Athletic Insurance Information
The University of Cincinnati has a self funded program designed as a secondary coverage for costs incurred as a result of injuries sustained during supervised practiced, contests, or travel. The insurance is an “excess type” of coverage. All claims must first be submitted to the athletes insurance, parents insurance or guardian insurance company for payment. The self funded secondary coverage program will then pay the remaining balance according to our policy. If a student athlete does not have personal coverage under a parent or guardians plan, then the student will be responsible for obtaining the University Student Health Insurance. No outside treatment will be covered by our self fund without first obtaining referral by one of our team physicians. All referred bills will be paid within the limits of our policy. For further contact information, contact the athletic insurance coordinator, located in the Lindner Center for Varsity Sports at 513-556-3178.
All non- athletically related injuries and illnesses will be submitted to the athlete’s primary insurance, and the remaining balance will be the responsibility of the student athlete and/or parent or guardian. Medical abnormalities, or pre-existing conditions, are the responsibility of the student athlete and/or their parents/ guardians.
Injury Claim Form:
Primary and/or Secondary Insurance
Responsibilities of Student Athletes
Student athletes are expected to be aware of and comply with the requirements described above. If you sustain an injury during a supervised practice or competition, or during travel, report to the athletic training room for an evaluation. Should your medical problem require further testing, or generate medical bills, then feel free to discuss them with the athletic insurance office located in 265 Lindner Center. The athletic insurance office can help familiarize you with the claims process or check on the status of pending claims.
It must be understood by student- athletes and their families that medical expenses are not “automatically taken care of” by the athletic department or the University. Athletic scholarships do not cover medical expenses or Student Health Insurance. Your medical expenses are “real world” debts and you are responsible for ensuring their settlement. Paying athletic related medical expenses requires coordination of the student athlete and his/her family and coordination between various offices and departments in and around the University of Cincinnati community. The ongoing responsibility and cooperation of student- athletes and their families are both necessary and expected.
Student- Athletes are expected to understand that if they receive medical bills, they should be presented to the athletic insurance office and not taken or sent to the coach or Certified Athletic Trainers. This creates delays in filing a claim. With due respect to varying health care provider billing cycles, statements for athletic related medical expenses that are presented to the athletic insurance office 30 days or more after the issue date, may not be suitable for payment consideration. Payments must be filed within 90 days of the injury date.
June 30, 2011
Dear Bearcat Parent or Legal Guardian;
Effective May, 1, 2011, the University of Cincinnati adopted a new Medical Expense and Reimbursement Policy. While tailored specifically for our athletic program, the policy is very similar to those being followed by our partner schools in the Big East Conference. The requirement for all student-athletes to carry a primary insurance policy remains the same. This coverage typical originates through a policy which belongs to their parents, a legal guardian or, in some cases, even themselves, which has been purchased through the University of Cincinnati Student Health Center.
The student-athlete’s primary insurance policy continues to serve as the initial claims provider, for all athletically-related injuries and illnesses. In the event, a claim is not paid in full by the primary insurance provider; in most cases the University of Cincinnati Athletic Department will accept responsibility for the remaining charges. However, and this is a very important distinction, student-athletes and their families and/or guardians will be fully responsible for all medical expenses related to illness, or injuries that occur outside of officially sanctioned intercollegiate athletics participation at UC.
Once the decision by the primary insurance is received, the claim and Explanation of Benefits (EOB) will be reviewed by the Sports Medicine Department’s insurance coordinator. Any remaining expenses will then be considered for payment based on usual and customary reimbursement rates, and once the injury/illness is determined to be a direct result of the student-athlete’s participation in intercollegiate athletic activity at UC. The student- athlete, and his/her family or guardian, will be responsible for providing any and all insurance information to the Sports Medicine staff to assist in completion of the process. Your cooperative and prompt response to requests for information will allow us act quickly and keeps medical bills from being sent out to collection agencies.
Enclosed you will find a copy of the University of Cincinnati Athletic Department Medical Expense Reimbursement Policy for your review. We also will have an online question and answer section under the Sports Medicine Department policy on medical expense (http://www.gobearcats.com/school-bio/uc-athletic-training-main.html).
