[WWW - 2023.07.31]

Data Element Detail

Episode of admitted patient care-health insurance fund code
Identifying and Definitional Attributes
QH 041524 v17
Data Element
Data Element
Draft
11-Mar-2021		Current
31-Jan-2023		Superseded
15-May-2023
Standard
Information Management Strategic Governance Committee (IMSGC), Queensland Health
01-Jul-2021
30-Sep-2022
The health insurance fund that the patient is a member of at the start of an episode of admitted patient care, as represented by a code.
Finance revenue - Private health insurance
Health insurance fund code
Representational Attributes
Numeric Character
Code
N(3)
3
3
Permissible Values

Permissible_values

CodeDescription
002Medibank Private Limited
003HCF Hospitals Contribution Fund of Australia Ltd
004NIB Health Funds Limited
005Queensland Country Health Fund
007ACA Health Benefits Fund Ltd
008The Doctors' Health Fund
009AMEX American Express Health Fund
011ANZ Health Insurance
014Austasia Health Services
015Australian Country Health
016ahm Health Insurance
017Australian Health Plans
020Australian Unity Health Limited
021AXA Health Insurance
024BUPA Australia Pty Ltd
026CBHS Health Fund Ltd
027Central West Health Cover
028CDH Benefits Fund
034CUA Health Ltd
036Defence Health
041GE Healthcare
042GMF Health
043GMHBA Ltd
044Government Employees Health Fund
045GU Health
048HBF Health Limited
050Health Care Insurance Limited
052Health Insurance Fund of Australia
053Health Partners Ltd
058Illawarra Health Fund
059International Medical Assistance Network
060Latrobe Health Services
066Mildura District Hospital Fund Limited
071National Health Benefits Australia Pty Ltd
074Navy Health
079Onemedifund
082Peoplecare Health Insurance
083Phoenix Health Fund
085Police Health
086Power Health
090Reserve Bank Health Society Limited
091RT Health Fund Ltd
098St.Lukes Health Ltd
101Teachers Health Fund
102TUH Teachers' Union Health (Qld)
103TIO
106Transport Health Pty Ltd
111Westfund Health
113Frank Health Insurance
115Overseas Travel Insurance
116International Health and Medical Services
117Allianz Global Assistance OSHC
118Australian Pensioner Insurance Agency Health Insurance
119Budget Direct Health Insurance
120CBHS Corporate Health Pty Ltd
121Qantas Assure Health Insurance
122MO Health Pty Ltd
123Suncorp Health Insurance
124Nurses & Midwives Health
125RACQ Health Insurance
126Emergency Services Health
127Union Health
128AIA Health Insurance Pty Ltd
888Other
997No Private Hospital Insurance
Supplementary Values

Supplemenary_values

CodeDescription
998Unknown
Collection and Usage Attributes
Health insurance fund codes are assigned by Finance Branch, and are based on funds identified in the Queensland public hospital system.

Note that a patient with private health insurance may not necessarily have hospital cover and therefore not have cover for their hospital accommodation, prostheses, and medical expenses.
Health insurance fund information should only be provided where a patient has hospital level insurance with their health fund.

Queensland Hospital Admitted Patient Data Collection (QHAPDC):
Transmit via HBCIS extract: Enter the code for the health insurance fund which the patient is currently a member for their hospital insurance. At the time of admission to a facility, it is important to correctly identify and capture a patient's Hospital insurance status (appropriate hospital cover) and (where applicable) the Health insurance fund code.

Health insurance fund code is validated against the data item Hospital insurance status (Y/N).
- If the health insurance fund is supplied and the patient has valid hospital insurance (Hospital Insurance and/or Hospital Insurance plus Extras), Hospital insurance status must be 'Y'.
- If no health insurance fund is supplied and the patient does not have hospital insurance, Hospital insurance status must be 'N'.
- If the health insurance fund is supplied and the patient does not have hospital Insurance, but has exclusions or extras only, Hospital insurance status must be 'N'.
- If the health insurance fund is supplied and the patient has valid hospital insurance, but is on a waiting period, Hospital insurance status must be 'U'. Where 'U' is identified, the waiting period will need to be checked.

Hospital Based Corporate Information System (HBCIS):
Health insurance fund code should be recorded irrespective of whether the patient is admitted as a public or private patient or whether the patient intends to use the insurance for their admission.

When the code for 'Other health fund' is chosen, the "Please Specify" field becomes mandatory to enter free text. A space or spaces will not be acceptable as valid entry in the "Health Fund Code", however, are acceptable in the "Please Specify" field. Any health insurance fund identified through the use of code "other" will provide the opportunity to add new codes to the health insurance fund reference file in future versions.
The Revenue Strategy and Support Unit (RSSU) utilise health insurance fund information for the purpose of optimising health fund revenue.
Relational Attributes
Related Metadata References

Related Metadata References_IR

  • 1 - 7
ViewRelationshipMetadata Item TypeMetadata Item SubtypeNameIdentifier & VersionApproval Status
SupersedesData ElementData ElementEpisode of admitted patient care-health insurance fund codeQH 041524 Version 16Superseded
Has been superseded byData ElementData ElementEpisode of admitted patient care-health insurance fund codeQH 041524 Version 18Current
Is qualified byData ElementDerived Data ElementPatient-hospital insurance status (QHAPDC)QH 040020 Version 3Current
Is supplemented byData ElementData ElementEpisode of admitted patient care-health insurance fund abbreviationQH 041525 Version 16Superseded
Is used in conjunction withData ElementData ElementEpisode of admitted patient care-health insurance fund descriptionQH 042437 Version 2Current
Relates toData ElementData Element ConceptEpisode of admitted patient careQH 041604 Version 1Current
Relates toData ElementData Element ConceptHealth insurance fundQH 041530 Version 1Current
Implementation in Metadata Sets

Implemented

  • 1 - 3
ViewMetadata Item TypeMetadata Item SubtypeNameIdentifer & VersionObligationApproval StatusEffective FromEffective To
Information AssetData CollectionQueensland Hospital Admitted Patient Data Collection (QHAPDC)QH 020001 Version 2ConditionalCurrent01-Jul-202130-Sep-2022
Data Supply RequirementHHS Service AgreementQueensland Hospital Admitted Patient Data Collection (QHAPDC) Public Hospital Services Data Supply Requirement (DSR) 2021-2022QH 020781 Version 1ConditionalSuperseded01-Jul-202130-Jun-2022
Data Supply RequirementHHS Service AgreementQueensland Hospital Admitted Patient Data Collection (QHAPDC) Public Hospital Services Data Supply Requirement (DSR) 2022-2023QH 0140697 Version 1ConditionalCurrent01-Jul-202230-Sep-2022
Source and Reference Attributes
Funding; Health fund; Hospital insurance; Insurance fund;