Match Day Checklist (PDF, 167KB)Personal Accident: Non Medicare Medical Expenses (and other benefits)
What does this section cover?
This cover reimburses expenses that are not standard Medicare items and incurred within twelve (12) calendar months of you sustaining an injury and paid by you for treatment certified necessary by a legally qualified medical physician. This cover includes the cost of medical supplies and ambulance hire.
Important Information
The Health Insurance Act (Cth) 1973 does not permit the Trustee or Insurer to contribute to any charges covered by Medicare (including the Medicare Gap).
This means that any charges for treatment from a Doctor, Surgeon, Anaesthetist or Surgeon’s Assistant are not covered. It also means charges for X-Ray, some MRI Scans (if Medicare registered) and Public Hospitals are not covered. In addition, there will be no refund in respect of:
- any expenses recoverable by you from any other insurance scheme or plan providing medical or similar coverage or from any other source except for the excess of the amount recoverable from such other policies/plans.
- any expense to which the National Health Act (Cth) 1953 or any of the regulations made there under apply.
What are the benefits payable? (Insurance Cover Limits)
Non-Medicare Medical Expenses
Four levels of cover are available under this Program:
| Bronze (automatic min. level) | Silver (optional upgrade)* | Gold (optional upgrade)* | Platinum (optional upgrade)* |
|---|---|---|---|
| 50% reimbursement | 75% reimbursement | 90% reimbursement | 90% reimbursement |
| $2,000 max per claim | $2,500 max per claim | $3,500 max per claim | $7,500 max per claim |
| $100 excess per claim | $75 excess per claim | $50 excess per claim | $50 excess per claim |
Clubs choosing to upgrade their Non-Medicare Medical coverage to Silver, Gold or Platinum, and therefore providing increased benefits to members, are asked to complete and return the Optional Upgrade Form. To obtain a copy of the Optional Upgrade Form please refer to the Upgrading Cover section of this web site or contact JLT Sport on 1300 130 373.
Additional Benefits
| Benefit | Description | Cover |
|---|---|---|
| Student Assistance | Covers reasonable and necessary expenses incurred and paid by you or your parents or guardian for services relating to education, schooling, travel costs, home tutoring, special tutoring and special equipment. Available to full time students under 25 yrs of age only. |
|
| Parents Inconvenience Allowance | Covers reasonable and necessary expenses incurred by Your parents to visit you whilst hospitalised through injury. Available for each day a full time student under 20 years of age is hospitalised. |
|
| Home Help Expenses | Covers reasonable and necessary expenses incurred and paid by you for services related to home duties, for every week of continuous total disablement. Available to non-Income earners only. |
|
| Funeral Expenses | Reimbursement of actual costs of your funeral if you die as a result of an injury for which a claim is payable. |
|
Hypothetical example of how to make a Non-Medicare Medical Claim
- As soon as possible following the injury, the player should obtain a JLT Sport Claim Form via the Making a Claim section of this website or by contacting 1300 130 373. Section A of the form must be completed by the player and Section B must be completed by the club. The completed claim form must be submitted to Echelon within 180 days of the date of injury.
- Have the surgeon or treating physician complete and sign the Physicians Report and Incapacity to Work Statement within the claim form. When all sections are completed, post or fax the claim form to Echelon.
- Should the player have private health insurance, it is a requirement to claim expenses covered by the private health fund first. A Statement of Payment should be obtained from the private health insurer and forwarded to Echelon.
- Following treatment post all non-Medicare accounts to Echelon, or alternatively post them periodically throughout the duration of treatment. Do not send in any accounts that are partially or wholly claimable through Medicare.
Example Scenario
The Injury and Treatment
Peter has sustained a serious knee injury playing football and requires a consultation with a physician to ascertain the extent of his injuries and to discuss the necessary treatment that he must undertake. Following initial treatment (including physiotherapy and arthroscopic surgery), a follow-up consultation with his surgeon reveals that Peter is required to undergo reconstructive surgery and intensive rehabilitation.
