Medical Insurance Information
Primary Insurance Requirements
Student-athletes must be covered by a primary medical insurance plan to participate in intercollegiate athletics at DePauw.
Your primary medical insurance coverage must be payable up to a benefit of not less than $10,000 for injuries arising out of practice for or participation in intercollegiate sports. If you do not have primary medical insurance coverage, or your current medical coverage does not cover intercollegiate athletics, or does not meet the minimal coverage requirement above, you will need to purchase coverage prior to starting your intercollegiate sport participation at DePauw (please note that out of state Medicaid programs typically do not meet the requirement above). No student-athlete will be allowed to participate in any organized team activity until documentation of medical insurance coverage and a copy of the medical insurance card are provided in the Medical Insurance Section of the Part 1 Pre-Participation Form.
The secondary athletic accident insurance at DePauw University provides coverage for student-athletes who are injured in an accident while a participant in a DePauw intercollegiate varsity sport.Accidents which occur during participation will be considered for coverage by the secondary insurance. An Accident is defined as an unexpected, sudden and definable event, which is the direct cause of a bodily injury, independent of any illness, prior injury or congenital predisposition. Conditions which result from participation in sports do not necessarily constitute an accident but are considered under the policy. This coverage is only for accidents occurring in official practices or games that have direct coaching supervision whether in the traditional or non-traditional season. Injuries from conditioning and strength training activities which are not both a supervised and official team activity are not covered during either the traditional or non-traditional seasons. This coverage is secondary to the student-athlete’s primary group insurance or plan, which must contribute its maximum benefit, before the secondary policy has any liability. If the claim is otherwise payable and the deductible of the student’s primary insurance has not been met, this coverage will apply. For the 2013-2014 school year, the secondary coverage has a deductible of $1000 and a medical maximum of $90,000 per claim. Coverage is underwritten by the Guarantee Trust Life Insurance Co. of Glenview, IL. This policy also contains a $1000 Accidental Death Benefit and a $5000 Dismemberment Schedule.
Secondary Insurance Claim Procedure for Parent or Guardian
All medical bills for your son/daughter resulting from an accident in the intercollegiate sports program should be sent directly to your home address or primary insurance company. In some cases the athletic office may get a copy of the bill, but in no case will the athletic office be the primary place for the bill incurred to be sent. When filing a claim, please check the following:
Submit the bills incurred to your family, employer group coverage or plan first. Each charge must be submitted to your insurance before it can be processed by Student Athletic Protection even if you know it will be applied to your deductible. Student Athletic Protection is unable to contact your insurance company for this information.
If there remains a balance after your family, employer group insurance or plan has contributed towards the claim:
- Your son or daughter should inquire on secondary coverage and the desired intent to file should be made to their staff athletic trainer for their sport. The staff athletic trainer can then submit an accident report to Student Athletic Protection for those accidents/injuries that appear to meet the policy provisions and for further coverage consideration. .
- You must complete and submit a Student-Athlete Claim Information Form. This form can be accessed from the link above or your son or daughter may request it from their DePauw staff athletic trainer. Make sure that all blanks are completed and the claim form is signed. If the whereabouts of a parent are unknown, please state this rather than leave it blank.
- Be sure that all photocopies are legible. If a bill can't be read, it cannot be considered for payment. Also, please be sure that anything you send has the student's name on it.
- Send all claim sheets (EOB - Explanation of Benefits) from your insurance company. Be sure to provide an explanation of benefit statement for each charge which you send to be processed. You will also need to send a copy of the itemized bills incurred. Be sure to include only itemized bills. A balance forward statement is not acceptable. An itemized bill would inclue the following information:. The patient's name, exact services performed, exact date(s) of service, itemized charges for all services, diagnosis, condition, or symptoms that required the service, the provider's name, address, and federal tax ID number. All EOB's and itemized bills should be sent to: Student Athletic Protection, Inc., P.O. Box 20237, Kalamazoo, MI 49019. (Phone- 800-232-1579 and Fax- 269-375-3103)
- If Student Athletic Protection needs any additional information, they will contact you. Please cooperate with them and they will review and process the claim in the least possible amount of time. It is in your best interest to have the claim settled promptly since all of the medical bills incurred are in your son’s/daughter’s name.