If you have any questions or need more information, please feel free to contact our insurance coordinator, Trisha Dee at 5135563178 or me directly at (859)802-2524.
Bob Mangine, MEd, PT, ATC
Associate AD for Sports Medicine
1. What is a Self Funded Secondary Coverage Program?
The University of Cincinnati Secondary Coverage Program is available to all our intercollegiate athletes. It is a secondary (excess) coverage that only begins to pay after your primary and personal insurance has paid on a bill that was generated as a direct result of intercollegiate sports participation. Once a bill is generated and has been processed through the athlete’s primary and/or secondary insurance, the secondary coverage fund goes into effect. The fund is a direct cost of the University and is not supported by a third party. This fund is not for general personal use such as birth control, acne medication, mental health medication, over-the-counter medication, etc.It is available for use only under very specific conditions, and usually begins to provide assistance after all other sources of payment (other insurance policies) have been exhausted.
2. What must my son or daughter do in order to be sure that the university will pay for his or her medical care related to an eligible athletic injury?
To ensure coverage, all services must be coordinated and approved by the university’s sports medicine staff. Your son or daughter should contact a staff athletic trainer in order to begin this process. In the case of an emergency, your son or daughter should go directly to the nearest emergency room and then contact a staff athletic trainer as soon as possible afterwards. Please note that, except in an emergency we cannot cover medical services that have not received prior authorization by our sports medicine staff.
3. What will the university’s athletic insurance cover?
The university can cover medical services that have been pre-authorized and are related to injuries sustained during a sanctioned university intercollegiate athletics event (e.g. scheduled game, competition, or practice).
4. What is NOT Covered by the Athletic Insurance?
5. What happens if my son or daughter is also covered by a private insurance policy through a parent or employer?
The university’s athletic insurance policy provides “excess-only” coverage. This means our insurance can only pay for a medical service after the bill for that service has been submitted to and considered by the other insurance policy that covers the student. Once all other insurance policies have paid or denied the claims for an eligible athletic injury, we are generally able to pay 100% of the remaining co-payments and deductibles from the other policies. Please be aware that, unlike auto insurance, making claims against a health insurance policy generally will not affect your premiums. We strongly recommend that you maintain coverage on your son or daughter as long as the policy permits. New laws which went into effect during the Obama Administration allow you to maintain insurance coverage on your children up to the age of 26.
6. Why does my son or daughter need to be covered by a health insurance plan? Won’t the athletic insurance policy cover him or her without one?
Because the athletic program is only able to cover authorized treatments of sports injuries sustained while participating in our programs, it is important that your son or daughter also be covered by a policy that will pay for treatment of illnesses and injuries that are not related to athletic participation. As a condition of enrollment, the university requires that all students be covered by a major medical health insurance plan. A flexible spending account, in and of itself, is not considered a major medical health insurance plan .If your HMO or PPO does not accept the proposed change of Primary Care Physician, you will be required to purchase the student health insurance plan. The Athletic Department will only consider payment for injury coverage upon receipt of an EOB or denial from the primary insurance.
7. How can my son or daughter purchase insurance if he or she is not covered by a parent’s policy?
All students at the University of Cincinnati are eligible to purchase the UC Student Health Insurance Plan. Your son or daughter will automatically be enrolled in the Student Health Insurance Plan unless he or she files a waiver form indicating that he or she is covered by another insurance plan. An additional charge for this insurance will appear on his or her tuition bill each semester. For more information about the Student Health Insurance Plan program and its benefits and restrictions, please contact 513-556-6868
8. How can my son or daughter waive out of the Student Health Insurance Plan?
You can access the waiver at http://www.uc.edu/uhs/student_health_insurance.html if your son or daughter is covered under another health insurance plan. The form must be filled out and returned in order the waived to take effect. A new waiver must file each year your son or daughter is enrolled at UC. The Student Health Insurance office can be reached at 513-556-6868 for further questions.
9. What can I do to speed up processing of medical claims?Tips to Facilitate Care of your Son/Daughter:
10. What should I do if I receive a bill for medical services or have any questions about the Athletic Health Insurance Program?
