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Insurance Packet

Insurance Packet

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Published by jered86

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Categories:Types, Brochures
Published by: jered86 on Jul 01, 2009
Copyright:Attribution Non-commercial

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02/04/2013

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1
Student Athletic Insurance Information
PARENTS: PLEASE READ AND KEEP PAGES 1 & 2 FOR FUTURE REFERENCEWe are extremely pleased to have your daughter/son as a student athlete at Greenville College and hopeshe/he will achieve academic, social and athletic success.EACH STUDENT ATHLETE IS REQUIRED TO:1.
 
COMPLETE & RETURN ALL ATTACHED FORMS by August 1
st
.2.
 
ALL FRESHMAN AND TRANSFER students must HAVE A PHYSICAL EXAM prior to anyparticipation in any intercollegiate sport, including official practice. Please get a physicalBEFORE coming to school. RETURNING STUDENTS DO NOT NEED A NEWPHYSICAL, but must complete and return the rest of the packet before the first practice.3.
 
EVERY ATHLETE MUST HAVE PRIMARY INSURANCE and/or basic health insurance atall times. College health insurance can be added if you are in need of primary coverage. If youare currently covered by an individual or family plan, it is to your benefit to continue with thiscoverage ra
ther than purchase the college’s health insurance.
 4.
 
EVERY ATHLETE MUST HAVE ATHLETIC INSURANCE
 – 
a second layer coverage
through the college’s athletic insurance plan is required.
This insurance is secondary and hasa deductible of $250
. Any athlete who participates in practice will be billed for this athleticinsurance.
5.
 
PLEASE NOTE
The College has purchased an accident only policy that will cover amaximum of $250 for athletic injuries (covers the deductible) and $5000 on non-athleticinjuries. This is also a secondary policy that will only pay out after your primary has paid theirportion.6.
 
USE ONLY THE AUTHORIZED MEDICAL VENDORS IF YOUR PRIMARYINSURANCE IS AN HMO or PPO. (Contact with the HMO/PPO is the responsibility of thestudent athlete or the family.)7.
 
GET AUTHORIZATION from the athletic trainer TO SEEK MEDICAL TREATMENT,except in emergency cases.8.
 
FILL OUT A CLAIM FORM in the Athletic Trainer Office EACH TIME A NEW ACCIDENTOCCURS.
(Our athletic insurance carrier requires that all bills submitted must be accompanied by aclaim form in order to be processed. Without this, a delay in processing is inevitable
.CLAIM PROCEDURE:
1.
 
Submit the bills incurred to your primary insurance carrier first. If a balance remains after yourinsurance
company has responded, SEND THE “EXPLANATION OF BENEFITS” from your insurance
company AND A COPY OF THE ITEMIZED BILLS to the company.2.
 
IF ADDITIONAL INFORMATION IS REQUIRED
for claim processing, please respondimmediately so all paperwork can be processed in the least amount of time. It is in your best interest tohave the claim settled promptly since all bills incurred are in your name.
 
2
ONE FIRM STATEMENT
:
The NCAA Division III does not permit any college or universityto provide coverage or pay bills incurred for expenses related toillness or conditions not sustained as the direct result of anACCIDENT in our intercollegiate sports program.
 
INSURANCE COVERAGE
: The college athletic accident insurance provides coverage for yourson/daughter for
ACCIDENTS
incurred while participating in theplay or
official
team practice of intercollegiate sports, includingsponsored and authorized team travel. Off-seasonconditioning/lifting, games and practices are not covered.$75,000 is the maximum amount per injury and the injuries are onlycovered for two years.
ACCIDENT DEFINITION
:
An unexpected, sudden and definable event which is the directcause of a bodily injury, independent of any illness, prior injury,or congenital predisposition.
An accident is determined by the following:1.
 
A specific time2.
 
A specific place3.
 
A specific occurrence4.
 
A specific trauma (i.e. contact with an external force)
EXCLUSIONS
: Conditions not covered by athletic insuranceGlasses* ArthritisContact Lenses* Osteochondritis dissecans* Covers injury of the eyes, but not breakage or loss of glasses orcontactsBills incurred beyond the policy benefit period.Orthopedic appliances for participation unless prescribed byphysician.Chiropractic visits (Physical Therapy visits shall be limited to $200per visit and a maximum of $2000 per claim.This policy will pay for claims that are denied by the HMO/PPO forfailure to follow their prescribed procedures
up to a maximum of $5000 per claim.
For a full list of benefits and exclusions contact Mike Peppler at(618)664-6629 or at mike.peppler@greenville.edu
INJURIES OCCURRING ONLY DURING THE OFFICIAL SPORTS SEASON WILL BECOVERED BY THE ATHLETIC INSURANCE!!!
 
 
3GREENVILLE COLLEGEStudent Athletic InsuranceAcknowledgement of Responsibility_________________________________ Social Security # _______/________/______Name of Student
 – 
(Please Print)I, the undersigned, acknowledge receiving the information from Greenville College concerning athleticinsurance coverage and procedures.
I understand the limited extent of Greenville College’s responsibility to its student athletes in that:
 1.
 
Greenville College provides excess or secondary insurance coverage, which goes into effectaft
er receipt of Explanation of Benefits paid by the athlete’s personal insurance carrier. This
secondary coverage has a deductible of $250. Contact with any HMO/PPO will be theresponsibility of the student athlete or the parent/guardian of the student athlete.2.
 
Medical bills incurred, as a result of a coverage injury sustained by the student athlete during
the athlete’s participation in NCAA D
-
III sponsored sport, are ultimately the athlete’sresponsibility and could affect the athlete’s credit rating.
 3.
 
Greenville College, as per NCAA D-III regulations, cannot be responsible for illnesses.4.
 
Greenville College, as per NCAA D-III regulations, cannot be responsible for any injuries thatoccur outside of officially designated intercollegiate practice or competition. (See StudentAthletic Insurance Information)5.
 
Referral of an athlete for precautionary medical attention by the athletic trainer to healthproviders may not guarantee athletic insurance coverage. Greenville College cannot beresponsible for any medical bills incurred relating to pre-existing conditions, injuries orillnesses.I, the undersigned, will cooperate to the best of my ability to see that all medical bills incurred are filedwith the appropriate insurance carrier and that I quickly return any requests for information submitted tome by Greenville College and/or its insurance carrier of record._____________________________________________Parent
 – 
Guardian
 – 
Spouse (Circle One)_______/__________/__________Date

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