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Non-Medicare medical expenses
This cover reimburses expenses that are not standard Medicare items (up to a maximum of $3,000 as per terms and conditions of the policy) and incurred within twelve (12) calendar months of you sustaining an injury, and are 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, anesthetist 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?
The table of benefits below must be read in conjunction with the policy wording.
Benefit |
Description |
Cover |
| Non Medicare medical | Reimbursement of non-Medicare medical expenses incurred within 12 calendar months. | - 80% reimbursement - $3,000 maximum per claim - $50 excess per claim |
| Domestic home help | Reimbursement of actual costs of domestic home help. Available to non-income earners only. |
- 100% reimbursement - $300 maximum per week - 14 day excess period - 26 week maximum benefit period |
| Student allowance | Reimbursement of actual costs incurred for home tutorial expenses. Only available to full time students who are non-income earners. |
- 100% reimbursement - $300 maximum per week - 14 day excess period - 26 week maximum benefit period |
| Bed care patient | Weekly payment to an insured person who is confined to a bed after a bodily injury for a period of not less than 7 days. | - 100% reimbursement - $300 maximum per week - 14 day excess period - 26 week maximum benefit period |
| Chauffeur plan | - $200 reimbursement - $200 maximum per week - 7 day excess period - 26 week maximum benefit period |
|
| Rehabilitation | Reimbursement of all reasonable costs incurred for the rehabilitation of a bodily injury including but not limited to a gymnasium, pilates studio or physical trainer. | - up to $5,000 maximum per claim |
| Home / vehicle modification | Reimbursement of costs incurred for home / vehicle renovations required as a direct result of bodily injury which is claimable under events 2 - 7 of Capital Benefits including but not limited to ramps, guide rails etc. | - up to $10,000 maximum per claim |
| Funeral expenses | Reimbursement of costs as a result of event 1 of Capital Benefits . | - $5,000 maximum per claim |
| Broken or fractured bones | - $3,000 maximum per claim |
If an Insured Person suffers an Injury resulting directly (and within 12 month of the date of Injury) in:
Broken or fractured bones
We will pay to the Insured Person the corresponding benefits specified in the benefits column below (subject to the terms and conditions of this Policy)
The Conditions |
The Benefits |
| Neck, skull or spine (full break) |
$3,000 |
| Hip | $1,500 |
| Jaw, pelvis, leg, ankle, knee (Other fracture) |
$1,000 |
| Cheekbone, shoulder or hairline fracture of skull or spine |
$600 |
| Arm, elbow or wrist (other fracture) |
$500 |
| Leg, ankle or wrist (Simple fracture) |
$400 |
| Nose or collar bone | $400 |
| Arm, elbow, wrist or rib (simple fracture) |
$200 |
| Finger, thumb, foot, hand or toe |
$150 |
Theatre fees and other non-Medicare medical related costs will paid as per the benefits and conditions in Section 4.2 of the policy
In the case of and established non-union of any of the above breaks or fractures, we will pay an additional benefit of 5% of the relevant Benefit shown in the Table of Benefits above.
Where an Insured Person suffers from more than one incident of broken or fractured bones as listed above arising from any one Injury, the maximum Benefit payable shall be the largest Benefit specified in the table of Benefits for the relevant condition suffered.
(a) “Simple Fracture” means a fracture in which there is a basic and uncomplicated break of bone and which in the opinion of a legally qualified medical practitioner required minimal and uncomplicated medical treatment: and
(b) “Other Fracture” means any fracture other than a Simple Fracture.