Calisthenics Victoria Members

Medicare is a Commonwealth Government programme that provides eligible Australian residents with free or low-cost medical and hospital care.

Medicare provides access to:

• Free treatment as public (Medicare) patient in public hospital
• Free or subsidised treatment by practitioners such as Doctors or specialists.

The medical benefits schedule (MBS) lists all treatments and Associated MBR relating to Medicare.

You can access the MBS at any time by Medicare’s website. Items commonly used by sports participants that are Medicare listed can include general practitioners, surgeons and anaesthetists.

The MBS lists a rebate amount for each Medicare Item.

Example: A short consultation with a Doctor = Medicare rebate of $15.36

However, doctors or specialists may charge more than the listed MBS amount.

The difference between what is charged and the MBS rebate is called the “Medicare Gap”

1. The Doctor charges $45
2. Medicare provides a rebate of $15.35
3. Medicare Gap = $29.65 (out of pocket expense).

The Health Insurance Act 1973 (Cth) strictly prohibits any general insurer from insuring any item that is listed on the Medicare Benefits Schedule.

This also means that regardless of your out of pocket expenses, it is against the law for the insurer to cover the Medicare Gap.

So what does that mean?

If your medical or other treatment has a Medicare Item number, such as the doctor fee above, it is claimable on Medicare by is uninsurable and you may not claim for reimbursement.

In the example you cannot claim the $29.65.

If your medical or other treatment does not have a Medicare Item Number, you may claim for reimbursement through Marsh. For specific insurance and Risk Protection information please visit the making a claim section of this website.

No, insurers are unable to pay claims already covered under Medicare, including the Medicare gap in accordance with the Health Insurance Act (Cth) 1973.

Personal accident insurance provides coverage for injuries sustained whilst participating in an activity under the following circumstances:

• An official match or training session
• Traveling to and from an official club activity
• Participation in an official club function
• Tours or representative matches

Yes, subject to the policy limits and sub-limits

Yes, the two policies will work together. You need to lodge a claim with your private health insurer first, then submit your claim via Sports cover. Costs that exceed your private health cover may be insured via the Calisthenics Victoria policy. We suggest you contact Sports cover on 1300 134 956 for further details.

Subject to the policy limits and sub-limits you can make more than one claim during the policy period. It is important however, that you obtain a clearance from your treating physician prior to returning to calisthenics.

If your business is not deemed to be a safe environment caused by deliberate neglect, then your policy may become void. In this instance, you are personally liable for the financial burden of the liability claim. Often an excess will be in place. This excess is not covered by the insurance policy.