Most medical providers will send/file their claim directly to the primary insurance for you. By thoroughly completing the Insurance Information Form each year and providing us with a copy of the front and back of your most current primary insurance card, we can provide proper information to the medical provider for you. Otherwise, you may receive the bill at home and need to send it to your insurance company yourself. Once your primary insurance has made payment or deductible application you need to send a copy of any EOBs (Explanation of Benefits) that you have received from your insurance company as well as the corresponding bill or statement from the medical provider that cared for your son/daughter, to the Athletic Insurance Office.
11. What is an EOB?
EOB stands for “Explanation of Benefits.” It is a statement that your insurance company sends to the policy holder. It provides details regarding who was seen, the date of visit, what charges are covered or not covered, as well as how application to deductible and how network provider discounting has been applied, under the terms of your policy.
12. What if I don’t see an answer listed for a question I have?
For answers to all other question, please contact the UC Athletic Insurance Coordinator at 513-556- 3178.
Participation in intercollegiate athletics carries an inherent risk of injury to student athletes. When such injuries occur, the University cannot assume indefinite responsibility for continuing medical care that might be subsequently required. Subject to the limitations stated hereinafter, however, the University does choose to accept certain limitations. The procedures spelled out in this document, follow in accordance with the NCAA, Big East Conference, and the University of Cincinnati Athletic Department Policies and Procedures.
The University of Cincinnati provides secondary insurance coverage on student-athletes as a self-funded medical expense program (SFP), and serves as a secondary medical fund. The SFP is considered an excess type fund. All claimed medical expenses directly related to a student-athlete’s participation in a university sanctioned activity, i.e. practice, competition, or mandatory conditioning activity, will be considered for coverage by the SFP. In order to be considered for reimbursement, the medical care must be initiated and approved by the staff athletic trainer responsible for the student-athlete’s care, and a UC team physician must provide, or refer for treatment.
The student-athlete, their parents and /or legal guardians must provide primary medical insurance. Medical care costs which exceed allowable reimbursement, as determined by the student-athlete’s primary insurance, will be considered for coverage based on customary and usual charges for the service(s) being billed. In order to determine eligibility for reimbursement, the student-athlete will provide to the Athletic Department SFP an explanation of benefits (EOB) from their primary insurance company, which will be reviewed for consideration.
Exclusions for Athletic Coverage
Injuries and/or illnesses that are not a result of sanctioned activity by Athletic Department are not eligible for SFP coverage and may result in discontinued Athletic Department financial support.
All pre-existing injuries/conditions that are sustained by the student-athlete prior to enrollment at the University, must be disclosed/or evaluated upon the student-athletes pre-season physical examination. Pre-existing medical conditions are solely the financial responsibility of the student-athlete and/or legal guardian and not the UC Athletic Department. Without such notification, subsequent reinjury or exacerbation of the illness or medical condition may result in the University denying coverage for any related claim.
Treatment for injury/illness which are initiated by the student-athlete (and not UC Staff) for non-athletic related injury/illness (NARI) resulting in either physician evaluation, emergency room evaluation and treatment, prescriptions, or diagnostic tests, and/or any illnesses will be the financial responsibility of student-athlete’s family and /or legal guardians. Once an NARI is resolved the student-athlete must receive medical clearance to return to play/participation. In the event a student-athlete voluntarily chooses not to return, the Athletic Department’s obligation to continue coverage for medical services and Athletic Grant-In-Aid financing can be discontinued.
Injuries/illnesses which are simply coincidental to attendance at the University are not covered by the Athletic Department’s SFP and are the responsibility of the student-athletes primary insurance carrier, parents or legal guardian.
Examples include, but are not limited to:
Student-athletes are responsible for all medical expenses incurred including second opinion consultation, and student health services without prior consent and knowledge of the Athletic Department Sports Medicine staff (see policy on obtaining a second opinion). The University and its agents reserve the right to refuse payment for unapproved second opinions.
Injuries associated with or caused by participation in summer volunteer workouts will be covered only if the student-athlete is injured while working out on campus under the supervision of the University’s strength and conditioning coaches and athletic trainers. Injuries caused by voluntary summer workouts, will qualify for the University’s SFP coverage only if approved by the Athletic Department Sports Medicine staff. The student-athlete will cooperate with the Sports Medicine staff to fill out all necessary secondary insurance information or risks having to personally cover expenses associated with injury.