University Of Southern California Student-Athlete Post-Separation Medical Coverage Program

Transcription

1 University Of Southern California Student-Athlete Post-Separation Medical Coverage Program In the interests of promoting and maintaining the health and welfare of its Student-Athlete and in order to implement applicable California law and Pac-12 Executive Regulations, the University of Southern California (USC) has prepared and now implements the Post-Separation Medical Coverage Program set forth below. Reporting of All Athletically-Related Injuries All Student-Athletes are required to timely report any Athletically-Related Injury to the Athletic Trainer for his or her team. Exit Interview/Physical Examination In order to promote the health of student-athletes and comply with and implement Pac-12 Conference Executive Regulations and California State law, all USC Student-Athletes are required, as an express condition of receiving benefits from USC under this program, Pac-12 Executive Regulation 7(1)(e) and/or California Education Code Section 67453, to fully complete, execute and submit a USC Student-Athlete Exit Interview Form ( Exit Interview Form ), and, if requested, participate in an inperson interview and/or physical examination with USC Athletic Training Staff and/or designated Medical Professionals/Team Physician, within twenty-one (21) days after their last date of practice or competition for a USC intercollegiate athletic program at USC, whichever occurs earliest ( Exit Interview ). The Exit Interview Form (and Exit Interview, if conducted) and Athletic Training records for each Student-Athlete will (1) document each Student-Athlete s health status, any Athletically-Related Injuries and (2) allow each Student-Athlete to disclose any on-going or unresolved Athletically-Related Injuries. Any and all injury concerns and on-going or unresolved Athletically-Related Injuries should be disclosed on the Exit Interview form and at the Exit Interview, if conducted. Complying with the Exit Interview Requirement Within 21 days of his or her last date of practice or competition for USC, whichever occurs earlier, every Student-Athlete must fully complete, execute and submit to USC an Exit Interview Form, a copy of which shall be provided to each Student-Athlete at the beginning of each academic year and before the Student-Athlete s last day of practice or competition, via or by the Sport Administrator, Head Coach, Director of Operations or Athletic Trainer for the Student-Athlete s team. Student-Athletes who have not sustained an Athletically-Related Injury Student-Athletes who have not sustained an Athletically-Related Injury shall fully complete, execute and submit the Exit Interview Form without the need for an Exit Interview. In order to 1

2 utilize this option, the Student-Athlete must verify, under penalty of perjury, that he or she has not sustained any Athletically-Related Injury while participating in intercollegiate athletics at USC. Student-Athletes who have sustained an Athletically-Related Injury but do not have any current ongoing or unresolved symptoms or concerns Student-Athletes who have sustained an Athletically-Related Injury, but are not currently experiencing any injury concerns or on-going or unresolved medical issues shall also fully complete, execute and submit the Exit Interview Form without the need for an Exit Interview. In order to utilize this option, the Student-Athlete must verify, under penalty of perjury, that he or she is not experiencing any injury concerns, on-going or unresolved injury issues from any Athletically-Related Injuries. Student-Athletes who have sustained an Athletically-Related Injury and are currently experiencing ongoing or unresolved symptoms or concerns Student-Athletes who have sustained an Athletically-Related Injury and are currently experiencing any injury concerns or on-going or unresolved medical issues shall (1) fully complete, execute and submit the Exit Interview Form, and (2) contact USC s Head Athletic Trainer to schedule an in-person Exit Interview and/or physical examination within twenty-one (21) days of his or her last date of practice or competition for USC, whichever is earlier. After the Exit Interview, USC shall provide such Student-Athletes with an evaluation and recommended course of treatment, where appropriate or necessary. The Head Athletic Trainer or his or her designee shall review each Exit Interview Form within 21 days of receipt and verify that the disclosure contained in the Exit Interview Form is consistent with the Student- Athlete s medical records. Loss or Limitation of Benefits (1) Exit Interview Form: Failure of a Former Student-Athlete to fully complete, execute and submit the Exit Interview form, and where required participate in the in-person Exit Interview/Physical Examination within twenty-one (21) days of his or her last date of practice or competition, for USC, whichever is earlier, shall release USC from any medically related financial obligation under this program, Pac-12 Executive Regulation 7(1) (e), and/or California Education Code Section (2) Required Pre-Approval: Failure of a Former Student-Athlete to obtain the required preapproval for a medical treatment or service for an Athletically-Related Injury shall release USC from any obligation for the medical treatment or service sought under this program, Pac-12 Executive Regulation 7(1) (e), and/or California Education Code Section (3) Declination of Recommended Treatment: After fully completing, executing and submitting the Exit Interview Form, certain Student-Athletes may be requested (or may request themselves) to participate in an in-person Exit Interview with USC Head Athletic Trainer or other designated medical professionals, which may result in a recommended course of medical treatment. If a Student-Athlete declines to follow that recommendation, the Student- 2

