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General PHIAC Circulars 

 ATTRIBUTION OF CLAIMS COST FOR REPORTING ON THE PHIAC 1 FORM

To achieve consistency in industry practice PHIAC is issuing this circular to clarify when claims costs should be recognized and reported on the PHIAC 1 Form.

Benefits that have been recorded, and liability accepted, during a quarter are to be regarded as paid during that quarter, attributed to risk equalisation where relevant, and reported on the PHIAC 1 Form for that quarter. The physical payment may occur in a later quarter.However, there should not be an unreasonable delay between the date of processing a claim and the date of release of the physical payment. A “reasonable delay” would be regarded as:

• No more than five days for payments directly to policy holders, or

• Agreed / negotiated payment terms in regard to payments directly to providers.

PHIAC believes this process is already widely practiced in the industry. Adoption of the process as an industry practice will aid in achieving wider industry consistency and data comparability.