Touch Football Players

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.

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

• Doctor’s Fees
• Surgeon’s Fees
• Anaesthetist 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 (i.e. cancer, heart condition)

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.

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.

Loss of Income is not a standard inclusion under the TFA 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 fourteen-day waiting period on any loss of income claims in accordance with the policy terms and conditions.