Insurance Programme Summary

Transcription

1 Insurance Programme Summary What does the VAFA s insurance Programme cover your club for? The following benefits will provide cover from 1 st March st March 2013 Public Liability Protection for your club s legal liability to pay compensation in respect of Bodily Injury or Property Damage in respect to the sport of Australian Rules Football. Cover Limit $10,000,000 Excess Nil Professional Indemnity Protection for Club and Association Officials Trainers & Umpires for alleged negligent instructions (errors & omissions) Cover Limit $2,000,000 Excess Nil Directors & officers Protects the personal assets of Committee/ Board Members of your club by providing indemnity for loss arising from a claim as a result of a wrongful act committed by them in the course of performing their duties Cover Limit $1,000,000 Excess Nil Death, Disability & Capital Benefits Benefits for Club Players, Members, Officials, Coaches, Trainers & Volunteers Death (20% for U/18) $50,000 Disability $50,000 Loss of use (Up to) $50,000 Medical Expenses $Not Covered Weekly Income Benefits $Not Covered Excess Nil Club Top Up Options Non-Medicare Medical Expenses & Weekly Income Benefits Non-Medicare Medical Expenses (including physiotherapy benefits) & Weekly Income benefits for Club Players, Members, Officials, Coaches, Trainers & Volunteers. Visit the website f to purchase this cover. Refer to page 2 for further details.. Optional Top Up for Individuals Non-Medicare Medical Expenses & Weekly Income Benefits Players can purchase individual insurance for Non-Medicare Medical Expenses (including physiotherapy benefits) & Weekly Income Benefits. Refer to page 2 for further details - nwalravens@wwsi.com.au - info@wwsi.com.au

2 How to Top Up Club Accident & Injury cover For Clubs Step 1. Visit and enter the clubs login details found on the clubs insurance renewal letter received with this programme. Step 2. Once you have logged in, update your club details and team numbers before selecting the Player Accident Insurance tab on the left menu bar. Upgrades for your senior and junior teams must be done separately. Step 3. Enter the dollar amounts the club would like to insure for each cover section. (I.E Non- Medicare Medical Expenses, Loss of Income, Capital Benefits) The examples on page 3 can be used as a guide to assist in determining the appropriate cover levels for your club members. Premiums will be displayed when the information is entered in the website and the calculation button is selected. To proceed with cover you will need to submit and then confirm your entry is correct. You will then receive an with the schedule of cover. The VAFA will invoice the clubs in April/May for payment. For Players Players are also able to Top Up and purchase their own insurance for Weekly Income Benefits and or Medical Expenses. As an indication for Weekly Benefits the premium to cover $750 p/w of loss of income is around $ per year The maximum loss of Income (weekly benefits) provided is $800 per week. The maximum Medical Expenses cover is $5,000 per claim The maximum Death & disability additional limit is $150,000 Players will need to complete and send the Player Top Up Form to Nicole Walravens at to obtain cover or quotation. Nwalravens@wwsi.com.au - info@wwsi.com.au

3 Club Accident & Injury cover limit examples Clubs will need to logon to the insuresoft.com.au/vafa to obtain premiums for the below covers. VAFA current cover for all clubs - Bronze Death, Disability & Capital Benefits $50,000 Maximum U/18 $10,000 (Death) Not Covered (Can purchase through Top up cover ) Not Covered (Can purchase through Top up cover ) Example Top Up Option - Silver Death Disability & Capital Benefits Up to $100,000 Maximum payout 50% Reimbursement $1,500 Maximum per claim $50 Excess per claim Up to $250 P/W Excess 14 days Example Top Up Option - Gold Death Disability & Capital Benefits Up to $150,000 Maximum payout 50% Reimbursement $3,000 Maximum per claim $50 Excess per claim Up to $500 P/W Excess 14 days Example Top Up Option Platinum Death Disability & Capital Benefits Up to $200,000 Maximum payout 50% Reimbursement $5,000 Maximum per claim $50 Excess per claim Up to $800 P/W Excess 14 days

