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.
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
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.
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.
There are other additional benefits available under the Sports Personal Injury policy including:
For details of these additional benefits, covered under this policy please contact Aon.
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.
