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Circular No 08/19

General PHIAC Circulars

Notification of changes to PHIAC 1 Form effective from the September quarter 2008

This Circular is to inform Private Health Insurers, their software suppliers and other stakeholders of changes to the PHIAC 1 Form which will be implemented for the September 2008 quarter.

The changes have been requested by private health insurers to provide clarity and more useful information.

The changes will include:

• Part 1, page 2 –cells have been added under general treatment to collect policies and insured persons for General Treatment excluding Hospital-Substitute and CDMP in the six membership categories. Policies and persons with coverage for Hospital Substitute or CDMP but no other general treatment coverage should not be reported in this section.

• Part 3, page 4 –The column titled “Benefits” has been renamed to “Other HT benefits”. Reporting in this column will not change, and will continue to exclude medical treatment and prostheses benefits

• Part 4, page 5 – The column titled “Benefits” has been renamed to “Other H-ST benefits”. Reporting in this column will not change, and will continue to exclude hospital-substitute treatment medical and prostheses benefits

• Part 6, page 7 – Insured persons to be reported only for persons with General Treatment cover excluding cover for Hospital-Substitute and CDMP. If a person has General Treatment cover for Hospital Substitute or CDMP but no other general treatment cover they are not to be included in this section. Insured persons by age group in this section has been changed to be consistent with other data reported in Part 6. The total for male and female must equal total insured persons for General Treatment excluding Hospital-Substitute and CDMP on page 2.

• Part 11, page 12 – totals have been added for No-gap agreement and Known gap agreement to assist in reconciling the PHIAC 1 to PHIAC 4.

The revised PHIAC 1 Form, revised field PHIAC 1 field template and revised PHIAC 1 field mapping are available on PHIAC’s web site on the Forms page. A revised PHIAC 1 validation template and revised PHIAC 1 Guidance will be available in the near future.

Insurers should ensure that their systems are able to incorporate these changes for reporting in the September quarter 2008.