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Motorcycling Australia Insurance FAQ’s

When it comes to reimbursement of Personal Injury claims, some people get confused about Medicare, the Medicare Gap and what is covered through MA’s National Risk Protection Programme.

  • 18 September 2017
  • Posted By: Linda
  • Number of views: 256
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Motorcycling Australia Insurance FAQ’s


Medicare vs MA’s Risk Protection

When it comes to reimbursement of Personal Injury claims, some people get confused about Medicare, the Medicare Gap and what is covered through MA’s National Risk Protection Programme.

What is Medicare?
Medicare is a Commonwealth Government programme that provides eligible Australian residents with free or low-cost medical and hospital care.
Medicare provides access to:
  • Free treatment as a public (Medicare) patient in a public hospital
  • Free or subsidised treatment by practitioners such as Doctors and Specialists

What's covered by Medicare?
The Medicare Benefits Schedule (MBS) lists all treatments and associated rebates relating to Medicare. You can access the MBS at any time via Medicare's web sitewww.medicare.gov.au.

What is the Medicare Gap?
The MBS lists a rebate amount for each Medicare Item.

Example: A short consultation with a Doctor = Medicare rebate of $16.95

However, some consultations are different. In some cases, doctors or specialists may charge more than the MBS amount.

The difference between what you have been charged and the amount listed on the MBS is called the "Medicare Gap".

Example: The Doctor charges you $45.00 for a short consultation. Medicare provides a rebate of $16.95 (as per the MBS). You are out of pocket $28.05(this is known as the Medicare Gap).

What's the difference between Medicare and MA’s National Risk Protection Programme?

The Health Insurance Act 1973 (Cth) strictly prohibits any general insurer from covering any item that is listed on the Medicare Benefits Schedule.

This also means that regardless of your out of pocket expenses, it is against the law for the Insurer to cover you for the Medicare Gap.

So what does that mean?

If your medical or other treatment has a Medicare Item Number, it is uninsurable and you may not claim for reimbursement through MA Insurance Limited.

If your medical or other treatment does not have a Medicare Item Number, you may claim for reimbursement through MA Insurance Limited.

For specific Medicare information please visit
www.medicare.gov.au.

For specific Insurance and Risk Protection information please refer to the Insurance tab on the Motorcycling Australia websitewww.ma.org.au

How does Medicare, private health care and sports injury insurance work together?

The table to the left is a guide only to explain an example of how coverage can work and should not be relied upon to make an accurate assessment of actual costs and procedures to be incurred. These will vary from actual costs.

Example : Two riders, one with and one without Private Health Insurance, suffer the same injury, require the same treatment and incur the same medical costs.
Rider 1 (No Private Health Insurance)
Service Fee Medicare Private Health MA Insurance Limited Total Reimbursements Out of pocket
General Practitioner -$90 $40 - - $40 -$50
Surgeon -$2,500 $1,350 - - $1,350 -$1,150
Anaesthetist -$1,200 $400 - - $400 -$800
Imagery (X-Ray) -$120 $85 - - $85 -$35
Imagery (MRI Non-rebateable) -$300 $0 - $300.00 $300 Nil
Hospital fee -$1,000 - - - $0 -$1,000
Physiotherapy -$600 - - $600 $600 Nil
Medications, Crutches, Aids -$200 $0 - $200 $200 Nil
Total -$6,010 $1,875 - $1,100 $2,975 -$3,035
Rider 2 (With Private Health Insurance)
Service Fee Medicare Private Health MA Insurance Limited Total Reimbursements Out of pocket
General Practitioner -$90 $40 - - $40 -$50
Surgeon -$2,500 $1,350 $450 - $1,800 -$700
Anaesthetist -$1,200 $400 $640 - $1,040 -$160
Imagery (X-Ray) -$120 $85 - - $85 -$35
Imagery (MRI Non-rebateable) -$300 - - $300.00 $300 Nil
Hospital fee -$1,000 - $800 - $800 -$200
Physiotherapy -$600 - $270 $330 $600 Nil
Medications, Crutches, Aids -$200 - - $200 $200 Nil
Total -$6,010 $1,875 $2,160 $830 $4,865 -$1,145






















* Based on 80% private health re-imbursement of surgery incurred costs and 45% of extra’s cover on physiotherapy N.B.: With Private Health Insurance coverage (to be claimed on before claiming under the MA Insurance Limited Policy), the person claiming will further reduce the non-Medicare rebate available.

1. The medicare and private health information are examples only to illustrate the benefits available through the Motorcycling Australia PA Policy. Individuals should contact Medicare for full terms and conditions available.
2. MA are not and do not represent themselves as licensed insurance brokers by endorsing the products outlined in this information. The information is provided to assist in explaining the insurance benefits to members.
3. This insurer for the Public Liability & Professional Indemnity and Personal Accident Program is MA Insurance Limited.
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