BENEDICTINE UNIVERSITY ATHLETICS MEDICAL PAYMENT POLICY

 

1. Benedictine University will only provide secondary insurance coverage to all athletic related injuries and illness once a deductible of $500.00 has been covered. Primary coverage WILL BE the athlete’s personal insurance. Personal insurance IS REQUIRED. Should the athlete not be covered under a family plan, student plans can be purchased through the school at minimal costs.

 

2. The $500.00 deductible is a “disappearing” deductible. This means that the amount put towards your primary insurance plan is also applied towards the school insurance policy. Once $500.00 is met, the deductible “disappears.”

 

2. Since Benedictine University provides athletic health care to its athletes, any unauthorized medical care provided to BU athletes will be the athlete’s responsibility. Unauthorized medical care means any care of an injury/illness that is given to an athlete without discussing with the athletic training staff first. Authorization for outside medical care may only be obtained through the athletic training staff. (Laura Gorski, Allan Prasil, or Missy Shultz at 630-829-6152).

 

3. In order to facilitate medical payments of athletic injuries, any payments or denials related to athletic health care received from the athlete’s primary insurance company must be directly forwarded to:

First Agency, Inc.

Attn: Dawn Witz

5071 W. H Avenue

Kalamazoo, MI 49009-8501

(269) 381-6630 (phone)

(269) 381-3055 (fax)

 

4. Benedictine University’s Athletic Department will only be responsible for athletic medical expenses during the athlete’s eligibility while enrolled at Benedictine University.

 

I HAVE READ AND UNDERSTAND THE STATED BENEDICTINE ATHLETICS MEDICAL PAYMENT POLICY.

 

 

 

_____________________________________                      _______________

Signature of Student Athlete                                                      Date

 

 

 

_____________________________________                      _______________

Signature of Parent/Guardian                                                     Date

(if under 18 years of age)