Tri Tag Rugby Personal Accident Insurance Policy
Tri Tag Rugby has taken out Personal Accident Insurance to provide some level of comfort should you suffer the unlikely event of an accidental injury.
We have provided some important information in layman’s terms to help you best understand your position before taking the field. For more information refer to the Product Disclosure Statement.
What can Personal Accident Cover pay for?
Personal Accident Cover CAN pay for NON-MEDICARE MEDICAL EXPENSES ONLY. ‘Non-Medicare’ means medical costs that can’t be claimed through Medicare. Items include physio, chiro, dental, ambulance transport, and private hospital accommodation.
Personal Accident Cover is NOT Private Health insurance It is law that Medicare items can’t be claimed on Personal Accident Cover. These items can be claimed on Private Health Insurance and include services such as doctors, surgeons, and anaesthetists.
Personal Accident Cover is NOT intended to be Life Insurance Personal Accident Cover is a policy for injuries occurring due to an accident. It is not a sickness or illness policy.
It is strongly recommended that all participants investigate their personal insurance needs. Participants should consider the benefits of:
- Private Health insurance
- Life Insurance
- Loss of Income (particularly for self-employed players or those in heavy manual labour reliant employment)
- Ambulance Subscription
What is Medicare?
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 a public (Medicare) patient in a public hospital
Free or subsidised treatment by practitioners such as Doctors and Specialists
What’s covered by Medicare?
The MBS lists a rebate amount for each Medicare Item.
For Example: A short consultation with a Doctor = Medicare rebate of $20.00.
In some cases, doctors, surgeons or specialists may charge more than the MBS amount. The difference between what you have been charged and the amount listed on the MBS is called the “Medicare Gap”.
Example: The Doctor charges you $45.00 for a short consultation. Medicare provides a rebate of $20.00 (as per the MBS). You are out of pocket $25.00 (this is known as the Medicare Gap).
What’s the difference between Medicare and the Tri Tag Rugby Personal Accident Policy?
The Health Insurance Act 1973 (Cth) strictly prohibits any general insurer from covering 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 you for the Medicare Gap.
So what does that mean?
If your medical or other injury related treatment has a Medicare Item Number, it is uninsurable and you may not claim for reimbursement through the policy. If your medical or other treatment does not have a Medicare Item Number, you may claim for reimbursement under the Tri Tag Rugby Personal Accident Policy.
- 85% of Non-Medicare Medical Expenses up to $1,500 with a benefit period of 52 weeks from the date of injury.
- 85% of Loss of Income up to a maximum of $250 per week with a 52-week benefit period.
An excess fee of $50 is deducted from any claim.
We hope you never need it!
In the unlikely event you do need to make a claim then please follow the instructions under the “how to make a claim” heading.
How to make a claim
Log into your Tri Tag Rugby account. Go to ‘More’, then select ‘Insurance Claim’ and download the claim form.
Filling out the form
You complete Section A and B.
If you have a ‘Non Medicare Expense’ claim, you should also complete Section C. You should only submit this section of the form if you have completed all treatment, and no further treatment is required.
Your Sports club completes Section D.
Your Medical practitioner completes Section E.
If you wish to claim for loss of earnings, your Employer completes Section F. Should you be self-employed, please ask your accountant to provide a written statement confirming your pre-tax earnings for the 52 weeks immediately prior to your injury.
If you went to hospital following an injury, attach a copy of the hospital admission notes.
Check all questions have been answered (including by selecting either ‘Yes’ or ‘No’ wherever this option is given) and each Section has been signed and dated. Your claim will be delayed if the insurer has to return your claim form to you because it is incomplete.
Please keep a copy of the completed claim form and attachments for your records.
Send, or fax, or scan and email, or deliver your completed form in person to:
ATC Insurance Solutions Pty Ltd
Level 9, 499 St Kilda Road,
Melbourne VIC 3004
Fax: (03) 9867 5540
Call ATC for any assistance when completing the claim form on 1800 994 694.