Player's claim for medical expenses - Randwick Myrtle Green Warriors
Non-Medicare Medical Expenses
In terms of the coverage, I have attached a summary brochure which provides some further information for you. This policy operates on a pay and claim basis i.e. you will need to incur the expenses, and then claim for them through this policy afterwards.
Due to government legislation, the Insurer is prohibited from reimbursing for any expense where a Medicare benefit is available.
This means that any treatment which is afforded a Medicare rebate such as:
cannot be afforded any further reimbursements through this policy. An easier way to look at it is – if there is a Medicare Item No. attached to the medical expense, it cannot be covered by this policy.
This policy covers Non-Medicare Medical Expenses such as:
Ancillary Services (e.g. Physio, Chiro)
Private Hospital Accommodation/Theatre Fees (e.g. the cost of the bed accommodation in hospital/cost of operating theatre – both not related to a Medicare Item No)
Inpatient Hospital Excess charged by a Private Health Fund
Appliances/Prosthesis (e.g. Knee Braces, Crutches, Moonboot)
The rates for Non-Medicare Medical Expenses are as follows:
Covered at 100%
To a Maximum of $3,000
A once-off $100 excess applies – this will come off the first Non-Medicare Medical Expenses payment the Insurer makes. If you are claiming for an Ambulance Bill only – NIL excess applies.
If you have Private Health Insurance any Non-Medicare Medical Expenses able to be claimed through Private Health Insurance will need to be pursued for a reimbursement, and then the gap claimed through this policy afterwards.
All claims need to be lodged with the Insurer and treatments completed within 12 months from date of injury. On the first page of the claim form you will note the comment that claims need to be lodged within 30 days of injury, please be advised that this is just an indication and your claim can still be lodged after this time.
Once the claimant has sign off from their treating physician & club official (President, VP, Secretary or Treasurer) they will need to make copies of everything for themselves, then send through to the insurer, SLE firstname.lastname@example.org or call 1800 002 676.
SLE will issue claim number that will be the point of reference when forwarding supporting documentation or liaising with the Insurer. Please allow 9-10 business days for this turnaround.
Should you have any other questions, please don’t hesitate to contact the Sports Claims Team on 02 8267 9999.