Commonwealth Coat of Arms of Australia

Financial Sector (Collection of Data) (reporting standard) determination No. 1 of 2024

Reporting Standard HRS 601.0 Statistical Data by State

Financial Sector (Collection of Data) Act 2001

 

I, Andrew Robertson, delegate of APRA, under paragraph 13(1)(a) of the Financial Sector (Collection of Data) Act 2001 (the Act) and subsection 33(3) of the Acts Interpretation Act 1901:

 

(a)          revoke Financial Sector (Collection of Data) (reporting standard) determination No. 22 of 2016, including Reporting Standard HRS 601.0 Statistical Data by State made under that Determination; and

 

(b)          determine Reporting Standard HRS 601.0 Statistical Data by State, in the form set out in the Schedule, which applies to the financial sector entities to the extent provided in paragraph 3 of the reporting standard.

 

Under section 15 of the Act, I declare that Reporting Standard HRS 601.0 Statistical Data by State shall begin to apply to those financial sector entities, and the revoked reporting standard shall cease to apply, at the start of the day after the instrument is registered on the Federal Register of Legislation. 

 

This instrument commences at the start of the day after the instrument is registered on the Federal Register of Legislation.

 

Dated: 1 February 2024

 

 

 

Andrew Robertson

General Manager – Chief Data Officer

Technology and Data Division

 

Interpretation

In this Determination:

APRA means the Australian Prudential Regulation Authority.

Federal Register of Legislation means the register established under section 15A of the Legislation Act 2003. 

financial sector entity has the meaning given by section 5 of the Act. 

Schedule

 

Reporting Standard HRS 601.0 Statistical Data by State comprises the document commencing on the following page.

Commonwealth Coat of Arms of Australia

 

Reporting Standard HRS 601.0 

Statistical Data by State

Objective of this Reporting Standard

This Reporting Standard sets out the requirements for the provision of information to APRA allowing for the calculation of the risk equalisation special account and calculation of levies in respect of private health insurers, administered by APRA.  

It includes Form HRF 601.1 Statistical Data – Cover Page, Form HRF 601.1 Statistical Data - by State and associated specific instructions.

 

Authority

  1. This Reporting Standard is made under section 13 of the Financial Sector (Collection of Data) Act 2001.

Purpose

2.             Information collected under this Reporting Standard, as set out in Form HRF 601.1 Statistical Data - by State, is used by APRA for prudential supervision, risk equalisation purposes and for publication.

Application

3.             This Reporting Standard applies to all private health insurers.

4.             This Reporting Standard applies for reporting periods ending on or after
31 March 2024.

Information required

5.             A private health insurer must provide APRA with the information required by  Form HRF 601.1 Statistical Data - by State in respect of each reporting period.

6.             The information required by this Reporting Standard must be provided for:

(a)          each health benefits fund of the private health insurer; and

(b)          in relation to Form HRF 601.1 Statistical Data - by State, each risk equalisation jurisdiction of the health benefits fund[1].

Method of submission

7.             The information required by this Reporting Standard must be given to APRA:

(a)          in electronic format using an electronic method available on APRA’s website; or

(b)          by a method notified by APRA prior to submission.

Reporting periods and due dates

8.             A private health insurer to which this Reporting Standard applies must provide the information required by this Reporting Standard for each calendar quarter (i.e. the periods ending 30 September, 31 December, 31 March and 30 June).

9.             The information required by this Reporting Standard must be provided to APRA within 28 calendar days after the end of the reporting period to which the information relates.[2]

10.         APRA may, in writing, grant a private health insurer an extension of a due date, in which case the new due date for the provision of the information will be the date on the notice of extension.

Quality control

11.         All information provided by a private health insurer under this Reporting Standard must be subject to systems, processes and controls developed by the private health insurer for the internal review and authorisation of that information. It is the responsibility of the Board and senior management of the private health insurer to ensure that an appropriate set of policies and procedures for the authorisation of information submitted to APRA is in place.

Annual audit requirements

12.         By 30 September each year, a private health insurer must give to APRA an auditor’s report relating to:

(a)          the information provided by the private health insurer under this Reporting Standard for each quarter in the year ending 30 June of that year; or

(b)          if the private health insurer provides an amended quarterly return to replace a return referred to in paragraph (a) — the amended quarterly return.

13.         The auditor providing the report to a private health insurer must not be an Officer of, or employed by, the private health insurer.

