GROUP PERSONAL ACCIDENT POLICY SCHEDULE

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1 QBE INSURANCE (AUSTRALIA) LIMITED ABN GROUP PERSONAL ACCIDENT POLICY SCHEDULE Policy Number: AN A PAD Policy Wording: The Insured: The Business: Period of Insurance: QBE QM Sports Injury Insurance Policy Wording (as attached) Western Australia Basketball Federation Inc. including their affiliated Leagues, Associations, Centres and Clubs Principally Administration, Promotion, Organisation, Participation and Control of Basketball including Sanctioned Training Sessions and Training Camps, School Promotions and Competitions, charity activities, coaching, umpiring / referring, the rendering of First Aid, provision of food and drink, publication of newsletters, sale of merchandise, property owners or property occupiers of stadiums and other properties, social activities including awards presentations, fundraising BBQ s and other gatherings and other activities carried out by Basketball States & Territories its member associations and / or clubs in the course of conducting or promoting basketball. and any other activity incidental thereto From: 1 st September, 2015 at 4:00 pm To: 1 st September 2016 at 4:00 pm Insured Persons: Scope of cover; All Registered Members, Players, Voluntary Workers, Umpires/Referees, Coaches, trainers, Officials and Employees, Members of the Board of Management and Executives and including non-affiliated clubs as declared, Affiliated Women s National Basketball League and South East Australian Basketball League Teams, and financial Institutions and other corporations having an insurable interest herein and subsidiary and/or related corporations (as defined under the Australian Corporations Law ) now existing or hereafter constituted or acquired and social and sports clubs (including their committees and officers from time to time) and the trustees of superannuation funds and/or welfare organizations associated with the named insured; all for respective interests, rights and liabilities and to the extent that they are not more specifically insured. Whilst participating in sanctioned WA Basketball & Women s National Basketball (WNBL) activities including: a) Engaging / Playing in official club matches including club, championship or representative matches b) Organised training or practice sessions for activities as described in (a) Above c) Travelling directly between matches / activities in a) or b) above, and residence or place of employment or the premises of the insured or its affiliated Associations, Leagues or Clubs. AN A PAD Sports Schedule WA Basketball

2 QBE INSURANCE (AUSTRALIA) LIMITED ABN d) Staying away from your home district during a tour for the purpose of participating in representative matches / activities. e) Engaging in administrative or organised social activities or fundraising activities of the insured or its affiliated Associations, Leagues or Clubs Age Limits: Geographical Limits; years old World wide Benefits & Sums Insured: Section A Capital benefits Accidental Death Event years $100,000 Accidental Death Event 1 Under 18 and over 65 years $ 20,000 Capital Benefits Events 2 & 6-30 $100,000 Paraplegia / Quadriplegia Events 4-5 $250,000 Funeral Expenses $10,000 as a result of an Accident Only Modification Benefit 85% of costs to a maximum of $ 10,000 Section B Weekly benefits injury Loss of Income 85% of gross weekly income Members to a maximum of $200 Volunteers to a maximum of $700 All State Territory Board members to a maximum of $1,000 Maximum Benefit Period 52 Weeks Excess: The first 7 days income from the date of treatment by a doctor is excluded Section D Injury assistance benefit Student Tutorial Costs 80% of costs, to a maximum of $10,400 Maximum benefit $200 pw Maximum Benefit Period: 52 weeks Excess: First 7 days costs from the date of treatment by a doctor is excluded - Domestic Home Help 80% of costs, to a maximum of $10,400 Maximum Benefit $200pw AN A PAD Sports Schedule WA Basketball

3 QBE INSURANCE (AUSTRALIA) LIMITED ABN Maximum Benefit Period 52 weeks Excess First 7 days costs from the date of treatment by a doctor is excluded - Parents Inconvenience Benefits Based on a maximum of $50.00 per day to a maximum of $2,000 Section E Non medicare medical expenses 75% of Expenses per injury $50.00 each & every if no private health insurance NIL excess if Privately insured Ambulance Costs Only based on 100% of Costs Excess: NIL Members $2,000 Volunteers $5,000 Premium: GST Stamp Duty Total $As Agreed $As Agreed $As Agreed $As Agreed ENDORSEMENTS ATTACHING TO AND FORMING PART OF POLICY NUMBER AN A PAD Endorsement 1 Aggregate deductible Memorandum This policy is subject to an aggregate deductible of $56,950 Aggregate Deductible means the total amount of any one claim or series of claims (less the applicable excess/s) which be first borne by you during any one period of insurance. It is agreed that we will not be liable to make any payment under this policy until the paid losses exceed the aggregate deductible during any one period of insurance. It is agreed that you will advise all insurable losses to us and we will manage all claims on your behalf until the aggregate deductible is reached and standard excesses only will apply thereafter. Endorsement 2 Compensation Table Capital Benefits The benefits listed in the Compensation table for Events 1 & 2 are deleted and replaced by the benefits listed in the Schedule Endorsement 3 AN A PAD Sports Schedule WA Basketball