4 Claim Example one Player Accident Insurance Club purchased Medical Expenses only Player purchased Loss of Income only Stuart Smith is a 23 year old Electrician who dislocates his shoulder during a football match. He requires surgery and ongoing physiotherapy treatment. As a result of his injuries Stuart has 6 weeks off work. Unfortunately due to The Health Insurance Act 1973 the insurer s are prohibited from paying the MEDICARE GAP. Any out of pocket expenses from Medicare receipts are not claimable. (these are claimable through your private health fund) Medical Expenses Physiotherapy $70 per visit (10) $ Medications: $ MRI $ Overnight Hospital stay Covered by Medicare / can not be claimed Total out of pocket Non-Medicare Medical Expenses $ 1, Stuart s club Topped Up their insurance to include Medical Expenses up to $2,000 and claimed the following: Physiotherapy costs - Visits % charged at $70 per visit $ Visits % charged at $70 per visit $ Remaining expenses 50% per invoice $ Less excess - $ Claimable Non-Medicare Medical Expenses $ Stuart Topped Up individual Loss of Income protection to a maximum of $750 per week and claimed the following: Weekly Income Benefits Loss of Income 6 weeks 75% Net wage or $750 max (whichever is the lesser) $4, (less 14 day excess) -$1, Claimable Loss of Income paid to Stuart $3, Total Claim Payment to Stuart $3, ***it is extremely important to discuss insurance cover s and options with your players so they are aware of the cover that is in place for them and give them the option to obtain cover of their own***

5 How to lodge a Claim Claims must be lodged within 45 days of the injury occurring. Invoices, doctors reports and statements can be sent in after the claim has been lodged. Settlement is paid when treatment is completed. There are two ways that a claim can be lodged. Option 1 Complete a manual claims form which your club secretary should have on hand, if not you can obtain a form from Nicole Walravens at nwalravens@wwsi.com.au or Option 2 Complete and lodge your claim online at the following link Once your claim has been lodged, Sportscover s claims department will be in contact with you to provide you with your claim reference number and what steps need to be taken next. Should you have any questions or concerns about your claim or would like to check on the progress, please contact the claims hotline on Claims History over the pat 4 years Year Outstanding 2012 (Claims to be paid) No. Of Claims Claims paid $47, $70, $96, $33, $121, Over the past 4 years every $1 Sportscover received from Top up purchases they paid $1.22

6 FAQ s Frequently asked Questions 1. Can I claim the MEDICARE gap through the VAFA Insurance Program? Unfortunately due to The Health Insurance Act 1973 the insurer s are prohibited from paying 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 the expenses NOT claimable through this section include: i) The Gap between the registered Medical Practitioner's fee and the amount you receive back from Medicare for the following medical services: Doctors, Surgeons, Anaesthetists, Pathologists & Radiologists. ii) Other items where a Medicare refund (in any part) is recoverable. 2. Will the Insurer pay my bills upfront? All accounts must be paid and private health insurance claimed prior to sending them to Sportscover. 3. What are Ancillary medical procedures? The main ancillary benefits are - Acupuncture, Osteopath, Naturopath, Massage, Hydrotherapy, Podiatry. 4. Are the fees for the Theatre covered under my Policy? Provided that a Medicare rebate is not applicable the Theatre fee will be covered under Non- Medicare Medical expenses cover however please note that the limit the Insurer will pay any one claim is $1, Is it possible to receive an extension past the 12 month period of my claim for Non- Medicare Medical expenses? The maximum time limit for benefits under our current policy is twelve months from the date of the accident.

7 FAQ s Frequently asked Questions 6. What benefits are covered with the policy that my Association has arranged for me? The policy covers many Non-Medicare Medical expenses such as Private Hospital accommodation, physiotherapy, chiropractic, dental, ambulance, some MRI'S and other ancillary expenses. The policy also extends to provide some cover for loss of earnings. 7. Can I claim Non-Medicare medical benefits progressively similar to a private health fund? Claims for Non-Medicare Medical expenses such as private hospital accommodation, physiotherapy, chiropractic, dental, ambulance and other ancillary expenses are settled upon completion of the treatment. 8. If I hold private health insurance can I still claim? Certainly, where private health insurance is held, a proportion of the gap is usually refunded by Sportscover. The Northern Netball Group benefit for the GAP is 50% of each invoice submitted (less any excess) and limited to $1,000 any one claim. 9. When should I return the completed claim form? As soon as possible would be the best answer but the completed claim form should be returned within 30 days of the accident even if treatment is not yet complete. The Non-Medicare medical accounts can be forwarded at a later date once treatment is complete. 10. What sections of the claim form require completion? In order to process your claim as quickly as possible the Insurer requires the following to be completed: Claim form, witness statement, official report, copy of teamsheet/injury report and employer's statement (if claiming loss of earnings). 11. When I lodge my claim will I receive regular updates? Sportscover will provide you with an update every sixty (60) business days. You will also be given access to the Sportscover website. They will issue you with a password which will allow you to track and see how your claim is progressing.