveries, determined in accordance with HPS 340.  The risk margin is that which has been applied to the Premium Liabilities for HIB and HRIB, and may include diversification across the insurance portfolio within the health benefits fund or general fund.

Risk margin at 75th POA – risk equalisation transfers amount

This is the value, as at the relevant date, of the risk margin component of risk equalisation transfers, determined in accordance with HPS 340.

Settled but not paid claims - OCL amount

This is the value, as at the relevant date, of unpaid claims amounts where the value has been determined. This includes claims that have been settled but not paid and included within the central estimate of OCL determined in accordance with HPS 340. These items should be disclosed as OCL instead of current liabilities or trade creditors. This item is to be reported gross of any discounting, as all discounting is to be reported in discount on OCL amount.

Single Equivalent Units (AES) count

This is the value of forecast Single Equivalent Units after the Adverse Event Stress, as defined in HPS 115, for that month.

Single Equivalent Units (CE) count

This is the central estimate forecast of Single Equivalent Units for that month.

Single Equivalent Units (fund) count

This is the value, at the health insurance business membership reporting period, of the SEUs for the health benefits fund.

The value of SEUs should be consistent with that calculated from the relevant HRS 601 return.

Single Equivalent Units (MA) count

The is to be reported for months 10, 11 and 12 only. This is to be determined by adjusting Single Equivalent Units (AES) count for management actions as defined in HPS 115.

Single Equivalent Units (MA) must only reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer’s expectations and not be limited to the extent that these result in an insurance profit. This constraint will be applied separately in insurance profits forecast after management actions amount.

For months 1 to 9 inclusive this is a derived item and is equal to Single Equivalent Units (AES) count.

Single equivalent units (SEUs)

This refers to the relevant forecast of Single Equivalent Units as defined in HPS 001.

Single Equivalent Units (transferor funds) count

This is the value, at the health insurance business membership reporting period, of the SEUs for all health benefits funds which have since transferred into the health benefits fund.

That is, where another health benefits fund/s has been transferred into this health benefits fund, the Single Equivalent Units (transferor funds) count is the total SEUs from all transferor health benefits funds at the relevant period. This may include from before the transfer took place.

For example, where fund A has been transferred into the reporting health benefits fund by the end of the reporting period, the SEUs of fund A should be reported for previous health insurance business membership reporting periods.

For periods after the transfer has occurred, the value for the transferor/s Single Equivalent Units (transferor funds) count is to be reported as zero.

State levies

State levies are all state ambulance levies payable by the health benefits fund.

State levies (AES) amount

This is the forecast of state levies after the Adverse Event Stress, as defined in HPS 115, for that month.

State levies (CE) amount

This is the central estimate forecast of state levies for that month.

State levies (MA) amount

The insurer is required to report this item for months 10, 11 and 12 only. This is to be determined by adjusting the state levies amount for management actions as defined in HPS 115.

State levies (MA) amount must only reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer’s expectations and not be limited to the extent that these result in an insurance profit. This constraint will be applied separately in insurance profits forecast after management actions amount.

For months 1 to 9 inclusive this is a derived item and is equal to state levies (pre-MA) amount.

State levies (pre-MA) amount

This is a derived item, which provides an approximation of state levies, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115. This derived item provides a basis from which management actions can be taken in determining state levies (MA) amount.

State levies (pre-MA) amount is calculated as:

Where:

A equals State Levies (AES) amount

B equals HIB stress %

Unbilled calculated deficit amount

Unbilled calculated deficit means the central estimate of the total amount that would have been payable by the insurer should each SEU been entitled to the average amount as defined in rule 11(1)(e) of the Private Health Insurance (Risk Equalisation Policy) Rules 2015 or its replacement, and under the following conditions:

• over the period up to the reporting date;

• where the risk equalisation levy has accrued but has not yet been paid; and
• where an invoice, notice or receipt from APRA has not yet been received by the private health insurer, for that period.

