We
are extremely pleased to have your son/daughter as a student athlete at
Benedictine University and hope that he/she will achieve academic, social, and
athletic success. Each student athlete is required to have a physical
examination prior to any participation in any intercollegiate sport. Should an
athlete not be cleared to participate, the team physician and athletic trainers
will work with the primary care physician to sort through the issues. The team
physician and athletic training staff also make the decisions on when an athlete
may return to competition after a previous injury.
The following forms must also be completed in entirety and returned to the athletic trainers, Attn: Laura Gorski, via fax, mail, or hand delivery by the student-athlete. Any athlete, who has not returned these forms prior to the first day of practice, will not be allowed to participate until all forms are returned.
Accidents do occur and we
attempt to provide our athletes with the very best possible care. Medical bills
may be incurred when the athlete is treated for bodily injury due to an
accident, whether it is locally, during a road trip, or by a medical vendor in
his/her own home area.
ONE FIRM
STATEMENT:
NCAA/NAIA/NJCAA discourages any college or university from
providing coverage or paying the bills incurred for expenses related to
illnesses or conditions which are not sustained as the direct result of an
accident in our intercollegiate sports program. (This includes pre-existing
conditions and non-athletic injuries)
The
INSURANCE
COVERAGE:
The athletic accident insurance at Benedictine University provides coverage for your son/daughter for accidents while participating in the play or official team practice of intercollegiate sports, including sponsored and authorized team travel.
CLAIM
PROCEDURE:
All medical bills for your son/daughter incurred as the result of an accident in the intercollegiate sports program will be sent directly to your son/daughter or to your home address, unless the college or university has instructed the medical vendors otherwise. In some cases, the athletic department may get a copy of the bill, but in no case will the athletic department be the primary place for the bill to be sent.
A. Submit the bills incurred
to your family primary insurance plan first. They will do one of two
things:
1. Honor the claim and pay all
or a portion of the bills incurred.
2. Not honor the claim and
send you a letter of denial. An example might be that your son/daughter is no
longer part of your policy after attaining the age of
twenty-three.
B. If there remains a balance
after your family primary insurance plan has contributed towards the claim, send
the claim sheet from the insurance company and a copy of the itemized bill bills
incurred to the First Agency claim agent listed at the end of this letter.
If
you receive a letter of denial from your family primary insurance plan
administrator, then send the letter of denial and a copy of the bills incurred
to the First Agency claim agent listed at the end of this letter. If no coverage
is available, a letter from your employer with verification will be necessary.
C. If the bills incurred and
not paid by the family primary insurance plan, exceed the deductible, the claim
must be sent to the First Agency claim agent for processing. If they need
additional information, please cooperate with them and they will process the
claim in the least possible amount of time. It is in your best interest to have
the claim settled promptly since all the bills incurred are in your name.
PLEASE NOTE: If the primary family coverage is
through an HMO or PPO, you must follow the proper procedures required by your
plan in order for the college’s insurance to satisfactorily complete its portion
of the claim. This is especially important if your plan requires
pre-authorization to have your son/daughter treated if out of your plan’s
service area.
Parents should retain this
letter for future references. In addition, we ask that you complete the attached
form in DETAIL and return to us prior to any athletic participation. Your
cooperation in this is important area will help make this program successful in
minimizing delays and accomplishing the purpose for which it is intended.
Benedictine University’s
claim agent:
Dawn Witz
(269) 381-6630 (phone)
First Agency, Inc.
(269) 381-3055 (fax)
5071 W. H Avenue
Kalamazoo, MI
49009-8501
Thank you for your cooperation!
The
Benedictine University Athletic Training
Staff