GROUP PERSONAL ACCIDENT POLICY SCHEDULE

QBE INSURANCE (AUSTRALIA) LIMITED

AN A044726 PAD Sports Schedule – WA Basketball 2015-2016

GROUP PERSONAL ACCIDENT POLICY SCHEDULE

Policy Number: AN A044726 PAD

Policy Wording: QBE QM 360-0312 Sports Injury Insurance Policy Wording (as

attached)

The Insured: Western Australia Basketball Federation Inc. including their

affiliated Leagues, Associations, Centres and Clubs

The Business: Principally Administration, Promotion, Organisation,

Participation and Control of Basketball including Sanctioned Training Sessions and Training Camps, School Promotions and Competitions, charity activities, coaching, umpiring / referring, the rendering of First Aid, provision of food and drink,

publication of newsletters, sale of merchandise, property owners or property occupiers of stadiums and other properties, social activities including awards presentations, fundraising BBQ’s and other gatherings and other activities carried out by Basketball States & Territories its member associations and / or clubs in the course of conducting or promoting basketball. and any other activity incidental thereto

Period of Insurance: From: 1st _{September, 2015 at 4:00 pm}

To: 1st _{September 2016 at 4:00 pm}

Insured Persons: All Registered Members, Players, Voluntary Workers,

Umpires/Referees, Coaches, trainers, Officials and Employees, Members of the Board of Management and Executives and including non-affiliated clubs as declared, Affiliated Women’s National Basketball League and South East Australian Basketball League Teams, and financial Institutions and other corporations having an insurable interest herein and subsidiary and/or related corporations (as defined under the Australian Corporations Law ) now existing or hereafter constituted or acquired and social and sports clubs (including their

committees and officers from time to time) and the trustees of superannuation funds and/or welfare organizations associated with the named insured; all for respective interests, rights and liabilities and to the extent that they are not more specifically insured.

Scope of cover; Whilst participating in sanctioned WA Basketball & Women’s

National Basketball (WNBL) activities including:

a) Engaging / Playing in official club matches including club, championship or representative matches

b) Organised training or practice sessions for activities as described in (a) Above

c) Travelling directly between matches / activities in a) or b) above, and residence or place of employment or the premises of the insured or its affiliated Associations, Leagues or Clubs.

QBE INSURANCE (AUSTRALIA) LIMITED

AN A044726 PAD Sports Schedule – WA Basketball 2015-2016

d) Staying away from your home district during a tour for the purpose of participating in representative matches / activities. e) Engaging in administrative or organised social activities or fundraising activities of the insured or its affiliated Associations, Leagues or Clubs

Age Limits: 2-100 years old

Geographical Limits; World wide

Benefits & Sums Insured: Section A – Capital benefits

■ Accidental Death Event 1 18 – 65 years $100,000

■ Accidental Death Event 1 Under 18 and over 65 years $ 20,000

■ Capital Benefits Events 2 & 6-30 $100,000

■ Paraplegia / Quadriplegia – Events 4-5 $250,000

Funeral Expenses $10,000 as a result of an Accident Only

Modification Benefit 85% of costs to a maximum of $ 10,000

Section B – Weekly benefits injury

■ Loss of Income

85% of gross weekly income

Members to a maximum of $200 Volunteers to a maximum of $700 All State Territory Board members to a maximum of $1,000

Maximum Benefit Period 52 Weeks

Excess: The first 7 days income from the date of treatment by a doctor is excluded

Section D – Injury assistance benefit

■ Student Tutorial Costs – 80% of costs, to a maximum of $10,400 Maximum benefit $200 pw

Maximum Benefit Period: 52 weeks

Excess: First 7 days costs from the date of treatment by a doctor is excluded

- Domestic Home Help

■ 80% of costs, to a maximum of $10,400 Maximum Benefit $200pw

QBE INSURANCE (AUSTRALIA) LIMITED

AN A044726 PAD Sports Schedule – WA Basketball 2015-2016

Maximum Benefit Period 52 weeks

Excess First 7 days costs from the date of treatment by a doctor is excluded

- Parents Inconvenience Benefits

■ Based on a maximum of $50.00 per day to a maximum of $2,000

Section E – Non medicare medical expenses

75% of Expenses per injury

$50.00 each & every if no private health insurance NIL excess if Privately insured Ambulance Costs Only based on 100% of Costs Excess: NIL

Members $2,000 Volunteers $5,000

Premium: $As Agreed

GST $As Agreed

Stamp Duty $As Agreed

________

Total $As Agreed

ENDORSEMENTSATTACHING TO AND FORMING PART OF POLICY NUMBER

AN A044726 PAD

Endorsement 1 – Aggregate deductible Memorandum

This policy is subject to an aggregate deductible of $56,950

“Aggregate Deductible” means the total amount of any one claim or series of claims (less the applicable excess/s) which be first borne by you during any one period of insurance.

