ST. MARY S UNIVERISTY-ATHLETIC TRAINING Athletic Insurance Coverage

Transcription

1 ST. MARY S UNIVERISTY-ATHLETIC TRAINING Athletic Insurance Coverage This information has been compiled and handed to you to help give you a better understanding of your son s/daughter s coverage while they are participating in intercollegiate athletics at St. Mary s University. Rules governing NCAA sponsored organizations require all student-athletes to be covered by an insurance program. THERE WILL BE NO EXCEPTIONS TO THIS POLICY. Insurance Types There are three standard insurances that claims will follow in the event your son/daughter suffers an injury while directly participating in an intercollegiate activity. These insurances will be bill in the following order: 1. Student-Athlete s Primary Insurance Policy: As mentioned earlier, any individual participating in intercollegiate athletics MUST provide proof of medical insurance coverage. Athletes may be covered under their parent s policy or the St. Mary s University Student Health Care Plan (offered through St. Mary s University and may be purchased by the student athlete). NOTE: St. Mary s Athletic Department DOES NOT purchase primary insurance for ANY of their athletes. It is the sole responsibility of the student-athletes to provide their own primary medical insurance. a. In the event of an injury, medical expenses will be processed FIRST through the student-athlete s primary insurance policy. i. Proof of primary insurance payment must be established before the secondary insurance policy will provide payment. ii. St. Mary s University will NEVER receive any bills associated with any medical bills. It is the responsibility of the student-athlete to bring any statements, explanations of benefits (EOB), or any communication from the provider or primary insurance company to the Head Athletic Trainer. iii. Athletes will have 120 days, from primary insurance company payment date, to provide the university with any billing statements. After this 120 day period, they will assume the cost of any medical expenses incurred as a result of their injury. iv. If these matters are not taken care of in a timely manner, the charge will be shown on their personal credit report

2 b. It is the SOLE RESPONSIBILITY of the student-athlete to: i. Show proof of medical health insurance for the academic year. They WILL NOT be allowed to participate in any St. Mary s sponsored activities until this is done. ii. Provide information regarding changes in primary insurance coverage ASAP to the Head Athletic Trainer. If proper notification is not received, St. Mary s University will not be responsible for any medical expenses that may incur due to any injury. iii. Check with your insurance company: Regarding out of area/network coverage while they are away at school. Regarding coverage for athletic injuries. Some insurance programs will not cover athletic type injuries. Regarding dental injuries/coverage. There is an inherent risk of injury to every athlete s teeth. It is recommended that studentathletes have dental coverage. If the student-athlete suffers a dental injury and is not covered by a dental plan, they will assume all costs associated with the injury, following St. Mary s Secondary Insurance coverage. To see if a referral is required from your Primary Care Physician (PCP). Health Maintenance Organizations (HMO) and some other plans may require you to travel outside of San Antonio to see their PCP for any medical coverage. It is advised to change your son/daughter s PCP to our team physician. If this is not feasible, the athlete must enroll in the Student Health Care Plan. Otherwise, they are personally liable for all medical debts incurred. iv. Bring any and all statements, EOBs, or information from providers/insurances to the Head Athletic Trainer ASAP. c. ALL INTERNATIONAL STUDENT-ATHLETES AND STUDENT-ATHLETES RESIDING ON CAMPUS WILL AUTOMATICALLY BE ENROLLED IN THE STUDENT HEALTH CARE PLAN OFFERED THROUGH ST. MARY S UNIVERSITY.

3 2. St. Mary s Athletic Department s Secondary/Excess Insurance Policy: St. Mary s University automatically enrolls all student-athletes in their secondary insurance policy at no cost to the student-athlete. a. This plan is SECONDARY or in EXCESS TO the student-athlete s primary insurance only. Payment from the primary insurance or proof of denial of service from the primary insurance must occur prior to this policy covering expenses. b. The secondary insurance ONLY COVERS ATHLETIC RELATED INJURIES. The following ARE NOT covered by this plan: i. General medical illnesses or injuries occurring outside athletic events, ii. Contact lenses/glasses, iii. Orthotics (unless dictated by injury), iv. Chiropractic expenses, v. Physical therapy (unless approved by the University), vi. Special fit braces that cannot be reused by the University, and vii. Unauthorized second opinions. c. REFERRAL NOTICE! i. Athletes that suffer an injury MUST be seen by and evaluated by their Athletic Trainer before seeking further medical assistance. ii. All injuries needing further medical attention MUST be referred by the University s Athletic Trainer. Even if the treatment is directly related to an injury, if you seek additional treatment on your own, without the consent of the Athletic Training Staff, you will be responsible for any expenses that incur. iii. Athletes with a referral will be given a claims form that must be given to any provider seen for that injury. Athletes are responsible for getting the claims form to any provider. If no claim form was given to an athlete OR if they do not give the claim information form to the provider, the athlete will be SOLELY RESPONSIBLE FOR ANY AND ALL COSTS THAT INCUR. d. Secondary insurance payments: i. The secondary insurance payments will occur once proof of primary insurance payment/denial of service has been established. This is usually done with an E.O.B. (Explanation of Benefits) from the primary insurance. ii. Payments from the secondary insurance may take up to days to be processed. iii. St. Mary s University CANNOT guarantee payment of 100% of all related billing occurrences. Once the secondary insurance pays their portion of

