Surf Schools & Participants

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.

In general, all Surfing activities. This includes activities such as Competitions, Training, Social Surfing, Stand Up Paddle Boarding, Body Boarding and all other Surfing related activities (anywhere in Australia).

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.

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

Yes, the two policies can 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 Surfing Australia policy. We suggest you contact Sportscover 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 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.

No, being a participant at a surf school alone does not cover you for personal accident insurance through Surfing Australia and our State bodies. You MUST be a financial State member in order to be covered by the insurance policy.

All staff who are financial State members are covered for Personal Injury Insurance, which is why this is a mandatory requirement of all Surfing Australia coaches to have a financial State membership while coaching. Your business is covered under Public Liability and Professional Indemnity policies as it relates to your business operations.

Yes, if you sustain an injury resulting from a shark attack it will be covered for non-Medicare medical expenses up to a limit of $1,000. The excess for this would also be $20 per claim.

It is important to inform us of any injury or potential claim as soon as you are aware of it. Ideally we need to be made aware of the injury or potential claim within 30 days of the incident occurring.