Unbilled gross deficit amount

Unbilled gross deficit means the sum of the eligible benefits notionally allocated to the aged-based pool and the high cost claimants pool, calculated for each risk equalisation jurisdiction, in accordance with Part 2, rule 11(1)(a) of the Private Health Insurance (Risk Equalisation Policy) Rules 2015 and under the following conditions:

• over the period up to the reporting date;
• where the risk equalisation levy has accrued but has not yet been paid; and
• where an invoice, notice or receipt from APRA has not yet been received by the private health insurer, for that period.

1

Private Health Insurer Fund Type

• Health benefits fund
• General 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 an insurer has multiple health benefits funds.

In the event an insurer has only one health benefits fund, its name should be the same as the insurer.

For the general fund, report the same name as the insurer.

3

Health-Related Insurance Business Accrued Premium Amount

Whole dollars

Report the health-related insurance business accrued premium amount.

1

Private Health Insurer Fund Name

Free text

Report the name of the health benefits fund. This is in the event an insurer has multiple health benefits funds.

In the event an insurer has only one health benefits fund, its name should be the same as the insurer.

2

Health Insurance Business Membership Reporting Period

• As at the current reporting date
• One year prior to the reporting date
• Two years prior to the reporting date
• Three years prior to the reporting date

Report the health insurance business membership reporting period.

3

Single Equivalent Units (Fund) Count

Whole number

Report the Single Equivalent Units (fund) count.

4

Single Equivalent Units (Transferor Funds) Count

Whole number

Report the Single Equivalent Units (transferor funds) count.

Single Equivalent Units (transferor funds) count is to be left blank where the health insurance business membership reporting period is ‘As at the current reporting date’.

1

Private Health Insurer Fund Type

• Health benefits fund
• General 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 an insurer has multiple health benefits funds.

In the event an insurer has only one health benefits fund, the name should be the same as the insurer.

For the general fund, report the same name as the insurer.

3

Private Health Insurer Business Type

• Health insurance business
• Health-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.

Report health-related insurance business where the private health insurer fund type is general fund.

4

Claims Component - OCL Amount

Whole dollars

Report the claims component - OCL amount.

5

Claims Handling Expenses - OCL Amount

Whole dollars

Report the claims handling expenses - OCL amount.

6

Risk Equalisation Component - OCL Amount

Whole dollars

Report the risk equalisation component - OCL amount.

Report risk equalisation amounts payable as a positive value.

Report risk equalisation amounts receivable as a negative value.

7

Settled But Not Paid Claims - OCL Amount

Whole dollars

Report the settled but not paid claims - OCL amount.

8

Reinsurance Recoverables - OCL Amount

Whole dollars

Report the reinsurance recoverables - OCL amount.

9

Non-Reinsurance Recoveries - OCL Amount

Whole dollars

Report the non-reinsurance recoveries - OCL amount.

10

Discount on Outstanding Claims Liability Amount

Whole dollars

Report the discount on OCL amount.

Report any discount on OCL as a positive value.

11

Risk Margin At 75th POA - OCL Amount

Whole dollars

Report the risk margin at 75th POA - OCL amount.

1

Private Health Insurer Fund Type

• Health benefits fund
• General 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 an insurer has multiple health benefits funds.

In the event an insurer has only one health benefits fund, the name should be the same as the insurer.

For the general fund, report the same name as the insurer.

3

Private Health Insurer Business Type

• Health insurance business
• Health-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.

Report health-related insurance business where the private health insurer fund type is general fund.

4

Claims Component - PL Amount

Whole dollars

Report the claims component - PL amount.

5

Claims Handling Expenses - PL Amount

Whole dollars

Report the claims handling expenses - PL amount.

6

Policy Administration Expenses - PL Amount

Whole dollars

Report the policy administration expenses - PL amount.

7

Risk Equalisation Component - PL Amount

Whole dollars

Report the risk equalisation component - PL amount.

Report risk equalisation amounts payable as a positive value.

Report risk equalisation amounts receivable as a negative value.

8

Expected Reinsurance Recoveries - PL Amount

Whole dollars

Report the expected reinsurance recoveries - PL amount.

