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 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 what 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.
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.
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Generally, the following expenses are not covered under the personal injury policy:
You also cannot make a claim if you:
In general, all touch football activities are covered. This includes matches, training, functions, meetings and the like (anywhere in Australia).
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 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.
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 $200 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 Touch Football Australia policy.
We suggest you contact Sportscover on 1300 134 956 for further details.
Loss of income is not a standard inclusion under the Touch Football Association personal accident policy, though it can be purchased as an additional benefit. You can check with your club if this cover has been added.
There is a 14-day waiting period on any loss of income claims in accordance with the policy terms and conditions.
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.
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 22/060
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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