Clearing the Confusion. Welcome to the world of insurance.

Transcription

1 Clearing the Confusion Welcome to the world of insurance.

2 What we will cover. Why do the athletes need insurance? What is a primary insurance? Are there different types? What does it cover? What if an athlete has a pre-existing condition? What is a secondary insurance? What does it cover? What is Coordination of Benefits (COB) Are there any restrictions or guidelines?

3 Why do they need insurance? NAIA-National Association of Intercollegiate Athletics. In the NAIA, a dedication to leadership development is balanced with sports accomplishment. A trailblazer in providing equal opportunity for all student-athletes. An expectation of ethical behavior, fairness in competition, access to athletic scholarship, sportsmanship and leadership development. At the core of all of this character.

4 The NAIA dictates what can and can not be done for student athletes. Part of this is based on the Division the school falls in. The goal of these regulations is to level the playing field. NNMC can not provide a primary health insurance coverage to their athletes because it would violate the regulations set up under your Division. Student athletes must have their own primary insurance coverage to be eligible to participate and to use the NNMC facilities.

5 What is a primary insurance? A Primary Plan is a Group Health Benefit Plan, an individual health benefit plan, or a governmental health plan designed to be the first payer of claims for an Insured Person prior to the responsibility of a secondary plan. Deductibles will always be the responsibility of the insured. For our purposes, these plans will either be short term or standard plans offered by Blue Cross/Blue Shield, Lovelace, or Presbyterian.

6 Are there different types? Yes, there are different types of health insurance. We will be discussing Short Term Policies and Standard Policies. There are benefits and drawbacks to each type of policy. Also, policies between companies vary on what benefits are included, health screening, pre-existing conditions, prescription drug coverage, and what benefits can be added for a cost.

7 What does it cover? Short Term Policy-BCBS Standard Policy-BCBS

8 Standard Policy-Lovelace Standard Policy-Presbyterian

9 Pre-existing Conditions Most insurance companies use one of two definitions to identify such conditions. Under the "objective standard" definition, a preexisting condition is any condition for which the patient has already received medical advice or treatment prior to enrollment in a new medical insurance plan. Under the broader, "prudent person" definition, a pre-existing condition is anything for which symptoms were present and a prudent person would have sought treatment. These conditions do not include common transient illness like colds, flu, chicken pox, etc. These are medical conditions such as heart disease, diabetes, drug addiction, high blood pressure, musculoskeletal trauma, (requiring more than time and ice to heal), etc.

10 Secondary Insurance Secondary health insurance plans may pay co-pays and expenses not covered by your primary plan. Often, your first insurance company must provide payment for the part it will cover before your secondary health insurance will issue payment for any difference. This is called Coordination of Benefits or COB. Once the primary insurer pays out their approved amount, the remaining balance due is submitted to the secondary insurer. The secondary insurer pays what is remaining based on the contract. This does not apply to the deductible. The situation we have here is not what is generally seen in the everyday world of secondary coverage. In this case, NNMC carries a policy to protect the school from the liability of health care expenses that may occur during the course of an athletic season. This policy acts as the secondary coverage for the athletes as long as they are eligible and are participating in an organized activity.

11 Restrictions or Guidelines Primary Insurer Short Term policies: Do not cover pre-existing conditions. Can only be written back to back once. A two month break must occur before a student can apply again. Can only be written for periods of 1-6 months or 7-11 months. deductibles renew every time the policy is rewritten. Are accepted as credible coverage if the insured is applying for a standard policy. Very limited health information required. Standard policies: Cover pre-existing conditions after a waiting period. (6-12 months) Will count credible coverage toward the waiting period as long as the coverage has not lapsed for more than 60 days. (The insured will receive the letter of credible coverage from their previous insurer at the termination of their policy.) Underwriting required for approval of coverage. Both types of policies require bank accounts to draft premiums. NNMC NNMC requires the student athletes to carry a primary coverage to participate in organized athletic activities.

12 My role as an agent. My role is fairly simple but has it s own restrictions. Inform the customer. Sell the policy the customer wants based on the decision they make after hearing the options presented to them. I know this sounds simple and in some respects it is. The one thing that needs to be understood is that I am unable to deny sale of a policy for any reason. What does this mean? If an athlete decides to purchase a policy that doesn t meet the requirements of the athletic department, I can not deny them that policy. What happens then? This is where it gets sticky. Yes, the athlete does have insurance. No, they are not eligible to play. The athlete will not be able to participate in collegiate sports if the primary insurance that is purchased does not meet the department requirements. My final role is to make sure that athletes that have been injured are rolled over into a standard policy so they can receive the treatment they need. This means it is vital that the athletes be advised to disclose any injury they have had under the previous coverage that may need further treatment, or could be aggravated again causing additional treatment to be required.

13 Don t worry!!!! I m here. Feel free to call me anytime with questions or concerns. If I don t know the answer I will find out for you. My contact information is below. The Trujillo Agency, LLC Christian Laumbach 807 Grand Ave. Las Vegas, NM Office Direct Line Cell Fax claumbach@thetrujilloagency.com