The medical excess applies to me

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If the TAC's medical excess applies to you, this means you* are responsible for your treatment and services to the value of $629 before the TAC can start to pay for your further treatment.

This does not necessarily mean you will be out of pocket $629 - you may be able to meet the cost of the medical excess by claiming through Medicare or your private health insurer. For example, if you see your family doctor for your accident injuries you can claim the cost of this visit through Medicare.

There are some services, such as ambulance and hospital, where the medical excess does not apply. A list of services where the medical excess applies and does not apply is below.

Keep your original receipts

Once you have received treatment to the value of $629 (even if it was paid for by Medicare or your private health insurer) you need to send the TAC a completed Medical Excess Declaration Form, your original receipts, accounts, health insurance and/or Medicare statement of benefits. Then the TAC can start paying for further treatment you may need.

* For the purposes of the medical excess "you" means you and any immediate family members involved in the same accident. "Immediate family members" includes your partner or dependent children under 18 years of age.

Services subject to excess

These services can't be paid for by the TAC until you have reached the medical excess.

Services provided in private rooms by a:
Medical practitioner (such as a doctor)
Dentist
Optometrist
Physiotherapist
Chiropractor
Osteopath
Podiatrist
Psychologist (after referral from doctor)
The excess also applies to the cost of:
Medication (including prescription medication) dispensed by a pharmacy
Crutches
Artificial limbs, hearing aids or spectacles that were damaged in the accident and need to be replaced
X-rays

Services not subject to the medical excess

If you have an accepted TAC claim, these services will be paid for by the TAC, even if you haven't reached the medical excess.

Not subject to excess
Ambulance services
Hospital services
Household support services (such as housekeeping)
Nursing services
Occupational therapy
Social work
Travel

Completing the TAC's Medical Excess Declaration form

If you have any questions about completing the Medical Excess: Declaration form please call the TAC on 1300 654 329.

What you need to do

If your transport accident involved immediate family members*, complete one Medical Excess Declaration Form per family.

Please refer to the table in the "Overview" section to check whether a service can be included in your medical excess. If you are unsure, please call the TAC on 1300 654 329 before submitting your form.

When the services you have received add up to $629**, send your completed form and your original receipts, accounts, health insurance and/or Medicare statement of benefits to the TAC.

Obtaining a Statement of Benefits from Medicare or your private health insurer

If you have claimed the cost of your services through Medicare or a private health insurer you can obtain a statement of benefits and use this as proof the services have been paid for.

The statement of benefits should only contain the services that relate to your transport accident. You should contact Medicare or your private health insurer directly to obtain your statement of benefits.

* A family member includes your partner or dependent children under 18 years of age.

** This medical excess amount is for accidents from 1 July 2016. This amount may change yearly, as it is usually indexed according to the Average Weekly Earnings (AWE).

This information applies to transport accidents on or after 27 November 2007. For any queries about the medical excess before this date, please contact the TAC policy team.

What is the medical excess?

The medical excess is the cost that a client may have to pay for medical treatment outside of hospital, such as visits to the doctor or physiotherapist

You are not responsible for paying the cost of other services such as ambulance and hospital treatment, because the medical excess does not apply to these services. This means the TAC can pay the reasonable cost of these services from the beginning of your claim.

To find out which treatments can be used to reach the excess and which are not subject to the excess, please refer to 'What services outside of hospital can be used to reach the excess?' in this policy.

The current medical excess amount is:

  • $629 (applies to accidents on or after 1 July 2015)
  • $623 for accidents between 1 July 2014 and 30 June 2015, or
  • $599 for accidents between 1 July 2013 and 30 June 2014, or
  • $584 for accidents between 1 July 2012 and 30 June 2013, or
  • $564 for accident between 1 July 2004 and 30 June 2012.

Contact the TAC policy team for medical excess amounts for transport accidents before 1 July 2004.

Transport Accident Act 1986 references:  s.3 'medical service' and s.43

You don't have to reach the medical excess if:

  • You or an immediate family member was admitted to hospital as an inpatient. The TAC will instead pay for the reasonable costs of your accident-related treatment from the time of your admission to hospital.
  • An immediate family member dies as a result of the transport accident.

Immediate family members are partners, parents, children or siblings.

Please note: the TAC cannot waive the medical excess because you are experiencing financial hardship.

How to reach the medical excess

Each time you have treatment outside of a hospital, the total cost of that treatment will be considered towards the medical excess.

If Medicare or private health insurance covers part or all of your treatment, this refund will also be considered towards the medical excess. For example, if you visit the doctor and are bulk-billed for the treatment, the cost of that consultation (although not paid for by you) will still contribute to the medical excess.

A statement can be obtained from Medicare or your private health insurer which outlines expenses they have covered for your accident injuries.

Transport Accident Act 1986 reference: s.3'medical service' and s.43

How does the medical excess apply to your immediate family members in the same accident?

Where immediate family members have been injured in the same accident, only one medical excess amount will apply. Immediate family members are partners, parents, children or siblings.

Only one medical excess declaration form needs to be completed per family.

Transport Accident Act 1986 reference: s.3 'member of the immediate family'.

How does the 2-year time limit apply when it takes more than 2 years to reach the medical excess?

There is no time limit on the services that can be used to reach the medical excess. However, the TAC is unable to reimburse any medical services after the medical excess has been reached where the application for payment of those services is received more than 3 years after the date of accident or more than 2 years after the date of service. Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.

What are hospital services?

A 'hospital service' includes medical treatment provided to you:

  • as an in-patient in a hospital, or
  • by the emergency, casualty, or outpatient department of a hospital

Investigative services (e.g. radiology and/or pathology) performed by private organisations upon referral by a hospital are also a hospital service, as long as they are directly related to the hospital visit.

Transport Accident Act 1986 reference: s.3'hospital service'

What services outside of hospital can be used to reach the excess?

Please refer to the table below for more information.

  • Acupuncture
  • Chiropractic
  • Dental
  • Doctor (GP or specialist)
  • Elective surgery not performed in a hospital
  • Equipment:
    • Replacement of medical equipment damaged in the accident, e.g. prescription spectacles, mobility scooters
    • Equipment required because of the accident injuries, e.g crutches, bandages, splints, etc.
  • Hyperbaric oxygen therapy
  • Medical reports not requested by the TAC
  • Medication and chemist/pharmacy items, e.g. Prescription, Panadol, bandages, crutches, etc.
  • Nutritional supplements/Special Food/Formula
  • Optometry
  • Osteopathy
  • Pathology, e.g. bloodtests (when not referred by a hospital)
  • Physiotherapy
  • Podiatry
  • Prosthetic services and prosthetics, e.g. shoe inserts
  • Psychology
  • Radiology, e.g. MRI or x-rays (when not referred by a hospital)