3 Athlete may forfeit any and all benefits under this program, Pac-12 Executive Regulation 7(1)(e), and/or California Education Code Section (4) Transfer by the Student-Athlete from USC to Another Institution: Should a Student- Athlete transfer to another institution before his or her undergraduate graduation from USC, the Student-Athlete shall only be eligible under this program for two years (as required under California Education Code Section 67453) from his or her separation from USC, and then only if all other eligibility requirements under this program are met. (5) Practice or Competition with a Professional Team or Organization: Once a Former Student-Athlete has successfully passed a pre-participation physical with a professional team/organization and participates in practice or competition for or with the professional team/organization, the Student-Athlete shall only be eligible under this program for two years (as required under California Education Code Section 67453) from his or her separation from USC, and then only if all other eligibility requirements under this program are met. Other Coverage To the extent that a Former Student-Athlete has any policy of insurance or other medical benefits coverage pursuant to which coverage may be available for the matters contemplated by this program, any and all benefits under this program, Pac-12 Executive Regulation 7(1)(e), and/or California Education Code Section 67453, shall respond and be provided to such Former Student-Athlete, if at all, after the exhaustion of such insurance or other medical benefits coverage. Medical Treatment Claim Process Subject to all of the requirements and conditions set forth above, USC will provide eligible Former Student-Athletes with reasonable medical treatment or services which are reasonably necessary for an Athletically-Related Injury, in accordance with the guidelines below, for up to four years after his or her Separation from USC, or age 26, whichever is earlier (provided that, regardless of a Former Student- Athlete s age, the coverage period shall in no event be less than two years under this program). In the absence of exceptional extenuating circumstances or emergency necessity, USC requires, as a condition of eligibility for any benefits under this program, that the Former Student-Athlete obtain pre-approval from the USC Post-Separation Medical Coverage Panel (the Panel ) for any medical treatment or services. The Panel shall include USC s Head Athletic Trainer, USC s Athletic Director (or designee), a USC Team Physician, the Faculty Athletics Representative, and a licensed physician not affiliated with USC s Athletic Department. To make a claim under this program, the Former Student-Athlete shall fully complete, execute and submit the USC Athletics Post-Separation Medical Authorization Claim Form ( Claim Form ) via the web address at least ten business days prior to any scheduled medical treatment related to the Claim. The Claim must include via attachment/upload all relevant information and documentation for any requested medical treatment, service and/or direct medical expense(s) regarding the Athletically Related Injury sought by a Former Student-Athlete, a Medical Release form authorizing the Panel to obtain and review any and all relevant and necessary medical records concerning the request and the claimant s address. The medical release is included as a part of the Claim Form available at Once a Claim and all relevant documents necessary to evaluate the Claim have been received, the Panel will review the Claim. The Panel s review of each Claim will be based upon the concept of 3