14.         For the purposes of paragraph 12, the auditor’s report must be addressed to APRA and must set out the auditor’s opinion as to whether:

(a)          the records for the health benefits fund contain the information required to be kept by this Reporting Standard and the Private Health Insurance Risk Equalisation (Administration) Rules 2015;

(b)          the submitted information for the purposes of this Reporting Standard, accurately reflects the information contained in the records of the health benefits fund; and

(c)          the records of the health benefits fund have been accurately compiled so as to permit the private health insurer to fairly state the information required by this Reporting Standard.

15.         If a private health insurer received a qualified auditor’s report for a health benefits fund for the year previous to the year for which the report is provided, the report for the year for which the report is provided must state whether the auditor has examined the issues identified and is satisfied that the private health insurer has taken the appropriate steps to rectify the matters raised in the previous report.

16.         The auditor’s report must:

(a)          state details of the program adopted to carry out the audit; and

(b)          include the name of, and be signed by, the auditor who takes responsibility for the accuracy of the report.

Authorisation

17.         A person who submits the information required under this Reporting Standard must be suitably authorised by an officer of the private health insurer.

Variations

18.         APRA may, in writing, vary the reporting requirements of this Reporting Standard in relation to a private health insurer.

Transitional

19.         A private health insurer must report under the old reporting standard in respect of a transitional reporting period. For these purposes:

old reporting standard means the reporting standard revoked in the determination making this Reporting Standard; and

transitional reporting period means a reporting period under the old reporting standard:

(a)          which ended before 31 March 2024; and

(b)          in relation to which the private health insurer was required, under the old reporting standard, to report by a date on or after the date of revocation of the old reporting standard.

Note: For the avoidance of doubt, if a private health insurer was required to report under an old reporting standard, and the reporting documents were due before the date of revocation of the old reporting standard, the private health insurer is still required to provide any overdue reporting documents in accordance with the old reporting standard.

Interpretation

20.         In this Reporting Standard:

(a)          unless the contrary intention appears, words and expressions have the meanings given to them in Prudential Standard HPS 001 Definitions (HPS 001); and

(b)          APRA means the Australian Prudential Regulation Authority established under the Australian Prudential Regulation Authority Act 1998;

officer has the meaning in the Private Health Insurance (Prudential Supervision) Act 2015;

Private Health Insurance (Health Insurance Business) Rules 2018 means the Private Health Insurance (Health Insurance Business) Rules 2018 dated 1 August 2022 as amended from time to time or any Private Health Insurance (Health Insurance Business) Rules subsequently made by the Minister under section 333-20 of the Private Health Insurance Act 2007;

Private Health Insurance (Medical Devices and Human Tissue Products) Rules (No. 1) 2023 means the Private Health Insurance (Medical Devices and Human Tissue Products) Rules (No. 1) 2023 dated 17 June 2023 as amended from time to time or any Private Health Insurance (Medical Devices and Human Tissue Products) Rules (subsequently made by the Minister under section 333-20 of the Private Health Insurance Act 2007;

private health insurer has the meaning in the Private Health Insurance (Prudential Supervision) Act 2015;

 

reporting period means a period mentioned in paragraph 8;

 

risk equalisation jurisdiction means the risk equalisation jurisdiction as defined in the Private Health Insurance (Prudential Supervision) Act 2015; and

 

risk equalisation special account means the risk equalisation special account as defined in the Private Health Insurance (Prudential Supervision) Act 2015.

 

 

HRF_601_1: Statistical Data - by State

 

 

 

 

 

 

 

 

Australian Business Number

Institution Name

 

 

 

 

Reporting Period

Scale Factor  

 

Quarterly

Whole dollars to two decimal places

 

Reporting Consolidation

 

 

Health Benefits Fund

 

 

 

 

Part 1 Policies and insured persons

 

 

 

 

Single

Family

Single parent

Couple

2+ persons no adults

3+ adults

Total

 

(1)

(2)

(3)

(4)

(5)

(6)

(7)

 

1. Total hospital treatment (includes hospital treatment only and hospital treatment and general treatment combined)

 

 

 

1.1. Policies

 

 

 

 

 

 

 

1.1.1. Exclusionary policies

 

 

 

 

 

 

 

1.1.1.1. Excess & co-payments

 

 

 

 

 

 

 

1.1.1.2. No excess & no co-payments

 

 

 

 

 

