When it comes to reimbursement of personal injury claims, it is important to understand Medicare, the Medicare gap and what is covered through the National Risk Protection Program.
Medicare is a Commonwealth Government program 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 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 called 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.
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 used above, 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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Generally, the following expenses are not covered under the personal injury policy:
You also cannot make a claim if you:
Your affiliation with your state or territory’s swimming association provides you with automatic cover for personal accident, public liability and management liability.
Check your club’s affiliation status with your state or territory association, if your affiliation has only recently been completed and paid for this may take some time to load on our website. For urgent queries, you can direct your request to Marsh at sport@marsh.com
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.
If your proposed activity involves any of the following, please contact Marsh to ensure that cover can be confirmed with the insurer before the activity: 4WD rallies, jumping castles, water activities, aircraft, fireworks, livestock, rides of any kind, large crowds or events involving security personnel.
Yes, the National Insurance Program extends to cover open water activities, subject to the use of lifeguards, qualified coaches/trainers, appropriate risk assessments and consideration of the weather and ocean conditions.
Yes, prospective or trial members are covered under the insurance program for up to four weeks from initial approach. After the four-week period, they will need to become a member to be covered by the program.
Guests invited on behalf of the club to participate in a swim meet are covered under the insurance program.
Yes, swim meets with affiliated clubs are covered as a club activity under the insurance program.
The club must keep all potential claim or injury information on file for at least seven years after the member has turned 18 years old.
Management liability insurance is only available to incorporated entities. If your club is not incorporated, individual committee members may run the risk of exposing their personal assets.
LCPA 22/059
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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