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Last Updated on 17 November 2018

Private Health Insurance for Athletes and Sports Players


Are you an avid sports player?  Do you consider yourself an athlete? If so, odds are you have at least thought about how you would be covered incase of an injury.

While it is worthwhile for the general population to take time and serious consideration when examining health insurance options, this task can be even more crucial for athletes and sports players.

Key Points
  • Athletes can evaluate the nature of their sport (e.g. its intensity and the frequency of their participation) to determine what additional coverage they may need.
  • Medicare will likely deem sport related surgeries as non-emergency. The wait time for Medicare elective surgeries can span over months or even years.
  • After considering your sports related healthcare needs, choose an insurance plan that accommodates your priorities. Private Health Insurance comes with the flexibility to select as much or as little coverage as you want.

Due to the active and sometimes aggressive or dangerous nature of sports, athletes are often more prone to injury than the general population. Furthermore, doctors are seeing an increase in children with serious sports injuries as sports become more competitive and professional in younger leagues.

While Australians are eligible for Medicare, and some sports organisations provide some supplemental sports insurance, it is important to understand what is covered and where health coverage liabilities still exist. Because the provided sports insurance may not cover all potential sports risks, those who participate in sports activities may choose to consider health insurance options to ensure that they are truly covered in the event of an accident, sports injury or unforeseen illness.

Of course, the type and frequency of sport is important in considering and comparing health insurance options. It is also important to be mindful of any previous injuries and how your body might be affected down the line with continued sports activity.

 

Sports that cause the most injuries, sending Aussies to hospital most frequently

Medicare and Sports

While Medicare alone may be adequate for some Australians, those who are active with sports may find that they face out-of-pocket costs when using Medicare alone.

Athletes must consider their individual circumstances and sporting activity to determine if Medicare alone will suffice. Specifically, sports participants should take the following into account:

Travel

Those who travel as part of their sports activities might run into unexpected difficulties when outside of their normal service area. While Medicare will cover all participants while they travel through Australia, athletes might notice a difference in availability and wait times depending on their location.  

Medicare-only coverage will certainly cause a substantial gap payment for those athletes who travel overseas as Medicare does not cover medical expenses incurred outside of the country.

While Medicare-only recipients might be eligible for state-sponsored healthcare under a Reciprocal Health Care Agreement, these agreements do not cover the totality of healthcare expenses and are only available in a handful of partnering countries.  

Countries that participate in Reciprocal Health Care Agreements with Australia and may cover some medical expenses include:

  • Belgium
  • Finland
  • Italy
  • Malta
  • Netherlands
  • New Zealand
  • Norway
  • Republic of Ireland
  • Slovenia
  • Sweden
  • United Kingdom

 

Countries that participate in Reciprocal Health Care Agreements with Australia

 

Countries outside of this list are not included in the agreement and will not cover any medical expenses under a state sponsored program – even for traveling athletes.  

When travelling outside of Australia, athletes, tourists, and other business travels should consider an insurance supplement.   

High Risk Injuries

Responsible athletes looking to ensure they have adequate health insurance should always consider injuries that are commonplace or more likely in their sport.  

For example: Knee traumas, such as cartilage tears and anterior cruciate ligament (ACL) sprains are some of the most common injuries in soccer. Unfortunately, these types of injuries often require surgery.  

 

Common injuries to body and common diagnoses in ERs for sports injuries: Infographic

 

Because these injuries are generally not life threatening, it is likely that Medicare will consider them as elective surgeries. In the most extreme cases, patients awaiting elective surgeries through Medicare can see wait times of over a year.  

For those needing orthopaedic surgery, like many athletes with knee injuries, wait times average around 70 days – or over two months.  

 

Number of patients admitted from elective surgery waiting lists: Graph

 

There are several other common sports injuries that may require specialist services such as:

  • Physiotherapy
  • Chiropractic Services
  • Podiatry

With that said, if an athlete knows that he or she is more likely to be at risk for a specific injury, he or she should make sure that they have adequate coverage for the related treatment.

Sports Insurance (Personal Accident Insurance)

Sports insurance sounds like it would be the obvious option for all athletes and avid sports players, but what is it?

Personal Accident Insurance is sometimes referred to as Sports Insurance when marketed specifically for athletes. This type of insurance acts as a filler to some items and services not covered by Medicare at all. Note that it does not provide coverage for gaps with items that may be partially covered under Medicare.  

Sports insurance may also cover an individual who sustains injuries that prevent him or her from working. These policies can cover up to 75% of lost income and could be a good option for those who play sports and also work in physical environments. For example, athletes who also work in the construction industry.  