4 the bill, ANY REMAINING BALANCE IS THE SOLE RESPONSIBILITY OF THE STUDENT-ATHLETE. 3. NCAA s Catastrophic Insurance Plan: The NCAA sponsors a catastrophic injury insurance program that covers a student-athlete who is catastrophically injured while participating in a covered intercollegiate athletic activity. a. The policy has a $90,000 deductible and provides benefits in excess of any other valid and collectible insurance. b. The policy will pay $25,000 if an insured person dies as a result of a covered accident or sustains injury due to a covered accident which, independent of all other causes, results directly in the death of the insured person within twelve (12) months after the date of such injury. c. Both catastrophic injuries and sudden deaths should be reported to the NCAA national office insurance staff. Insurance Information St. Mary s University student-athlete s will be automatically enrolled in two (2) different insurance programs. The first is the Student Health Care Plan that is also available for other students on campus. The second is the Athletic Department s Secondary/Excess Insurance Program. The following information is in regards to these two insurances. Student Health Insurance Plan The Student Health Insurance Plan is underwritten by ACE American Insurance Company out of Philadelphia, PA. and covers physicians, medical clinics, and specialists in the Texas True Choice Network. For complete information regarding the Student Health Insurance Plan coverage, deductible, co-pay, and waiver please visit the Academic Health Plans website at Enrollment: All intercollegiate athletes will be automatically enrolled in this plan at registration in both the Fall and Spring semesters, unless a waiver is on file. (Please see Waiver for more information). Payment: All individuals that are automatically enrolled in the plan will be billed the premium on their student tuition bill each semester. If your tuition bill does not show this charge and you know you are supposed to be enrolled in the insurance, please see the Head Athletic Trainer as soon as possible! Waiver: If you wish to not participate in the Student Health Insurance Plan, you must submit an online waiver. In order to waive the insurance, you

5 MUST show proof of comparable coverage (covered by own/parent s insurance). The waiver MUST BE COMPLETED BY THE 12 TH DAY OF CLASS. o If you do not complete the waiver before the 12 th day of class, there is no removing the bill from your account for that semester. o You will have to wait until the following semester for the waiver to take effect. If you are beginning school in the Fall: You may submit a waiver ONLY ONCE for that academic year of August-May (you will not need to submit another waiver in the Spring). If you begin school in the Spring: You will need to submit a waiver by the 12 th day of class in the Spring semester AND again in the Fall semester. All International (F,J, and H visa types) students must be enrolled in the Student Health Insurance Plan. Changes: Any changes that you wish to make must be brought to the attention of the Athletic Trainer as soon as possible. Changes include but are not limited to: o You are dropped from your own primary and need to enroll in the Student Health Insurance Plan. o Wish to no longer have the Student Health Insurance Plan. St. Mary s Athletic Department s Secondary/Excess Insurance Policy The St. Mary s University Athletic Department holds a secondary insurance to help cover any remaining monies due following initial primary insurance payments. Students may not waive this insurance, it is free and provided by the school. Sports Covered: St. Mary s secondary insurance will cover the following activities: baseball, basketball, cheerleading, cross country, drill team/dance, golf, soccer, softball, tennis, and volleyball. Sports Covered Activities: The secondary insurance will cover any loss only if the athlete is partaking in one of the following activities: 1. Regularly-scheduled practice or training, 2. Regularly-scheduled competition or exhibition game, 3. A scheduled tryout, workout session, or team meeting, 4. A supervised and sponsored sports activity, or

6 5. Covered sports travel (includes travel, only within the contiguous United States, including Alaska and Hawaii and only directly and without interruption): Between home and a. the premises of St. Mary s University, b. another site designated by St. Mary s University. Common Exclusions: The secondary insurance ONLY covers sport related injuries. Common exclusion include, but not limited to: 1. Sickness, disease, bacterial/viral infection or medical surgical treatment thereof, including exposure, whether or not accidental, to viral, bacterial, 2. Medical or surgical treatments unless it is in a direct response to a covered injury, 3. Injuries that occur during any sports activity not specifically authorized, sponsored and supervised by St. Mary s University. Insurance Compliance Due to Health Insurance Portability and Accountability Act (HIPAA), insurance companies will NOT give any insurance information to the St. Mary s University Athletic Training Medical Staff. It is the student-athlete s and his/her parent(s) / guardian(s) responsibility to understand the conditions that apply to their policy and comply with any requests for information, proof of full-time student status, etc. from the primary insurance company. Any delinquent bills resulting in bad credit due to non-compliance with insurance company requests will be the responsibility of the student-athlete and/or his/her parent(s) / guardian(s). Medical Bills In the event that a student-athlete should receive a bill/statement/eob for an injury or illness that occurred as a direct result of participation in intercollegiate athletics at St. Mary s University, the student-athlete must submit the bill/statement/eob to the Head Athletic Trainer within 30 business days of receipt. BILLS RECEIVED AFTER 30 BUSINESS DAYS WILL BE THE SOLE RESPONSIBILITY OF THE STUDENT-ATHLETE AND/OR THE STUDENT-ATHLETE S PARENT(S)/GUARDIAN(S). Submit all correspondence to: St. Mary s University ATTN: Nathan Byerley 1 Camino Santa Maria San Antonio, TX (210) Fax: (210) nbyerley@stmartx.edu