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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.
2. Not honor the claim and send you a letter of denial. An example might be that your son or daughter is no longer part of your group policy after attaining the age of 22.

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?
A: The family's insurance is the primary insurance and will dictate how the Sports Medicine Staff proceeds with a student athletes' injury. We must use the student athletes' own insurance first before we can initiate Loyola University Chicago as a secondary insurance provider. Loyola University Chicago has contracted with First Agency as the secondary insurance company. Bills are submitted for payment through First Agency who, if injury is verified and applicable, will provide payment for out-of-pocket expenses after deductibles have been met.

Q: What I decide to purchase the Loyola University Chicago Student Insurance plan as my primary insurance?
A: Athletic injuries are not covered under the Loyola University Chicago Student Insurance plan. You must notify your Athletic Trainer to purchase additional insurance coverage.

Q: Will my premiums increase if my son or daughter stays on my insurance?
A: No they will not. Health insurance does not increase on a yearly basis because of individual use and claims like auto insurance does.

Q: Does the athletics policy cover illnesses that may arise throughout the year?
A: 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.

Q: My family has an HMO, how do we go about obtaining treatment and diagnostic testing?
A: As the HMO is the primary insurance, the Sports Medicine Staff must utilize your in-network services. You are responsible for contacting your insurance company if referrals are needed for testing, appointments, diagnostics and treatment. The student athlete may be required to travel home for appointments, treatments or diagnostic testing.

Q: We live out of state and have an HMO, how do I obtain coverage while my child is at school?
A: The HMO needs to be informed that your student athlete will be going away to another state for school and to change coverage. Most HMOs will have you set-up a primary care physician in the area, please choose Loyola Medical Center if it is an available choice as our team physicians are part of the Loyola Medical Center. This will expedite any appointments, testing or diagnostics that are needed.

Q: My family has a deductible, will Loyola University Chicago be covering the deductible?
A: The family needs to reach their deductible before the University's insurance will pay out remaining out-of-pocket balances.

Q: Does Loyola University Chicago reimburse co-payments?
A: Co-payments are the responsibility of the family.

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?
A: Unfortunately, no. We are not able to pay for any services rendered that are not directly referred by a member of the Sports Medicine Staff. Even in emergency situations, the Sports Medicine Staff needs to be informed. In case of emergency, please inform the Sports Medical Staff within 24 hours of the injury.

Q: My child was injured during a summer game that was not supported by Loyola University Chicago, who is responsible for the medical bills?
A: Loyola University Chicago is not responsible for medical bills for injuries incurred that are not a direct result of an accident in our intercollegiate sports program.

Q: I filled out the Insurance Form last year and our coverage has not changed. Do I need still need to fill it again?
A: Yes, by filling it out each year we recognized that your student athlete is covered by insurance. Your student athlete will not be allowed to participate without this. We need annual confirmation that the student is covered by useable health insurance.

Q: My insurance has changed (or will change) during the year. What should I do?
A: Please inform the Sports Medicine Staff as soon as possible so that we may update our records and send a copy of the new insurance card. Failure to update Sports Medicine Staff may result in forfeit payment by Loyola University Chicago.

Q: What is the time frame for Loyola University Chicago's secondary insurance to pay for medical bills?
A: One year from date of reported injury.

Q: I just received a bill in the mail. What do I do now?
A: First send the bill to your primary insurance for initial payment. If there is a remaining balance, not including deductible, forward the bill immediately to your Athletic Trainer. We will initiate the claim to First Agency. First Agency then will be mailing the student athletes' home materials for updated information on the claim. They will be requiring you to send an EOB shortly after claim information has been updated.

Mail to:
Norville Center
6526 N. Winthrop
Chicago IL 60626

Fax to:
(773) 508-2310

Q: What is an Explanation of Benefits (EOB) and where do I get one?
A: The explanation of benefits is a statement from your primary insurance that explains how a bill from a provider was processed. It includes information like how much they paid, deductible and co pay amounts, and any network discounts. Most insurance carriers mail these to the member at the completion of the payment process. If you do not receive one, you will need contact your insurance carrier to request one.

 


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