Private Health Insurance
Peter has private health insurance and elects to undergo surgery in a Private Hospital. Following a hospital stay and numerous months of physiotherapy, Peter is ready to return to playing football. His club has increased their Non-Medicare medical coverage to Platinum so he is able to claim 90% of his non-Medicare medical expenses.
Paying the Claim
The application of The Health Insurance Act (Cth) 1973 does not permit the Trustee or Insurer to contribute to any charges covered by Medicare (including the Medicare Gap).
The table to follow is a guide only to explain an example of how coverage can work and should not be relied upon to make an accurate assessment of actual costs and procedures to be incurred. These will vary from actual costs.
As a guide, the standard Australia wide basic coverage option (Bronze) is also listed to demonstrate the added benefits of electing a higher level of cover (Silver, Gold or Platinum) with Platinum coverage shown.
| Function | Medicare | National Program | |||||
|---|---|---|---|---|---|---|---|
| Total Claim Result | |||||||
| Bronze Cover |
|
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| Platinum Cover |
|
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| Total Cost | Coverage | Gap | Coverage | Gap | |||
| Bronze | Platinum | Bronze | Platinum | ||||
| Surgeon Consultation (x 3 visits) | $190 | $143 | $47 | – | – | – | – |
| X-Ray | $90 | $67.50 | $22.50 | – | – | – | – |
| Surgeon’s Fee (arthroscopy) | $500 | $375 | $125 | – | – | – | – |
| Assistant Surgeon Fee | $120 | $90 | $30 | – | – | – | – |
| Anaesthetist | $300 | $225 | $75 | – | – | – | – |
| Surgeon’s Fee (reconstruction) | $1,500 | $1,125 | $375 | – | – | – | – |
| Assistant Surgeon Fee | $120 | $90 | $30 | – | – | – | – |
| Anaesthetist | $300 | $225 | $75 | – | – | – | – |
| * MRI Scans (x 2) | $500 | – | – | $250 * | $450 * | $250 * | $50 * |
| Private Hospital Stay (reconstruction) | $4,000 | – | – | $2,000 | $3,600 | $2,000 | $400 |
| Private Hospital Stay (arthroscopy) | $1,200 | – | – | $600 | $1,080 | $600 | $120 |
| Physio visits (x 14) | $1,150 | – | – | $575 | $1,035 | $575 | $115 |
| Prosthesis | $500 | – | – | $250 | $450 | $250 | $50 |
| Knee Brace | $150 | – | – | $75 | $135 | $75 | $15 |
| Pharmacy costs | $60 | – | – | $30 | $54 | $30 | $6 |
| Hydrotherapy | $90 | – | – | $45 | $81 | $45 | $9 |
| Gym Membership (unique discretionary payment) ^ | $200 | – | – | $100 ^ | $180 ^ | $100 ^ | $20 ^ |
| Less Excess (which reduces with higher coverage) | (-$100) | (-$50) | $100 | $50 | |||
| Sub-Total | $10,970 | $2,341 | $780 | $3,825 | $7,015 | $4,025 | $835 |
| Less additional amount non-claimable (Max – $3,500 Bronze/$7,500 Platinum) | (-$1825) | $1825 | |||||
| Total | $10,970 | $2,341 | $780 | $2,000 | $7,015 | $5,850 | $835 |
Variation between coverage benefits in this one example above is $5,015 between Bronze coverage and Platinum coverage.
N.B.: With Private Health Insurance coverage (to be claimed on before claiming under this program), the person claiming will further reduce the non-Medicare rebate available – up to the full 100% coverage.
The Medicare rebate does vary per item and also varies per state. The above coverage is a guide only.
- * MRI scans are covered under Medicare in certain situations. Ask when making payment and if claimable under Medicare, this is not covered under the Program.
- ^ Coverage not automatic and only provided in unique circumstances.