 

 

1.1.1.3. Total exclusionary policies

 

 

 

 

 

 

 

1.1.2. Non-exclusionary policies

 

 

 

 

 

 

 

1.1.2.1. Excess & co-payments

 

 

 

 

 

 

 

1.1.2.2. No excess & no co-payments

 

 

 

 

 

 

 

1.1.2.3. Total non-exclusionary policies

 

 

 

 

 

 

 

1.2. Total policies

 

 

 

 

 

 

 

1.3. Insured persons

 

 

 

 

 

 

 

1.3.1. Exclusionary policies

 

 

 

 

 

 

 

1.3.1.1. Excess & co-payments

 

 

 

 

 

 

 

1.3.1.2. No excess & no co-payments

 

 

 

 

 

 

 

1.3.1.3. Total exclusionary policies

 

 

 

 

 

 

 

1.3.2. Non-exclusionary policies

 

 

 

 

 

 

 

1.3.2.1. Excess & co-payments

 

 

 

 

 

 

 

1.3.2.2. No excess & no co-payments

 

 

 

 

 

 

 

1.3.2.3. Total non-exclusionary policies

 

 

 

 

 

 

 

1.4. Total insured persons

 

 

 

 

 

 

 

2. Hospital treatment only

 

 

 

 

 

 

 

2.1. Policies

 

 

 

 

 

 

 

2.1.1. Exclusionary policies

 

 

 

 

 

 

 

2.1.1.1. Excess & co-payments

 

 

 

 

 

 

 

2.1.1.2. No excess & no co-payments

 

 

 

 

 

 

 

2.1.1.3. Total exclusionary policies

 

 

 

 

 

 

 

2.1.2. Non-exclusionary policies

 

 

 

 

 

 

 

2.1.2.1. Excess & co-payments

 

 

 

 

 

 

 

2.1.2.2. No excess & no co-payments

 

 

 

 

 

 

 

2.1.2.3. Total non-exclusionary policies

 

 

 

 

 

 

 

2.2. Total policies

 

 

 

 

 

 

 

2.3. Insured persons

 

 

 

 

 

 

 

2.3.1. Exclusionary policies

 

 

 

 

 

 

 

2.3.1.1. Excess & co-payments

 

 

 

 

 

 

 

2.3.1.2. No excess & no co-payments

 

 

 

 

 

 

 

2.3.1.3. Total exclusionary policies

 

 

 

 

 

 

 

2.3.2. Non-exclusionary policies

 

 

 

 

 

 

 

2.3.2.1. Excess & co-payments

 

 

 

 

 

 

 

2.3.2.2. No excess & no co-payments

 

 

 

 

 

 

 

2.3.2.3. Total non-exclusionary policies

 

 

 

 

 

 

 

2.4. Total insured persons

 

 

 

 

 

 

 

 

3. Hospital treatment and general treatment combined

 

 

 

 

 

 

 

3.1. Policies

 

 

 

 

 

 

 

3.1.1. Exclusionary policies

 

 

 

 

 

 

 

3.1.1.1. Excess & co-payments

 

 

 

 

 

 

 

3.1.1.2. No excess & no co-payments

 

 

 

 

 

 

 

3.1.1.3. Total exclusionary policies

 

 

 

 

 

 

 

3.1.2. Non-exclusionary policies

 

 

 

 

 

 

 

3.1.2.1. Excess & co-payments

 

 

 

 

 

 

 

3.1.2.2. No excess & no co-payments

 

 

 

 

 

 

 

3.1.2.3. Total non-exclusionary policies

 

 

 

 

 

 

 

3.2. Total policies

 

 

 

 

 

 

 

3.3. Insured persons

 

 

 

 

 

 

 

3.3.1. Exclusionary policies

 

 

 

 

 

 

 

3.3.1.1. Excess & co-payments

 

 

 

 

 

 

 

3.3.1.2. No excess & no co-payments

 

 

 

 

 

 

 

3.3.1.3. Total exclusionary policies

 

 

 

 

 

 

 

3.3.2. Non-exclusionary policies

 

 

 

 

 

 

 

3.3.2.1. Excess & co-payments

 

 

 

 

 

 

 

3.3.2.2. No excess & no co-payments

 

 

 

 

 

 

 

3.3.2.3. Total non-exclusionary policies

 

 

 

 

 

 

 

3.4. Total insured persons

 

 

 

 

 