4 reasonableness, taking into account factors including: any prior approvals associated with the Claim, the immediate injury or symptoms associated with or related to the Athletically-Related Injury, the circumstances surrounding or causing the need for medical treatment, the Former Student-Athlete s Exit Interview Form (and, where applicable, in person Exit Interview and/or exit physical), the information submitted with the Claim Form, and other relevant information pertaining to the Claim (e.g., any emergency circumstances related to Athletically-Related Injury, the location of the Former Student- Athlete, the Athletically-Related Injury involved, the treatment requested, required, or performed relating to the injury, the nature/type of the medical treatment sought, etc.). The Panel shall render a written decision regarding each Claim within ten (10) business days of the receipt of each Claim and all relevant information necessary to evaluate the Claim. If approved in whole or in part, the Panel shall inform the Former Student-Athlete, via and U.S. Mail, that (1) Further information or a physical examination is required before a final determination regarding the Claim can be made, or (2) He or she is entitled to (a) The necessary medical treatment, whether via (i) Institutional Treatment and/or Rehabilitation to address the Athletically- Related Injury (including reasonable travel and lodging expenses associated with such Institutional Treatment and/or Rehabilitation), or (ii) USC s reimbursement or direct payment of some or all Direct Medical Expenses needed to address the Athletically-Related Injury, or (b) The procurement by USC of insurance or other funding source(s) for the medical treatment or service requested by the Former Student-Athlete relating to his or her Athletically-Related Injury. The option (from those set for the above) selected by the Panel will be within USC s sole discretion and will be based on factors affecting the reasonableness of each option (e.g., the location of the Former Student-Athlete, emergency circumstance necessitating medical treatment, injuries sustained prior to USC enrollment, etc.). Each Claim will be subject to a case-by-case review and decision. Appeal Process after Panel s Denial or Rejection of a Claim In the event a Former Student-Athlete submits a Claim under this procedure that is denied in whole or in part by the Panel, the Former Student-Athlete may elect to accept the denial or submit the denied Claim to USC s appeal process. The appeal process will be conducted by an independent third party claims appeals administrator (TPCAA) designated by USC. Any TPCAA performing the appeal review process shall be wholly independent of and from USC, and, compensation to the TPCAA for and/or any renewal of the TPCAA s services shall not be dependent upon, influenced, or affected in any way by the affirmation or reversal of any claim or claims in any given contractual period. Any appeal must be submitted by the Former Student-Athlete in writing to the TPCAA no later than twenty (20) business days after the Former Student-Athlete s receipt of USC s denial of the Claim. The appeal form shall be available at As a condition of initiating the appeal process, a Former Student-Athlete must provide a medical authorization for the TPCAA to review all relevant medical records and other documentation which was previously provided to USC by the 4

5 Former Student-Athlete as part of the Claim. Upon receipt of an appeal from a Former Student-Athlete, the TPCAA shall immediately notify the Panel of the appeal, the date it was received from the Former Student-Athlete, and provide the Panel with a copy of the appeal. USC shall have fifteen (15) business days from the receipt of any such notice to submit a written response or opposition to the appeal. The TPCAA will endeavor to complete the appellate review process and provide its written decision within 30 days of its receipt of the complete claim file including any response or opposition from USC. The TPCAA s decision will be final and binding on the Former Student-Athlete and USC. DEFINITIONS 1. Student-Athlete means any USC student who participates in an intercollegiate athletic program at or for USC. 2. Former Student-Athlete means a Student-Athlete who has Separated from USC. 3. Athletically-Related Injury means an injury sustained during a Student-Athlete s participation in an intercollegiate athletic program for USC that was timely reported by the Student-Athlete to the Athletic Trainer for the Student-Athlete s team. Medical conditions that existed prior to participation in an intercollegiate athletic program at USC or did not result from the participation in an intercollegiate athletic program for USC are excluded from the definition of Athletically- Related Injury. 4. Separation or Separated means the latter of a USC Student-Athlete s undergraduate graduation from USC or permanent withdrawal from all classes at USC. However, in the event a Student-Athlete receives an undergraduate degree from USC and continues to participate in an intercollegiate athletic program at USC with remaining NCAA eligibility, separation shall not take place until the student-athlete exhausts his or her NCAA eligibility. 5. Direct Medical Expenses means the reimbursement or direct payment by USC of fees or expenses on behalf of the Former Student-Athlete to the appropriate non-usc health care professional(s) and/or medical facilities, as designated by the Panel. 6. Claim means a request made by a Former Student-Athlete to the USC for the necessary medical treatment to address an Athletically-Related Injury, whether via Institutional Treatment and/or Rehabilitation or Direct Medical Expenses. The request is to be made via the form provided online for completion by the Former Student-Athlete. 7. Institutional Treatment and/or Rehabilitation means medical treatment and/or rehabilitation treatment conducted at USC facilities by USC health care professionals, as designated by the Panel. May