9

Non-reinsurance Recoveries - PL Amount

Whole dollars

Report the non-reinsurance recoveries - PL amount.

10

Discount on Premiums Liabilities Amount

Whole dollars

Report the discount on PL amount.

Report any discount on PL as a positive value.

11

Risk Margin At 75th POA - PL Amount

Whole dollars

Report the risk margin at 75th POA - PL amount.

1

Private Health Insurer Fund Type

• Health benefits fund
• General 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 an insurer has multiple health benefits funds.

In the event an insurer has only one health benefits fund, the name should be the same as the insurer.

For the general fund, report the same name as the insurer.

3

Unbilled Calculated Deficit Amount

Whole dollars

Report the unbilled calculated deficit amount.

4

Unbilled Gross Deficit Amount

Whole dollars

Report the unbilled gross deficit amount.

5

Billed Risk Equalisation Special Account Liability Amount

Whole dollars

Report the billed Risk Equalisation Special Account liability amount.

6

Risk Margin At 75th POA – Risk Equalisation Transfers Amount

Whole dollars

Report the risk margin at 75th POA – risk equalisation transfers amount.

1

Private Health Insurer Fund Type

• Health benefits fund
• General 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 an insurer has multiple health benefits funds.

In the event an insurer has only one health benefits fund, the name should be the same as the insurer.

For the general fund, report the same name as the insurer.

3

Private Health Insurer Business Type

• Health insurance business
• Health-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.

Report health-related insurance business where the private health insurer fund type is general fund.

4

Individual Other Insurance Liability Description

Free text

Report the individual other insurance liability description.

5

Individual Other Insurance Liability At 75th POA Amount

Whole dollars

Report the individual other insurance liability at 75th POA amount.

6

Individual Other Insurance Liability At 99.5th POA Amount

Whole dollars

Report the individual other insurance liability at 99.5th POA amount.

1

Private Health Insurer Fund Type

• Health benefits fund
• General 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 an insurer has multiple health benefits funds.

In the event an insurer has only one health benefits fund, the name should be the same as the insurer.

For the general fund, report the same name as the insurer.

3

Class Of Business

• Hospital treatment
• General treatment
• Health-related insurance business

Report the class of business.

Hospital treatment and general treatment do not apply where the private health insurer fund type is general fund.

Report health-related insurance business where the private health insurer fund type is general fund.

4

Future Exposure Risk Charge Period

• Month 1
• Month 2
• Month 3
• Month 4
• Month 5
• Month 6
• Month 7
• Month 8
• Month 9
• Month 10
• Month 11
• Month 12

Report the Future Exposure Risk Charge period.

5

Single Equivalent Units (CE) Count

Whole number

Report the Single Equivalent Units (CE) count.

Report this item only where the class of business is hospital treatment.

6

Accrued Premium (CE) Amount

Whole dollars

Report the accrued premium (CE) amount.

Report this item net of any reinsurance.

7

Claims Incurred (CE) Amount

Whole dollars

Report the claims incurred (CE) amount.

Report this item net of any reinsurance.

8

Gross Deficit (CE) Amount

Whole dollars

Report the gross deficit (CE) amount.

Report this item only where the class of business is hospital treatment.

9

Calculated Deficit (CE) Amount

Whole dollars

Report the calculated deficit (CE) amount.

Report this item only where the class of business is hospital treatment.

10

State Levies (CE) Amount

Whole dollars

Report the state levies (CE) amount.

Report this item only where the class of business is hospital treatment.

11

Management Expenses (CE) Amount

Whole dollars

Report the management expenses (CE) amount.

1

Private Health Insurer Fund Name

Free text

Report the name of the health benefits fund. This is in the event an insurer has multiple health benefits funds.

In the event an insurer has only one health benefits fund, the name should be the same as the insurer.

2

Class Of Business

• Hospital treatment
• General treatment

Report the class of business.

3

Future Exposure Risk Charge Period

• Month 1
• Month 2
• Month 3
• Month 4
• Month 5
• Month 6
• Month 7
• Month 8
• Month 9
• Month 10
• Month 11
• Month 12

Report the Future Exposure Risk Charge period.