 

 

4. General treatment ambulance only

 

 

 

 

 

 

 

4.1.1. Policies

 

 

 

 

 

 

 

4.1.2. Insured persons

 

 

 

 

 

 

 

5. Total general treatment only

 

 

 

 

 

 

 

5.1.1. Policies

 

 

 

 

 

 

 

5.1.2. Insured persons

 

 

 

 

 

 

 

 

6. General treatment excluding hospital-substitute, CD MP and hospital-linked ambulance treatment

 

 

 

 

 

 

 

6.1.1. Policies

 

 

 

 

 

 

 

6.1.2. Insured persons

 

 

 

 

 

 

 

7. Total general treatment

 

 

 

 

 

 

 

7.1.1. Policies

 

 

 

 

 

 

 

7.1.2. Insured persons

 

 

 

 

 

 

 

 

 

Changes during the quarter

 

 

 

 

Hospital treatment only

Hospital treatment and general treatment

General treatment only

 

 

Policies

Insured persons

Policies

Insured persons

Policies

Insured persons

 

 

(1)

(2)

(3)

(4)

(5)

(6)

 

8. Start of quarter

 

 

 

 

 

 

 

9. New policies/persons

 

 

 

 

 

 

 

10. Transferring from another state

 

 

 

 

 

 

 

11. Transferring to another state

 

 

 

 

 

 

 

12.   Transferring from another fund

 

 

 

 

 

 

 

13. Transferring from another policy

 

 

 

 

 

 

 

14. Transferring to another policy

 

 

 

 

 

 

 

15. Discontinued

 

 

 

 

 

 

 

16. End of quarter

 

 

 

 

 

 

 

 

 

Part 2 Total benefits paid for hospital treatment and hospital-substitute treatment

 

 

 

Total benefits for hospital treatment and hospital-substitute treatment

 

 

 

 

Episodes

Days

Benefits paid

 

 

(1)

(2)

(3)

 

 

 

 

17. Day hospital

 

 

 

 

18. Public hospitals

 

 

 

 

18.1. Day only

 

 

 

 

18.2. Overnight

 

 

 

 

19. Private hospitals

 

 

 

 

19.1. Day only

 

 

 

 

19.2. Overnight

 

 

 

 

20. Hospital-substitute day only

 

 

 

 

21. Treatment greater than one day

 

 

 

 

22. Total

 

 

 

 

23. Nursing home type patients

 

 

 

 

23.1. Public hospitals

 

 

 

 

23.2. Private hospitals

 

 

 

 

23.3. Total nursing home type patients

 

 

 

 

 

 

 

Number

Benefits paid

 

 

(1)

(2)

 

 

 

 

 

24. Medical benefits

 

 

 

25. Medical devices or human tissue products benefits

 

 

 

26. Total Chronic Disease Management Programs

 

 

 

 

 

 

Benefits paid

 

27. Total benefits paid for general treatment

 

 

28. Ineligible hospital benefits

 

 

29. Total benefits paid for hospital treatment and general treatment

 

 

 

 

 

High Cost Claimants Pool

 

 

 

 

 

30. Number of HCCP claimants (current quarter)

 

 

31. Gross benefits for current and preceding 3 quarters (for current quarter HCCP claimants)

 

 

32. Net benefits for current and preceding 3 quarters for HCCP claimants - after ABP

 

 

33. Net benefits above threshold for current and preceding 3 quarters (for current quarter HCCP claimants)

 

 

34. Total benefits to be included in HCCP (current quarter)

 

 

 

 

Part 3 Hospital treatment by age category

 

 

 

Hospital treatment by age category

 

 

 

35. Males

 

 

 

Age group

Insured persons

Episodes

Days

Other HT benefits

Medical benefits

Medical devices or human tissue products benefits

Fees excluding Medicare benefit

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

0-4

 

 

 

 

 

 

 

5-9

 

 

 

 

 

 

 

10-14

 

 

 

 

 

 

 

15-19

 

 

 

 

 

 

 

20-24

 

 

 

 

 

 

 

25-29

 

 

 

 

 

 

 

30-34

 

 

 

 

 

 

 

35-39

 

 

 

 

 

 

 

40-44

 

 

 

 

 

 

 

45-49

 

 

 

 

 

 

 

50-54

 

 

 

 

 

 

 

55-59

 

 

 

 

 

 

 

60-64

 

 

 

 

 

