Non-Medicare Medical Benefits

The section provides payment of 100% of Non-Medicare Medical Expenses after any reimbursement from your Private Health fund. A $100 excess applies once per Injury and the maximum benefit payable is $3,000. If claiming for Ambulance ONLY, then no excess is payable.

This benefit covers only expenses that are not covered by the Medicare Act 1973. i.e. expenses for which there is no full or partial Medicare rebate. Commonwealth Legislation prevents insurers, other than a registered private health insurer (BUPA, HCF, Medibank Private etc.) from insuring the Medicare Gap.

It is a requirement for claimants to submit all Non-Medicare medical expenses to their private health insurer initially and then submit a copy of the receipt and the applicable Health Insurance benefit statement showing any health fund rebate received as part of your claim.

It should also be noted that claimants need to obtain and follow medical advice from a doctor as soon as possible following an injury and obtain a doctor’s referral (if appropriate) before commencing treatment in order to be eligible to claim reimbursement of expenses such as physiotherapy, chiropractic, osteopathic, acupuncture, exercise physiology, remedial massage or similar treatments.

Examples of expenses that are generally claimable under this section are -
  • Private hospital accommodation
  • Physiotherapy and chiropractic treatment
  • Pharmacy
  • Ambulance
  • Dental
  • Hire of artificial aids such as orthotics, splints, crutches
Examples of expenses that are not claimable under this section include -
  • Doctors fees.
  • Surgeon and anaesthetists fees
  • X-Ray costs
 

The Health Insurance Act 1973 (Cth) prohibits general insurers from covering any item that is listed on the Medicare Benefits Schedule. This includes any out of pocket expenses you may incur following a doctor’s visit, it is against the law for the Insurer to cover you for the Medicare Gap.

For information on the Medicare Benefits Schedule – visit www.medicare.gov.au

Weekly Loss of Income Benefit

This section provides a loss of income benefit to insured persons that suffer an injury and are temporarily totally disabled from performing an occupation.

Percentage of income claimable 100%
Maximum Weekly benefit $300 per week
Excess 28 days
Maximum Benefit Period 52 weeks

Your average weekly income which can be claimed under the policy is net of business expenses and excluding bonuses, commissions, overtime payments and other allowances.

It should be noted that proof of consistent work and pay entitlements will be requested.

Note: Tax may be withheld by the insurer from your Weekly Benefit. Please speak with your Accountant about your obligations to the ATO.

Capital Benefits

This section provides a lump sum benefit to insureds that suffer permanent impairment or death.

The maximum benefit under this section is $750,000 for Paraplegia / Quadrilplegia.

There are benefits payable for various levels of disability for example;

Permanent Total Loss of sight of one eye $150,000
Permanent Total Loss of Hearing – One Ear $150,000
Both Ears $300,000
Permanent Total Loss of use of one leg $300,000

A detailed list of the benefits is contained in the policy wording, available from Aon.

Additional Benefits

There are other additional benefits available under the Sports Personal Injury policy including:

  • Student Assistance benefit
  • Domestic Home Help Expenses
  • Parents Inconvenience Allowance
  • Travel and Accommodation Expenses
  • Funeral Expenses Benefit
  • Overseas Medical / Repatriation Expenses

For details of these additional benefits, covered under this policy please contact Aon.

What injuries are not covered

The National Risk Management & Insurance Programme – personal injury section is designed to provide coverage for injuries incurred accidentally whilst playing, training, officiating and administering rugby.

The following circumstances & injuries are not included under the programme:
  • Aggravations of pre-existing injuries or physical or congenital conditions
  • a sexually transmitted disease, AIDS, HIV, childbirth or pregnancy
  • engaging in air travel except as a passenger in any properly licensed aircraft
  • effects of alcohol and/or drugs not prescribed by a medical practitioner
  • Deliberately self-inflicted injury or suicide
  • war, invasion or acts of foreign enemies etc.
  • any heat-stroke, sickness or disease and/or cardiac or pulmonary or cerebrovascular incident notwithstanding that such incident may have been caused by or induced by or accelerated by Injury
  • any act of Terrorism
  • Any reoccurring injury of any kind.  Although an injury may appear to have resolved, where an Insured Person suffers a recurrence or aggravation injury whilst playing rugby, the claim will be generally excluded in full.