Age Based Discount Percentages | Means the age based discount percentage applicable. - If an age based discount of 2% applies, report 2%.
- If an age based discount of 4% applies, report 4%.
- If an age based discount of 6% applies, report 6%.
- If an age based discount of 8% applies, report 8%.
- If an age based discount of 10% applies, report 10%.
- If an age based discount does not apply, report Not Applicable.
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Basic (private hospital insurance product tier type) | Means a health insurance policy (policy) that: a) covers hospital treatment; b) covers at least the treatments in all of the clinical categories indicated for a basic policy in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015; and c) is not a Gold, Silver, or Bronze policy. |
Bronze (private hospital insurance product tier type) | Means a policy that: a) covers hospital treatment; b) covers at least the treatments in all of the clinical categories indicated for a bronze policy in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015; and c) is not a Gold or Silver policy. |
Couple (policy cover type) | Means a policy under which two adults are insured (and no-one else). |
Day (length of treatment type) | Means the treatment is one day only. |
Day (private hospital type) | Means a private hospital that is not licensed or otherwise permitted to provide treatment that includes part of an overnight stay at a hospital. |
Discontinued (policy or person movement) | Means policies and insured persons leaving the health fund. Represents the balancing item for the aggregate fund coverage from one quarter to the next. This includes: - deaths (decrease in insured persons, not necessarily policies); and
- suspended policies, where they are not included in the coverage count for risk equalisation purposes.
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Excess Amount | Means an amount of money a policy holder agrees to pay before private health insurance benefits are payable. An excess amount may be capped at a total amount for the year. For taxation purposes those taxpayers who would be subject to the Medicare Levy Surcharge are exempted if they have a hospital treatment policy with an excess amount no greater than $750 for a policy covering a single person or an excess amount no greater than $1,500 for a policy covering more than one person. Excess policies includes all policy holders who contribute to hospital treatment policies under which an agreed, excess amount is paid by the policy holder for hospital treatment and/or general treatment services, reducing the benefit otherwise payable in exchange for lower premium costs. Excess amount (front-end deductible) An excess amount is an amount of money a policy holder agrees to pay for a hospital stay before health fund benefits are payable. For example, if a policy has an excess amount of $200, the insured person will be required to pay the first $200 of the hospital costs if they go to hospital as a private patient. An excess amount could apply every time the insured person goes to hospital in a year, or it may be capped at a total amount that will be paid in each year. |
Family (policy cover type) | Means a policy under which three or more people are insured, only two of whom are adults. |
Female (sex) | Means persons who have female or predominantly feminine biological characteristics, or female sex assigned at birth. |
General Treatment | Has the meaning given by the Private Health Insurance Act 2007 (PHI Act). |
General Treatment Only (policy treatment type) | Means a policy that does not cover hospital treatment or hospital-substitute treatments. |
Gold (private hospital insurance product tier type) | Means a policy that: a) covers hospital treatment; and b) covers the treatments in all of the clinical categories indicated for a gold policy in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015. |
Hospital Cover Travel And Accommodation (hospital and hospital substitute treatment type) | Means accommodation expenses for a parent/partner to accompany a patient who is an in-patient of a public or private hospital. It is also in relation to travel costs where a patient receives treatment at a hospital more than a specified distance from a patient’s home and in circumstances where the patient chooses not to be an in-patient. These benefits should be recorded against the private health insured person age of the patient, not the parent/partner. |
Hospital And General Treatment Combined (policy treatment type) | Means a policy that covers hospital and general treatments. |
Hospital Treatment | Has the meaning given by the PHI Act. |
Hospital Treatment Only (policy treatment type) | Means a policy that covers only hospital treatments. |
Male (sex) | Means persons who have male or predominantly masculine biological characteristics, or male sex assigned at birth. |
Medical Services (hospital and hospital substitute treatment type) | Means benefits paid for medical services provided as part of hospital treatment or hospital-substitute treatment if a Medicare benefit is payable for the service. |
New (policy or person movement) | Means the policy or insured person has joined but has not transferred from another fund. |
Not Applicable (Hospital And Hospital Substitute Treatment Type) | Means the hospital and hospital substitute treatment type does not apply. |
Not Applicable (Length Of Treatment Type) | Means the length of treatment type does not apply. |
Not Applicable (private hospital type) | Means a public hospital or a hospital substitute facility. |
Not Applicable (private hospital insurance product tier type) | Means the private hospital insurance product tier type does not apply. |
Not Day (private hospital type) | Means a private hospital that is licensed or otherwise permitted to provide treatment that includes part of an overnight stay at a hospital. |
Not Stated Or Inadequately Described (sex) | Means the sex of a person is not stated or is inadequately described. |
Other (hospital and hospital substitute treatment type) | Means a treatment other than Medical Services, Medical Devices Or Human Tissue Products, or Hospital Cover Travel And Accommodation. |
Other (sex) | Means persons who have mixed or non-binary biological characteristics (if known), or a non-binary sex assigned at birth. |
Overnight (length of treatment type) | Means the treatment involves more than one day. |
Persons Movement Count | Means the count of insured persons movements. Includes changes in the policy cover type. |
Policy | Means a health insurance policy. |
Policy Treatment Type | Means the type of treatment covered by a policy. The policy treatment types are: - General Treatment Only;
- Hospital And General Treatment Combined; and
- Hospital Treatment Only.