 

 

65-69

 

 

 

 

 

 

 

70-74

 

 

 

 

 

 

 

75-79

 

 

 

 

 

 

 

80-84

 

 

 

 

 

 

 

85-89

 

 

 

 

 

 

 

90-94

 

 

 

 

 

 

 

95+

 

 

 

 

 

 

 

 

 

35.1. Total males

 

 

 

 

 

 

 

 

 

36. Females

 

 

 

Age group

Insured persons

Episodes

Days

Other HT benefits

Medical benefits

Medical devices or human tissue products benefits

Fees excluding Medicare benefit

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

0-4

 

 

 

 

 

 

 

5-9

 

 

 

 

 

 

 

10-14

 

 

 

 

 

 

 

15-19

 

 

 

 

 

 

 

20-24

 

 

 

 

 

 

 

25-29

 

 

 

 

 

 

 

30-34

 

 

 

 

 

 

 

35-39

 

 

 

 

 

 

 

40-44

 

 

 

 

 

 

 

45-49

 

 

 

 

 

 

 

50-54

 

 

 

 

 

 

 

55-59

 

 

 

 

 

 

 

60-64

 

 

 

 

 

 

 

65-69

 

 

 

 

 

 

 

70-74

 

 

 

 

 

 

 

75-79

 

 

 

 

 

 

 

80-84

 

 

 

 

 

 

 

85-89

 

 

 

 

 

 

 

90-94

 

 

 

 

 

 

 

95+

 

 

 

 

 

 

 

 

 

36.1. Total females

 

 

 

 

 

 

 

 

 

Part 4 Hospital-substitute treatment by age category

 

 

 

Hospital-substitute treatment by age category

 

 

 

37. Males

 

 

 

Age group

Insured persons

Episodes

Days

Other H-ST benefits

Medical benefits

Medical devices or human tissue products benefits

Fees excluding Medicare benefit

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

0-4

 

 

 

 

 

 

 

5-9

 

 

 

 

 

 

 

10-14

 

 

 

 

 

 

 

15-19

 

 

 

 

 

 

 

20-24

 

 

 

 

 

 

 

25-29

 

 

 

 

 

 

 

30-34

 

 

 

 

 

 

 

35-39

 

 

 

 

 

 

 

40-44

 

 

 

 

 

 

 

45-49

 

 

 

 

 

 

 

50-54

 

 

 

 

 

 

 

55-59

 

 

 

 

 

 

 

60-64

 

 

 

 

 

 

 

65-69

 

 

 

 

 

 

 

70-74

 

 

 

 

 

 

 

75-79

 

 

 

 

 

 

 

80-84

 

 

 

 

 

 

 

85-89

 

 

 

 

 

 

 

90-94

 

 

 

 

 

 

 

95+

 

 

 

 

 

 

 

 

 

37.1. Total males

 

 

 

 

 

 

 

 

 

38. Females

 

 

 

Age group

Insured persons

Episodes

Days

Other H-ST benefits

Medical benefits

Medical devices or human tissue products benefits

Fees excluding Medicare benefit

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

0-4

 

 

 

 

 

 

 

5-9

 

 

 

 

 

 

 

10-14

 

 

 

 

 

 

 

15-19

 

 

 

 

 

 

 

20-24

 

 

 

 

 

 

 

25-29

 

 

 

 

 

 

 

30-34

 

 

 

 

 

 

 

35-39

 

 

 

 

 

 

 

40-44

 

 

 

 

 

 

 

45-49

 

 

 

 

 

 

 

50-54

 

 

 

 

 

 

 

55-59

 

 

 

 

 

 

 

60-64

 

 

 

 

 

 

 

65-69

 

 

 

 

 

 

 

70-74

 

 

 

 

 

 

 

75-79

 

 

 

 

 

 

 

80-84

 

 

 

 

 

 

 

85-89

 

 

 

 

 

 

 

90-94

 

 

 

 

 

 

 

95+

 

 

 

 

 

 

 

 

 

38.1. Total females

 

 

 

 

 

 

 

 

 

Part 5 Chronic Disease Management Program by age category

 

 

 

Chronic Disease Management Program by age category

 

 

 

39. Males

 

 

 

Age group

Insured persons

Programs

Eligible benefits

Ineligible benefits

Total benefits

Fees excluding Medicare benefit

 

(1)

(2)

(3)

(4)

(5)

(6)