It is agreed that we will not be liable to make any payment under this policy until the paid losses exceed the aggregate deductible during any one period of insurance.

It is agreed that you will advise all insurable losses to us and we will manage all claims on your behalf until the aggregate deductible is reached and standard excesses only will apply

thereafter.

Endorsement 2 Compensation Table – Capital Benefits

The benefits listed in the Compensation table for Events 1 & 2 are deleted and replaced by the benefits listed in the Schedule

QBE INSURANCE (AUSTRALIA) LIMITED

AN A044726 PAD Sports Schedule – WA Basketball 2015-2016

Section B – Weekly benefits Injury

What we will not pay is amended to read as follows

• any injury, medical condition, infirmity or weakness known to the insured person or which would have been known to a reasonable person in the circumstances to have existed prior to commencement of this Policy,

• illness

We will not pay weekly benefits:

• while you or the insured person are awaiting surgery unless agreed in writing by us

• for more than one injury at any one time.

The general and additional exclusions set out under ‘When you are not covered’ in this Policy may also affect your claim.

Weekly benefits – Injury

• Any payable condition claimed must occur within 12 months of the date of injury.

• Successive periods of disablement resulting from the same injury and which are not separated by a return to active full time employment for six months or more will be considered as one period of disablement.

• Weekly benefits will be paid after the excluded period of claim has elapsed.

• We will continue to pay weekly benefits while the insured person suffers disablement up to a maximum of 52 weeks or other period shown on the Policy Schedule.

The weekly benefit we pay will be the amount shown in the schedule and will be reduced by:

• paid sick leave or holiday pay

• weekly benefits paid or payable from any statutory transport accident scheme or statutory workers compensation scheme.

Endorsement 4

Section E – Non Medicare Medical Expenses

What we will not pay

• Costs associated with MRI scans, unless not covered under Medicare or Private Health Insurance

QBE INSURANCE (AUSTRALIA) LIMITED

AN A044726 PAD Sports Schedule – WA Basketball 2015-2016

• for costs incurred which are associated with the prevention of injury. For example, knee braces, mouth guards, ankle braces,

• for costs related to breakage of dentures, optical lenses or spectacles,

• expenses incurred for which a Medicare benefit is payable,

• expenses incurred more than 12 months after the date of injury,

• accounts covered by private health insurance unless the claimant has claimed a private health benefit. If that is the case we will pay the difference between any private health insurance rebate to which an Insured Person may be entitled to and the actual cost incurred by the Insured person less any excess applicable as per Policy Schedule

Non Australian Residents

Benefits will be paid on the same basis as though Medicare applied, therefore benefits that would normally attract Medicare for permanent residents will not be claimable. All benefits will cease if the claimant leaves Australia.

Endorsement 5

Under the Section When you are not covered General Exclusions applying to this Policy

Additional exclusions applying to this policy the following are amended

8. social matches unless sanctioned by the Insured

9. end of season trips for social purposes unless sanctioned by the Insured 10 activities involving parent/child competition unless sanctioned by the Insured

“Sanctioned” is defined as any event organised or under the control of the Insured

Endorsement 6

Any mention of the word repetitive nature or repetitive movements is deleted from the policy wording

Endorsement 7

If an insured person is paid a Section A capital benefit under Events 2, 4, 5 or 7 we will also pay for the cost necessarily incurred by the insured person in modifying

* their motor vehicle or * their home or

* in relocating to a suitable home

QBE INSURANCE (AUSTRALIA) LIMITED

AN A044726 PAD Sports Schedule – WA Basketball 2015-2016

Endorsement 8 – Counselling Support

We will pay up to $200 per week, subject to a maximum of $2,000 for counselling support to a financial member or the financial members immediate family by legally qualified medical practitioner if you witness the death of an athlete, or if you suffer death, quadriplegia or paraplegia

Endorsement 9 - Unexpired Membership

We will reimburse a member for a pro rata refund of the Insured Person’s membership/ registration fee from the date of bodily injury should the member be deemed by their legally qualified medical practitioner to be unable to participate in the playing of sport for the remainder of the season and this is as a result of an injury covered by this policy.

Benefit: Up to a maximum of $500

Endorsement 10 – Cardiac

We will not pay for any Injury directly or indirectly caused or contributed to by, or in consequence of any cardiac, pulmonary or cerebrovascular sickness or disease.

Endorsement 11 Difference in condition (DIC) / difference in limits (DIL)

It is hereby declared and agreed that we guarantee to provide as a minimum no less cover in conditions and limits than the coverage that exists under the expiring Sports Injury policy through DUAL Insurance Agency Pty Ltd on behalf of certain Underwriters at Lloyd’s which expired 1st

September 2015

Furthermore please note any endorsements added to this Policy Schedule will override and replace any exclusions under the Product Disclosure Statement (PDS) or Policy Wording