Members & Volunteers

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 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”

1. The Doctor charges $45
2. Medicare provides a rebate of $15.35
3. Medicare Gap = $29.65 (our 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.

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 Masters 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.

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.

• Doctor’s Fees
• Surgeon’s Fees
• Anaesthetist Fees
• X-rays
• Public hospital costs
• MRI Scans

You can’t claim if you …

• Play against medical advice
• Have a pre-existing injury
• Are under the influence of alcohol or drugs
• Are involved in a criminal act
• Have a pre-existing illness or disease (i.e. cancer, heart condition)