Football Federation Victoria

Making A Claim

Non Medicare Medical Claims

• Step 1: Notify SPORTSCOVER (within 30 days from the date of your injury) of your intention to lodge a claim. You can notify Sportscover via one of the following options:
  • Phone: 1300 134 956 or
  • Email: claims@sportscover.com or
  • Online: www.sportscover.com
• Step 2: Access a current claim form or call SPORTSCOVER on 1300 134 956 and a claim form will be sent to you via mail.
• Step 3: Complete all sections of the claim form.
  • Your claim form may be returned if there is important information missing
  • For assistance contact SPORTSCOVER on 1300 134 956
• Step 4: Send your claim form completed in full to SPORTSCOVER within 120 days from the date of injury.
  • Do not wait for all treatments to be completed before sending your claim form.
  • Treatments may continue even after you have submitted your claim form.
• Step 5: SPORTSCOVER will confirm receipt of your claim form or contact you should they require more information.
  • Please contact SPORTSCOVER directly if you have not received confirmation of your claim.

Important Information

SPORTSCOVER AUSTRALIA PTY LTD (Sportscover) is the administrator of the Personal Accident Policy (arranged by JLT Sport) for the Football Federation Victoria Insurance Programme. Sportscover administers all claims associated with this policy for 2008.

The Health Insurance Act (Cth) 1973 does not permit the Insurer to reimburse any costs for medical treatments that are registered with Medicare (this includes the Medicare Gap).

As Sportscover Australia Pty Ltd is a NON MEDICARE MEDICAL INSURER, they are prevented by government legislation from covering the MEDICARE GAP. This means that in most cases, a service that is performed by a registered Medical Practitioner will not be covered by the policy.

Some examples of expenses NOT claimable through this section include:

1. The Gap between the registered Medical Practitioner’s fee and the amount you receive back from medicare for the following medical services: Doctors, Surgeons, Anaethetists, Pathologists & Radiologists. And;
2. Other items where a Medicare refund (in any part) is recoverable.

Examples of items covered by Medicare. We can not reimburse you for these costs.

• Doctor
• Surgeon
• Surgeon’s Assistant
• Anaesthetist
• X-rays
• MRI Scans*
• Public Hospitals

Examples of Non-Medicare items. Claimable as per the Policy Schedule.

• Ambulance
• Physiotherapist
• Dental
• Private Hospital Accommodation
• Chiropractor
• MRI Scans*

* Some MRI machines are not registered with Medicare. Please check with your treating physician before lodging your claim.

Loss of Income Claims:

Firstly report the claim to Sportscover by completing the Loss of Income section of the Personal Accident Claim Form. The claim form can be accessed via any one of the three options outlined above.

IMPORTANT INFORMATION FOR LOSS OF INCOME CLAIMS

• The excess period is 14 days.
• You must be in full-time employment at the time of injury.
• Other benefits do not need to be exhausted prior to claiming on this section.
• The Attending Physicians Report must be completed by the practitioner who attended to you i.e. Doctor/Physiotherapist/Chiropractor; if a fee is charged for completing this section, that fee will be borne by the claimant.
• Your loss of income claims must be covered by a Medical Certificate for the full period of disability.
• For tax implications we recommend that you seek the advice of a qualified tax consultant. You may be required to pay tax on any Loss of Income benefit received.

Capital Benefits Claims

If you wish to make a capital benefit claim against this policy or there is a potential for such a claim relating to permanent or partial disablement please notify Sportscover immediately by phone. Claims staff will advise you on what you need to do next.

Liability Claims

If an incident occurs that may give rise to a liability claim (General Liability or Club Management Liability), it is essential that you notify JLT Sport immediately on 1300 130 373.

It is also extremely important not to admit liability or discuss the matter with a third party. JLT Sport staff will guide you as to the next step in the process.