Sporting Clays Australia Association Inc

Medicare is a Commonwealth Government program 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 on 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 call 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 but 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, club fundraising activities are automatically covered under the National Insurance Program. These automatic coverage inclusions would cover things such as Bunnings BBQ’s, Christmas parties or Come and Try days.

However, if your proposed activity involves any of the following, please contact Marsh to ensure that cover can be confirmed with the insurer prior to the activity: 4WD rallies, jumping castles, water activities, aircraft, fireworks, livestock, rides of any kind, large crowds or events involving security personnel.

No, you will be issued with a claim number shortly after the claim has been lodged. This claim number can then be used on any further documentation that needs to be submitted to Sportscover in order to support your claim.

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 training and/or competition.

Negligence is doing something without a reasonable amount of care, or failing to do something which might reasonably have been done to prevent the incident.

When you give your time and energy to a club, you want to make certain you’re not risking your personal or the organisation’s financial security. Therefore, a management liability insurance policy can help provide protection for you and the organisation in the event of legal action if sued for:

• Negligence, libel, slander, defamation, discrimination
• Employment matters (unfair dismissal)
• Club management liability can also cover some of the costs associated with an employee stealing funds from the club.

A management liability policy has important exclusions that you should be aware of including but not limited to:

• Fraud – any claim in consequence of a deliberate fraudulent act
• Insolvency – financial impairment of the insured organisation
• Known dishonesty
• Losses sustained from accounts at banks where only one signatory is required for transactions.

Management liability insurance is ONLY available to incorporated entities. If your club is not incorporated, individual committee members run the risk of exposing their home, car and financial assets.

Directors and officers: Legal action is taken against the club for defamation of a club member. This came about as a result of information printed in the monthly club newsletter.

Employment practices: Legal action is taken against the club for the unfair dismissal of a senior coach.

Employee theft: The club treasurer has been stealing money from the accounts over a period of time and the club now needs to claim the losses.

• Doctor’s fees
• Surgeon’s fees
• Anaesthetist fees
• X-rays
• Public hospital costs
• MRI scans

You can’t claim if you:

• Participate 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)

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

A $50 excess is applicable for each and every non-Medicare medical treatment or emergency transport claim in accordance with the policy terms and conditions.

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