4

Single Equivalent Units (AES) Count

Whole number

Report the Single Equivalent Units (AES) count.

Report this item only where the class of business is hospital treatment.

5

Accrued Premium (AES) Amount

Whole dollars

Report the accrued premium (AES) amount.

Report this item net of any reinsurance.

6

Claims Incurred (AES) Amount

Whole dollars

Report the claims incurred (AES) amount.

Report this item net of any reinsurance.

7

Gross Deficit (AES) Amount

Whole dollars

Report the gross deficit (AES) amount.

Report this item only where the class of business is hospital treatment.

8

State Levies (AES) Amount

Whole dollars

Report the state levies (AES) amount.

Report this item only where the class of business is hospital treatment.

9

Management Expenses (AES) Amount

Whole dollars

Report the management expenses (AES) amount.

1

Private Health Insurer Fund Type

• Health benefits fund
• General 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 an insurer has multiple health benefits funds.

In the event an insurer has only one health benefits fund, the name should be the same as the insurer.

For the general fund, report the same name as the insurer.

3

Class Of Business

• Hospital treatment
• General treatment
• Health-related insurance business

Report the class of business.

Hospital treatment and general treatment do not apply where the private health insurer fund type is general fund.

Report health-related insurance business where the private health insurer fund type is general fund.

4

Future Exposure Risk Charge Period

• Month 10
• Month 11
• Month 12

Report the Future Exposure Risk Charge period where management action is possible. That is, only months 10, 11 and 12.

5

Single Equivalent Units (MA) Count

Whole number

Report the Single Equivalent Units (MA) count.

Report this item only where the class of business is hospital treatment.

6

Accrued Premium (MA) Amount

Whole dollars

Report the accrued premium (MA) amount.

Report this item net of any reinsurance.

7

Claims Incurred (MA) Amount

Whole dollars

Report the claims incurred (MA) amount.

Report this item net of any reinsurance.

8

Gross Deficit (MA) Amount

Whole dollars

Report the gross deficit (MA) amount.

Report this item only where the class of business is hospital treatment.

9

State Levies (MA) Amount

Whole dollars

Report the state levies (MA) amount.

Report this item only where the class of business is hospital treatment.

10

Management Expenses (MA) Amount

Whole dollars

Report the management expenses (MA) amount.

1

Private Health Insurer Fund Type

• Health benefits fund
• General 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 an insurer has multiple health benefits funds.

In the event an insurer has only one health benefits fund, the name should be the same as the insurer.

For the general fund, report the same name as the insurer.

3

Private Health Insurer Business Type

• Health insurance business
• Health-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.

Report health-related insurance business where the private health insurer fund type is general fund.

4

Insurance Profits Forecast After Management Actions Amount

Whole dollars

Report the insurance profits forecast after management actions amount.

Insurance profits forecast after management actions amount is to be reported as a positive value, to reflect an addition to the Future Exposure Risk Charge.

5

Discount on Future Exposure Risk Charge Amount

Whole dollars

Report the discount on Future Exposure Risk Charge amount.

Discounts on insurance losses are to be reported as a negative value, to reflect a deduction to the Future Exposure Risk Charge.

1

Private Health Insurer Fund Type

• Health benefits fund
• General 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 an insurer has multiple health benefits funds.

In the event an insurer has only one health benefits fund, the name should be the same as the insurer.

For the general fund, report the same name as the insurer.

3

Private Health Insurer Business Type

• Health insurance business
• Health-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.

Report health-related insurance business where the private health insurer fund type is general fund.

4

DCL at 75th POA Amount

Whole dollars

Report the DCL at 75th POA amount.

5

DCL at 99.5th POA Amount

Whole dollars

Report the DCL at 99.5th POA amount.

6

DCL Aggregation Benefit

Whole dollars

Report the DCL aggregation benefit.

Report a DCL aggregation benefit that would result in decrease in the DCL Risk Charge as a positive value.