When it comes to reimbursement of Personal Injury claims, some people get confused about Medicare, the Medicare Gap and what is covered through the National Risk Protection Program.
Medicare is a Commonwealth Government programme that provides eligible Australian residents with free or low-cost medical and hospital care.
Medicare provides access to:
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 an 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 was is charged and the MBS rebate is call the “Medicare Gap”
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.
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Yes, coaches (volunteers or paid) are required to have appropriate qualifications or experience in order to take on a coaching role. Masters Swimming Australia (MSA) has a non-swimmer/coaching/volunteer membership of $10 that coaches should register to cover them under the MSA insurance policy.
Yes they are, however the policy provides cover for ocean swims under certain conditions only. These are:
All activities must take place within 100m of the shore
Members must swim in a group of two or more
Ideally at a patrolled beach with a coach present, but it is understood this is not always possible so this will not affect the cover if not in place.
Yes they are, however the policy provides cover for participation in Open Water Events under certain conditions only. These are:
The event must be a MSA sanctioned event
All activities must take place within 2,500m of the shore
Qualified lifeguards must be on duty at all times whilst participants are swimming in the open water event; and
A safety boat must attend at all times whilst participants are swimming in the open water event
The above conditions must be met in order for the event to be covered by the National Insurance Program.
The clubs should follow the policies and procedures in place at the club with respect as to if medics are required for events.
The insurance policy requires that clubs follow their own policies in this regard. For open water sanctioned events a condition of the insurance policy is that a life guard and safety boat must be in attendance at all times.
No, generally not. The Personal Accident policy can only cover medical costs where there is no Medicare rebate paid.
Legislation states that where a Medicare benefit is payable then no personal accident insurance is able to pay the gap. This means that if an injury requires surgery and the surgeon charges $5,000 and the Medicare rebate is $1,000, the remaining $4,000 that the insured is out of pocket is unable to be claimed under the Personal Accident policy.
Types of things that can be claimed under the policy are: physiotherapy, ambulance costs crutches, wheelchairs, private hospital excess payments among others.
1. Complete an incident report as soon as possible, keep this on file and send a copy to your Masters Swimming Australia branch office.
2. Advise the injured party that as an affiliated club, members are insured by a personal accident policy and provide the Marsh contact details so we are able to assist the claimant with the claims process.
Yes. Social activities run by a club, such as BBQ’s, Trivia Nights and Fundraising events are covered by the National Insurance program. Remember to apply for an Interested Parties certificate if holding Fundraising events alongside an associated partner, such as Bunnings.
You can’t claim if you …
LCPA 22/072
Marsh Advantage Insurance Pty Ltd (ABN 31 081 358 303, AFSL 238369) arranges the insurance and is not the insurer. This page contains general information and does not take into account your individual objectives, financial situation or needs. For full details of the terms, conditions and limitations of the covers, refer to the specific policy wordings and/or Product Disclosure Statements available from Marsh Advantage Insurance (MAI) on request. MAI makes no representation or warranty concerning the application of policy wordings or the financial condition or solvency of insurers or re-insurers. MAI makes no assurances regarding the availability, cost, or terms of insurance coverage.
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