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Circular No 09/04

Home » Circulars » 2009 » 09/04

General PHIAC Circulars

Circular No 09/04

Contact Officers:
Paul Collins (02) 6215 7955
email: paul.collins@phiac.gov.au

Replaces Circular: NA

2 March 2009

PDF Format:

Circ 09/04

Notification of changes to PHIAC 1 Form effective from the March 2009 quarter

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 March 2009 quarter.

The intention of these changes is to collect information on the policies and persons with ancillary/extra cover excluding those policies and persons that do not have ancillary extra cover but are classed as general treatment because they have a Hospital-linked Ambulance cover, Hospital substitute cover or CDMP cover. The changes will provide more useful information and enable comparison of current hospital treatment and general treatment membership to hospital and ancillary membership prior to 1 April 2007.

There are no changes to the formats or fields on the PHIAC 1 form, however, some fields have been redefined.

The changes will include:

Part 1, page 2 – the section titled General Treatment excluding Hospital-Substitute and CDMP has been renamed to General Treatment excluding Hospital-Substitute, CDMP and Hospital-linked Ambulance Treatment. Hospital-linked Ambulance Treatment is defined as ambulance cover provided together with hospital treatment cover without any other general treatment (other than Hospital Substitute or CDMP). Policies and persons with coverage for Hospital Substitute, CDMP or Hospital-linked Ambulance, but no other general treatment coverage, should not be reported in this section.

Part 6, page 7 – Insured persons to be reported only for persons with General Treatment cover excluding cover for Hospital-Substitute, CDMP and Hospital-linked Ambulance Treatment. If a person has General Treatment cover for Hospital Substitute, CDMP or Hospital-linked Ambulance Treatment, but no other general treatment cover, they are not to be included in this section.

Note

Services, benefits and fees charged reported in Part 6 exclude hospital substitute and CDMP and continue as ancillary/extras services and fees charged.

Total persons reported in Part 6 must agree with total persons reported in Part 1, page 2 in the section titled General Treatment excluding Hospital-Substitute, CDMP and Hospital-linked Ambulance Treatment.

The revised PHIAC 1 Form with changes to the section titles where the changes have been made is available on PHIAC’s web site on the Forms page. The PHIAC 1 validation template is also available on the Forms page and a revised PHIAC 1 Guidance is available on the Standards page.

Insurers should ensure that their systems are able to incorporate these changes for the March 2009 quarter.