Loyola Sports Medicine Insurance Policy
Injuries do occur and we attempt to provide our athletes with the very best possible care. Medical bills are incurred when the athlete is treated whether it is locally, during road trips, or by medical vendors in his or her home area. ONE FIRM STATEMENT: The NCAA does not permit us or any college or university to provide coverage or pay the bills incurred for expenses related illnesses or conditions which are not sustained as the direct result of an accident in our intercollegiate sports program. Please be aware that in all intercollegiate sports programs there are expenses incurred which are not covered under an athletic policy. Frequently, these are injuries that are due to participation in a sport, but are not due to a specific accident. Examples could include the following: hernia, sports hernia, fainting, arthritis, heat exhaustion, cardiovascular stroke, skin conditions, tendonitis, bursitis, osteochondritis dissicans, shin splints, sickness, orthotics or other custom made devices, or a pre-existing condition from high school or earlier in an intercollegiate career. INSURANCE COVERAGE: The athletic accident insurance at Loyola University Chicago provides coverage for your son or daughter for accidents while participating in the play or official practice of intercollegiate sports. CLAIM PROCEDURE: All medical bills for your son or daughter incurred as the result of an injury in the intercollegiate sports program will be sent directly to you home address unless the 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 incurred to be sent. A. Submit the bills incurred to your family, employer group coverage or plan first. They will do one of two things:
1. Honor the claim and pay all or a portion of the bills incurred. B. If there remains a balance after your family, employer group insurance or plan has contributed towards the claim, send the claim sheet from the insurance company and a copy of the itemized bills incurred to the university's athletic department. If you receive a letter of denial from your family, employer group insurance or plan administrator, then send the letter of denial and a copy of the bills incurred to the university's athletic department. If no coverage, a letter from your employer with verification will be necessary. C. If the bills incurred are not paid by the family, employer group insurance or plan, and are large enough, the claim will be sent from the athletic department to our insurance carrier office which is in Kalamazoo, Michigan for processing. If they need any 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 are in your name. NOTE: HMO (HEALTH MAINTENANCE ORGANIZATION) OR PPO (PREFERRED PROVIDER ORGANIZATION) If the parents or student athletes choose not to use authorized medical vendors of their plan, they should be aware that Loyola's coverage would not be able to pay the bills incurred that would have been honored had the individual used the proper medical vendors. If your insurance provider is an HMO, please be aware that medical care including MRI's, x-rays, or other diagnostic tests may have to be done in your hometown or wherever your primary physician resides. LAYERS OF COVERAGE, BENEFIT PERIOD, MAXIMUM MEDICAL FOR LOYOLA UNIVERSITY CHICAGO: a. $0-$250 b. Deductible $250-Medical maximum $14,750 per claim. The accident coverage is through Guarantee Trust Life Insurance Company and claims are processed by First Agency of Kalamazoo, Michigan. This is excess coverage and covers all claims up to one year from the date of the accident. The bills incurred for this layer of coverage will be in the parent's name and must be submitted to the family, employer group insurance, or plan first. c. Deductible $15,000-Medical maximum $10,000 per claim. This accident coverage is through AMEX Life Insurance Company and claims are processed through First Agency of Kalamazoo, Michigan. This is excess coverage and covers all claims up to four years from the date of the accident. The bills incurred for this layer of coverage will be in the parent's name and must be submitted to the family, employer group insurance or plan first. d. NCAA Lifetime Catastrophe Medial Plan FREQUENTLY ASKED QUESTIONS (FAQ)
Q: What is the difference between primary and secondary insurance?
Q: What I decide to purchase the Loyola University Chicago Student Insurance plan as my primary insurance?
Q: Will my premiums increase if my son or daughter stays on my insurance?
Q: Does the athletics policy cover illnesses that may arise throughout the year?
Q: My family has an HMO, how do we go about obtaining treatment and diagnostic testing?
Q: We live out of state and have an HMO, how do I obtain coverage while my child is at school?
Q: My family has a deductible, will Loyola University Chicago be covering the deductible?
Q: Does Loyola University Chicago reimburse co-payments?
Q: My child was injured while at practice but did not tell anyone about their injury. He/She went to the emergency room on their own to have an x-ray done. Will these charges be covered by the Athletic Department?
Q: My child was injured during a summer game that was not supported by Loyola University Chicago, who is responsible for the medical bills?
Q: I filled out the Insurance Form last year and our coverage has not changed. Do I need still need to fill it again?
Q: My insurance has changed (or will change) during the year. What should I do?
Q: What is the time frame for Loyola University Chicago's secondary insurance to pay for medical bills?
Q: I just received a bill in the mail. What do I do now?
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Q: What is an Explanation of Benefits (EOB) and where do I get one? |
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