When it comes to reimbursement of Personal Injury claims, some people get confused about Medicare, the Medicare Gap and what is covered through the National Risk Protection Program.
Medicare is a Commonwealth Government programme 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 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”
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.
Your registration with Tennis Australia provides you with automatic cover for Personal Accident and Public Liability.
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 (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.
There is a fourteen day waiting period on all loss of income claims in accordance with the policy terms and conditions.
The policy provides cover for emergency ambulance transport only, up to $1,000 for any one event with a $50 excess.
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 Tennis 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 playing tennis.
You can’t claim if you …
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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