(7)

 

0-4

 

 

 

 

 

 

 

5-9

 

 

 

 

 

 

 

10-14

 

 

 

 

 

 

 

15-19

 

 

 

 

 

 

 

20-24

 

 

 

 

 

 

 

25-29

 

 

 

 

 

 

 

30-34

 

 

 

 

 

 

 

35-39

 

 

 

 

 

 

 

40-44

 

 

 

 

 

 

 

45-49

 

 

 

 

 

 

 

50-54

 

 

 

 

 

 

 

55-59

 

 

 

 

 

 

 

60-64

 

 

 

 

 

 

 

65-69

 

 

 

 

 

 

 

70-74

 

 

 

 

 

 

 

75-79

 

 

 

 

 

 

 

80-84

 

 

 

 

 

 

 

85-89

 

 

 

 

 

 

 

90-94

 

 

 

 

 

 

 

95+

 

 

 

 

 

 

 

 

 

39.1. Total males

 

 

 

 

 

 

 

 

 

40. Females

 

 

 

Age group

Insured persons

Programs

Eligible benefits

Ineligible benefits

Total benefits

Fees excluding Medicare benefit

 

(1)

(2)

(3)

(4)

(5)

(6)

(7)

 

0-4

 

 

 

 

 

 

 

5-9

 

 

 

 

 

 

 

10-14

 

 

 

 

 

 

 

15-19

 

 

 

 

 

 

 

20-24

 

 

 

 

 

 

 

25-29

 

 

 

 

 

 

 

30-34

 

 

 

 

 

 

 

35-39

 

 

 

 

 

 

 

40-44

 

 

 

 

 

 

 

45-49

 

 

 

 

 

 

 

50-54

 

 

 

 

 

 

 

55-59

 

 

 

 

 

 

 

60-64

 

 

 

 

 

 

 

65-69

 

 

 

 

 

 

 

70-74

 

 

 

 

 

 

 

75-79

 

 

 

 

 

 

 

80-84

 

 

 

 

 

 

 

85-89

 

 

 

 

 

 

 

90-94

 

 

 

 

 

 

 

95+

 

 

 

 

 

 

 

 

 

40.1. Total females

 

 

 

 

 

 

 

 

 

Part 6 General treatment excluding hospital-substitute, CDMP and hospital-linked ambulance treatment

 

 

 

General treatment by age category

 

 

 

41. Males

 

Age group

Insured persons

Services

Benefits

Fees charged

 

(1)

(2)

(3)

(4)

(5)

 

 

 

0-4

 

 

 

 

 

5-9

 

 

 

 

 

10-14

 

 

 

 

 

15-19

 

 

 

 

 

20-24

 

 

 

 

 

25-29

 

 

 

 

 

30-34

 

 

 

 

 

35-39

 

 

 

 

 

40-44

 

 

 

 

 

45-49

 

 

 

 

 

50-54

 

 

 

 

 

55-59

 

 

 

 

 

60-64

 

 

 

 

 

65-69

 

 

 

 

 

70-74

 

 

 

 

 

75-79

 

 

 

 

 

80-84

 

 

 

 

 

85-89

 

 

 

 

 

90-94

 

 

 

 

 

95+

 

 

 

 

 

 

 

41.1. Total males

 

 

 

 

 

 

 

42. Females

 

 

 

Age group

Insured persons

Services

Benefits

Fees charged

 

(1)

(2)

(3)

(4)

(5)

 

 

 

0-4

 

 

 

 

 

5-9

 

 

 

 

 

10-14

 

 

 

 

 

15-19

 

 

 

 

 

20-24

 

 

 

 

 

25-29

 

 

 

 

 

30-34

 

 

 

 

 

35-39

 

 

 

 

 

40-44

 

 

 

 

 

45-49

 

 

 

 

 

50-54

 

 

 

 

 

55-59

 

 

 

 

 

60-64

 

 

 

 

 

65-69

 

 

 

 

 

70-74

 

 

 

 

 

75-79

 

 

 

 

 

80-84

 

 

 

 

 

85-89

 

 

 

 

 

90-94

 

 

 

 

 

95+

 

 

 

 

 

 

 

42.1. Total females

 

 

 

 

 

 

 

Part 7 Total hospital treatment policies by type of cover

 

 

 

Total hospital treatment policies

 

 

 

43. Number of policies

 

 

 

 