Sports insurance may assist in covering lost income due to a sport injury, and may also help supplement other costs for services not covered by Medicare.     

Private Health Insurance and Sports

Private health insurance can provide the most flexibility for athletes as they can often tailor their coverage to meet specific sporting needs. After evaluating which injuries are most likely to occur, and how travel could affect medical needs, athletes can select fully comprehensive or more limited private health insurance plans to suit their needs.  

With adequate private health insurance coverage, patients can save an estimated 85% on their out of pocket expenses when encountering a sports injury.  

Consider All of Your Medical Needs

Choosing the right type of healthcare coverage for your needs is important. You should consider being covered for routine check-ups as well as potential emergencies.

After considering your athletic needs and weighing them against your general healthcare needs, you can choose the type of coverage that is right for you. Fortunately, there are a wide variety of coverage options available. You can opt for minimal coverage that only covers specific items, or you can select more comprehensive care that leaves you with fuller coverage and fewer out-of-pocket expenses.  

No matter your decision, make sure that your health insurance choices reflect your priorities. Make a list of those priorities and base your more in-depth comparisons on those needs.      

Frequently Asked Questions About Health Insurance

There are three types of health insurance in Australia. They are:

  • Hospital Cover
  • Extras Cover (also known as general or ancillary cover)
  • Ambulance Cover

Hospital cover can ensure any unexpected surgeries, treatments or hospital stays you may require will be covered. With appropriate cover you will have the flexibility to choose your own doctor and the option of receiving treatment in a private hospital.  Most hospital covers allow you to stay in a private room. One other perk is skipping the public hospital systems’ waiting list, which can be lengthy for non emergency treatment.

Extras cover pays benefits for a a range of services, often including treatments and procedures related to the fullowing:

  • Dental/oral health
  • Glasses and contact lenses
  • Podiatry
  • Physiotherapy
  • Psychulogy
  • Acupuncture
  • Remedial massage
  • Chiropractic
  • Hearing aids
  • Travel vaccinations

Ambulance cover, as the name suggests, will cover you should you require emergency ambulance transport. In an emergency, there is enough to worry about. Having the expenses covered for provides security and peace of mind. Many hospital covers include emergency ambulance transport If yours doesn’t, you will need to shop for this separately.

Life is unpredictable. You never know when you might need cover. No matter what life stage you’re in, there’s a policy out there for everyone. You can select as much or as little cover as you want, depending on your health needs and requirements. It’s a small price to pay for the peace of mind health cover provides.

There is no one answer here. Costs vary across providers and policy types. Just because a policy is cheap, that does not mean it is ‘value for money’ and vise versa. Make sure you check what’s included and excluded in a policy before signing up, as you want to purchase a policy that best fits your specific needs.

Premium: A premium is the price you pay for your insurance policy (it may be paid annually or on an ongoing basis).

Policy: An insurance plan. In other words, it is the type of insurance you choose to select.

Policy Holder: The owner, or ‘holder’ of a policy.

Claim: In the event that you require treatment for a service covered by your policy, you can lodge a claim for reimbursement of all or part of the cost of that treatment.. These days, most claims are submitted electronically by the health care provider (dentist, physio etc)

Lifetime Health Cover: Lifetime Health Cover was put in place to encourage young Australians to seek out and maintain ownership of private health insurance early in their lives. If you do not take out a policy before you turn 31, extra charges will be applied should you take out a policy at a later time.

This means you will pay a 2% loading on top of your premium for every year that passes after you turn 30. For example, if you take out a policy for the first time at age 32, you will be charged 4% of your premium as an extra, then at age 40, 20% and so on, up to a maximum loading of 70%.

The loading is payable for 10 consecutive years of cover - after which it is removed and you premiums will be reduced.

Pharmaceutical Benefits Scheme (PBS): Medicare offers assistance for Australians with many of their their prescribed medication costs through the PBS. This assistance is in the form of subsidies towards the cost of many medications. You can check if your prescribed medication is on the list of subsidised items here.

Medicare Levy Surcharge: The Medicare Levy Surcharge is an additional charge (tax) applied to single Australian taxpayers who earn over the income threshold of $90,000 per year, or families/couples who earn over $180,000 per year. This surcharge is only applied to those who choose not to have a private health insurance policy.

The surcharge is designed to reduce pressure on the public health system by encouraging those with higher incomes to invest in private health cover.

Private Health Insurance Rebate: The government’s Private Health Insurance rebate lowers premiums for most Australians with private health insurance Older Australians may enjoy an even higher rebate. Our calculator can help you estimate the Government health insurance rebate you may receive.

Disclaimer: The above information is correct and current at the time of publication


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