4 QBE INSURANCE (AUSTRALIA) LIMITED ABN Section B Weekly benefits Injury What we will not pay is amended to read as follows any injury, medical condition, infirmity or weakness known to the insured person or which would have been known to a reasonable person in the circumstances to have existed prior to commencement of this Policy, illness We will not pay weekly benefits: while you or the insured person are awaiting surgery unless agreed in writing by us for more than one injury at any one time. The general and additional exclusions set out under When you are not covered in this Policy may also affect your claim. Weekly benefits Injury Any payable condition claimed must occur within 12 months of the date of injury. Successive periods of disablement resulting from the same injury and which are not separated by a return to active full time employment for six months or more will be considered as one period of disablement. Weekly benefits will be paid after the excluded period of claim has elapsed. We will continue to pay weekly benefits while the insured person suffers disablement up to a maximum of 52 weeks or other period shown on the Policy Schedule. The weekly benefit we pay will be the amount shown in the schedule and will be reduced by: paid sick leave or holiday pay weekly benefits paid or payable from any statutory transport accident scheme or statutory workers compensation scheme. Endorsement 4 Section E Non Medicare Medical Expenses What we will not pay Costs associated with MRI scans, unless not covered under Medicare or Private Health Insurance AN A PAD Sports Schedule WA Basketball

5 QBE INSURANCE (AUSTRALIA) LIMITED ABN for costs incurred which are associated with the prevention of injury. For example, knee braces, mouth guards, ankle braces, for costs related to breakage of dentures, optical lenses or spectacles, expenses incurred for which a Medicare benefit is payable, expenses incurred more than 12 months after the date of injury, accounts covered by private health insurance unless the claimant has claimed a private health benefit. If that is the case we will pay the difference between any private health insurance rebate to which an Insured Person may be entitled to and the actual cost incurred by the Insured person less any excess applicable as per Policy Schedule Non Australian Residents Benefits will be paid on the same basis as though Medicare applied, therefore benefits that would normally attract Medicare for permanent residents will not be claimable. All benefits will cease if the claimant leaves Australia. Endorsement 5 Under the Section When you are not covered General Exclusions applying to this Policy Additional exclusions applying to this policy the following are amended 8. social matches unless sanctioned by the Insured 9. end of season trips for social purposes unless sanctioned by the Insured 10 activities involving parent/child competition unless sanctioned by the Insured Sanctioned is defined as any event organised or under the control of the Insured Endorsement 6 Any mention of the word repetitive nature or repetitive movements is deleted from the policy wording Endorsement 7 If an insured person is paid a Section A capital benefit under Events 2, 4, 5 or 7 we will also pay for the cost necessarily incurred by the insured person in modifying * their motor vehicle or * their home or * in relocating to a suitable home up to a maximum of $10,000 as per Policy Schedule AN A PAD Sports Schedule WA Basketball

6 QBE INSURANCE (AUSTRALIA) LIMITED ABN Endorsement 8 Counselling Support We will pay up to $200 per week, subject to a maximum of $2,000 for counselling support to a financial member or the financial members immediate family by legally qualified medical practitioner if you witness the death of an athlete, or if you suffer death, quadriplegia or paraplegia Endorsement 9 - Unexpired Membership We will reimburse a member for a pro rata refund of the Insured Person s membership/ registration fee from the date of bodily injury should the member be deemed by their legally qualified medical practitioner to be unable to participate in the playing of sport for the remainder of the season and this is as a result of an injury covered by this policy. Benefit: Up to a maximum of $500 Endorsement 10 Cardiac We will not pay for any Injury directly or indirectly caused or contributed to by, or in consequence of any cardiac, pulmonary or cerebrovascular sickness or disease. Endorsement 11 Difference in condition (DIC) / difference in limits (DIL) It is hereby declared and agreed that we guarantee to provide as a minimum no less cover in conditions and limits than the coverage that exists under the expiring Sports Injury policy through DUAL Insurance Agency Pty Ltd on behalf of certain Underwriters at Lloyd s which expired 1 st September 2015 Furthermore please note any endorsements added to this Policy Schedule will override and replace any exclusions under the Product Disclosure Statement (PDS) or Policy Wording In all other respects this policy remains unaltered AN A PAD Sports Schedule WA Basketball

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