09/17
Circular No 09/17Contact Officers:
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Circular No 09/17
Replaces Circular: 09/15
01 October 2009
CLARIFICATION OF REPORTING ON THE PHIAC 1 FORM BY INSURED GROUPS
This Circular is to provide clarification to Private Health Insurers of reporting requirements on the PHIAC 1 Form in relation to insured groups, or categories of policies. It has come to PHIAC’s attention that reporting of insured groups, in particular the allocation of policies and persons to ‘Family’ or ‘Single parent’ and ‘3+adults’ is incorrect for some insurers. Variations in reporting appears seasonal in some cases and may be related to movements between student and non-student dependents.
It should be noted that the insured group listed in the Private Health Insurance (Complying Product) Rules 2009 (No. 1) (the Rules) as ‘3 or more people, at least 3 of whom are adults’ is not intended for the reporting of extended dependent policies. Under the definitions in the Private Health Insurance Act 2007 ‘adult’ children dependents are considered children, not adults.
It should also be noted that PHIAC has provided guidance previously in regard to student dependents. On page 4 of the Guidance for completion - PHIAC 1 Returns (see http://www.phiac.gov.au/resources/file/phiac1guidance.pdf is the following:
d) When the status of dependants (eg a student dependant) is temporarily unknown some restricted access funds do not take these dependants off the parent’s policy, although they do not provide cover for them. Due to the restricted nature of the fund, the person may not be able to re-join the fund on a single policy under the rules of the fund if they were taken off the policy. In this case it would not be appropriate to change the policy from Family to 3+Adults.
To clarify reporting requirements for the PHIAC 1 Form the following table shows the required mapping between insured groups from Part 2 (5) of the Private Health Insurance (Complying Product) Rules 2009 (No.2) and the reporting categories on the PHIAC 1 Form.
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Description of insured groups from the Rules
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Mapped to PHIAC 1
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(a) for policies other than a non-student policy (see the Rules for the definition of a non-student policy) or a policy referred to in paragraph (c), the insured groups are:
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(i) only one person;
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Single
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(ii) 2 adults (and no-one else);
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Couple
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(iii) 2 or more people, none of whom is an adult;
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2+ persons no adults
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(iv) 2 or more people, only one of whom is an adult;
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Single parent
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(v) 3 or more people, only 2 of whom are adults;
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Family
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(vi) 3 or more people, at least 3 of whom are adults;
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3+ no adults
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(b) for policies that are a non-student policy (unless the policy is a non-student policy referred to in paragraph (c)), the insured groups are:
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(i) 2 or more people, only one of whom is an adult;
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Single parent
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(ii) 3 or more people, only 2 of whom are adults;
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Family
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(c) for non-student policies which have as conditions of the policy that the dependent child non-student is not covered for general treatment, other than hospital-substitute treatment, and must have his or her own policy with the same insurer covering general treatment (other than hospital-substitute treatment), the insured groups are:
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(i) 2 or more people, only one of whom is an adult;
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Single parent
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(ii) 3 or more people, only 2 of whom are adults.
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Family
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