Full cover

Reduced cover but no lifetime exclusions

Reduced cover and some lifetime exclusions

Some lifetime exclusions but no reduced cover

Total

 

 

(1)

(2)

(3)

(4)

(5)

 

 

43.1. Excess & co-payments

 

 

 

 

 

 

NIL

 

 

 

 

 

 

<= $500/$1,000 (*)

 

 

 

 

 

 

> $500/$1,000 (*)

 

 

 

 

 

 

43.2. Total

 

 

 

 

 

 

 

 

(*) Excess <= $500 per policy covering only one person and excess <=$1,000 for all other policies  

 

(**) Excess > $500 per policy covering only one person and excess > $1,000 for all other policies

 

 

 

 

 

General treatment claims processing for the state (excluding hospital-substitute treatment and CDMP)

 

 

 

44. Percent of claims processed within five working days

 

 

 

 

National retention index - hospital treatment policy holders

 

 

 

45. Percent of policies existing two years or more that are still in force

 

 

 

 

Part 8 Benefits paid for Chronic Disease Management Programs

 

 

 

46. Benefits paid for CDMPs

 

 

 

CDMP deliverables

Services

Benefits

Fees charged

 

(1)

(2)

(3)

(4)

 

 

 

 

Planning

 

 

 

 

Coordination

 

 

 

 

Allied Health Services

 

 

 

 

Other  

 

 

 

 

 

 

46.1. Total CDMPs

 

 

 

 

47. Benefits paid by program type

 

 

 

 

 

Type of CDMP

Programs

Benefits

Fees charged

 

(1)

(2)

(3)

(4)

 

 

 

 

Risk factors for chronic disease

 

 

 

 

Cardiovascular

 

 

 

 

Diabetes

 

 

 

 

Mental Health

 

 

 

 

Other (specify)

 

 

 

 

 

 

47.1. Total by program type

 

 

 

 

 

 

Part 9 Benefits paid for general treatment (excluding hospital-substitute treatment and CDMP)

 

 

 

48. Type of treatment by service type

 

 

 

Service type

Services

Benefits

Fees charged

 

(1)

(2)

(3)

(4)

 

 

 

 

Accidental Death / Funeral Expenses

 

 

 

 

Acupuncture / Acupressure

 

 

 

 

Ambulance

 

 

 

 

Chiropractic

 

 

 

 

Community, Home, District Nursing

 

 

 

 

Dental

 

 

 

 

Dietetics

 

 

 

 

Domestic Assistance  

 

 

 

 

Ex gratia Payments

 

 

 

 

Preventative Health Products/Health Management Program

 

 

 

 

Hearing Aids and Audiology

 

 

 

 

Hypnotherapy

 

 

 

 

Maternity Services

 

 

 

 

Natural Therapies

 

 

 

 

Occupational Therapy

 

 

 

 

Optical

 

 

 

 

Orthoptics (Eye Therapy)

 

 

 

 

Osteopathic Services

 

 

 

 

Overseas

 

 

 

 

Pharmacy

 

 

 

 

Physiotherapy

 

 

 

 

Podiatry (Chiropody)

 

 

 

 

Medical devices or human tissue products, Aids and Appliances

 

 

 

 

Psych/Group Therapy

 

 

 

 

School

 

 

 

 

Sickness and Accident

 

 

 

 

Speech Therapy

 

 

 

 

Theatre Fees

 

 

 

 

Travel and Accommodation

 

 

 

 

 

 

 

 

 

 

48.1. Other (please specify)

 

 

 

 

Description

Services

Benefits

Fees charged

 

(1)

(2)

(3)

(4)

 

 

 

 

 

 

 

 

 

 

 

48.2. Total general treatment

 

 

 

 

 

 

Part 10 Lifetime Health Cover

 

 

 

49. Number of adults with hospital cover

 

 

 

Certified age at entry

Male

Female

Male LHC loading removed

Female LHC loading removed

LHC Loading %

 

 

(1)

(2)

(3)

(4)

 

 

 

30

 

 

 

 

0%

 

31

 

 

 

 

2%

 

32

 

 

 

 

4%

 

33

 

 

 

 

6%

 

34

 

 

 

 

8%

 

35

 

 

 

 

10%

 

36

 

 

 

 

12%

 

37

 

 

 

 

14%

 

38

 

 

 

 

16%

 

39

 

 

 

 

18%

 

40

 

 

 

 

20%