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Policy Cover Type | Means the type and number of people covered by a policy. The policy cover types are: - Single;
- Family;
- Single Parent;
- Couple;
- Two Plus Persons No Adults; and
- Three Plus Adults.
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Private Health Insured Person Age | Means the age of the insured person at the date of treatment, or where no treatment is provided, the age of the person at the end of the reporting period. Where an insured person changes age during an episode: a) the episode is to be reported in the age that the episode was finalised; b) the days and benefits are to be reported for the age in which they were incurred (e.g. a 20 day episode with an accommodation cost of $200 per day, where the insured person turned 50 on day 4, is reported as: 1 episode under 50, 3 days under 49 and 17 days under 50, $600 under 49 and $3,400 under 50) Note: apportionment of benefits by the number of days in each age only relates to the case where the treatment covers more than one age, for example an invoice is received for accommodation for a period where the person had a number of days in one age and a number of days in another age. In the case where individual treatments are paid during a single episode where the person moves from one age to another the benefits paid for those treatments should be reported against the age of the person as at the date of the treatment. Do not sum all benefits paid over an episode spanning two ages and then apportion them over the ages; and c) services are reported under the age at the date of treatment. |
Private Hospital Insurance Product Tier Type | Means the private hospital insurance product tiers as listed in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015. The private hospital insurance product tier types are: - Basic;
- Bronze;
- Silver; and
- Gold.
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Medical Devices Or Human Tissue Products (hospital and hospital substitute treatment type) | Means a treatment related to medical devices or human tissue products of the kinds listed in the Rules made under item 4 of the table in section 333-20 of the PHI Act. |
Risk Equalisation Jurisdiction | Means the risk equalisation jurisdiction as defined in the Private Health Insurance (Prudential Supervision) Act 2015. The jurisdictions are: - New South Wales (NSW);
- Victoria (VIC);
- Queensland (QLD);
- South Australia (SA);
- Western Australia (WA);
- Tasmania (TAS);
- Australian Capital Territory (ACT); and
- Northern Territory (NT).
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Silver (private hospital insurance product tier type) | Means a policy that: a) covers hospital treatment; b) covers at least the treatments in all of the clinical categories indicated for a silver policy in Schedule 4 of the Private Health Insurance (Complying Product) Rules 2015; and c) is not a Gold policy. |
Sex | Means the distinction between male, female, and others who do not have biological characteristics typically associated with either the male or female sex. |
Single (policy cover type) | Means a policy under which only one person is insured. |
Single Parent (policy cover type) | Means a policy under which two or more people are insured, only one of whom is an adult. |
Three Plus Adults (policy cover type) | Means a policy under which three or more people are insured, at least three of whom are adults. |
Transfer From Another Fund (policy or person movement) | Means the policy or insured person has transferred from another fund but is not joining as a new fund member to private health insurance. |
Transfer From Another Policy (policy or person movement) | Means the policy or insured person has transferred from another policy treatment type with the same insurer. Transfer from another policy refers to transfers between the treatment types of hospital treatment only, hospital treatment and general treatment combined and general treatment only. Note that a change in the policy cover type (e.g. single to couple) does not constitute a change in treatment policy. |
Transfer From Another State (policy or person movement) | Means the policy or insured person has transferred from another state within the same fund. |
Transfer To Another Policy (policy or person movement) | Means the policy or insured person has transferred to another policy treatment type with the same insurer. Transfer to another policy refers to transfers between the treatment types of hospital treatment only, hospital treatment and general treatment combined and general treatment only. Note that a change in the policy cover type (e.g. single to couple) does not constitute a change in treatment policy. |
Transfer To Another State (policy or person movement) | Means the policy or insured person has transferred to another state within the same fund. |
Two Plus Persons No Adults (policy cover type) | Means a policy under which two or more people are insured, none of whom is an adult. |
Waiting Period | The waiting period for a benefit under an insurance policy is the period: - starting at the time the person becomes insured under the policy; and
- ending at the time specified in policy;
during which the person is not entitled to the benefit. |
