Accredited coaches

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 by visiting 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”

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.

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 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.

Generally the following expenses are not covered under the personal injury policy:

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

You also cannot make 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 (ie cancer, heart condition)

Please be aware that the insurance arranged by Marsh on behalf of Swimming Australia does not necessarily cover all of the risks and exposures for an individual coach. Some additional insurance policies you may need to consider include:

• Property (fire and perils, burglary etc.)
• General property/portable equipment (used when coaching or in transit)
• Motor vehicle insurance
•  Workers compensation

Please note that if you employ staff or coach activities outside your Swimming Australia accredited coach scope of practice as dictated by your level of accreditation, the policy may not provide cover. Staff and volunteers engaged by coaches must fulfil the state/territory obligations relating to Working with Children Checks.

Please contact Marsh if you have any questions relating to this or would like advice on the insurance listed above.

No – insurance cover provided to coaches under the Swimming Australia insurance program is for approved affiliated club activities only.

Any coaching you do outside of the affiliated club environment may need additional insurance coverage, please refer to the relevant policy schedule and wording for more information. Contact Marsh on 1300 130 373 or sport@marsh.com