- Payment of claims by Student Athletic Protection, Inc. is made at the 90th percentile. This means that the maximum benefit payable is the amount that 90% of the physicians in the geographic area accept as payment in full for the services rendered. This may result in some unpaid balances.
HMO or PPO. For parents to have payable coverage on their son/daughter, when a member of these organizations, proper procedures outlined by that plan must be followed and authorized medical vendors from the list provided to you by your HMO/PPO must be used. The DePauw University coverage underwritten by Guarantee Trust Life Insurance Company and administered by Student Athletic Protection, Inc. is EXCESS coverage and does contain an exclusion for those bills incurred that were "payable" by the family insurance or plan. If you choose not to use the authorized medical vendors of your plan or you do not follow your plan's procedures, you should be aware that Student Athletic Protection, Inc. will not be able to pay the bills incurred that would have been honored had you used the proper vendors or procedures.
Treatment by a licensed practitioner of medicine must begin within 180 days of the accident.
- Accident claim forms must be submitted no later than 1 year and 3 months (15 months) from date of accident.
- Explanation of benefits from primary insurance, itemized bills(including provider's name, address, tax ID number, diagnosis, and procedures codes), and all information required to process charge must be submitted no later than 1 year and 3 months (15 months) from date of service.
- Only expenses incurred within 104 weeks of the original date of the accident are considered.
- The following are policy exclusions:
Suicide or a suicide attempt while sane; or self-destruction or an attempt to self-destroy while insane.
Riding in a vehicle or device for aerial navigation, except as a passenger in a scheduled aircraft used for the transportation of passengers.
Service provided by the policy Holder’s infirmary employees or salaried physician.
Declared or undeclared war
Expense covered by worker's compensation or an occupational disease law.
Loss covered by other valid and collectable insurance or plan.
Hernia, in any form.
Sickness or disease, in any form.
Fighting, unless an innocent victim.
Expense incurred for the use of orthotics unless used exclusively to promote healing.
Use of electric, biomechanical devices (bone growth simulation).
This notice applies to insurance products underwritten, or administered by, the Guarantee Trust Life Insurance Company of Glenview, Illinois. Information is the key to our ability to provide you with world class service. We want to keep your trust so we are committed to protecting and maintaining the privacy of your information in our possession, regardless of whether you are a customer, applicant, insured, or former insured.
Collection and Use of Information. We may collect information about your health including mental, dental and general health, substance abuse treatment and sexually transmitted diseases, including HIV and AIDS. We may also collect financial information relevant to your insurance, such as your income, other sources of benefits, or other types of work or job information. This information will be used for business purposes such as assisting you in your decision to purchase insurance, underwriting your application for insurance, and investigating your claim for benefits. We will only collect information from sources other than you as permitted by law or with your written authorization. This information will be used by authorized company personnel solely for these purposes, and it may be integrated into our databases for statistical and audit purposes.
Disclosure of Information. With some exceptions, we will not disclose your protected information without your written authorization. There are circumstances when we will disclose protected information related to medical underwriting or a claims investigation without your authorization to third parties or affiliates assisting us with medical underwriting or claim management, as permitted by law. We will also disclose protected information to third parties without your authorization as required by law such as in the case of subpoenas and mandated governmental disclosures. Protected information means any personally identifiable information including financial information, employment related information, genetic information, and diagnosis, treatment, and evaluation of any past and current medical or other conditions, including laboratory tests or examinations performed.
Access to and Correction of Information. You have a right to see and obtain copies of protected information in your file by submitting a written request to us. Within 30 business days of our receipt of your request you may have access to information about you which is reasonably locatable and retrievable. This right does not extend to information with relates to and is collected in reasonable anticipation of a civil or criminal proceeding, suspected fraud, or which we are otherwise permitted to withhold.
If the information is incorrect you have a right to have it corrected or amended. You may request correction or amendment b sending us a written request explaining why you believe the information is incorrect. Within 30 business days of our receipt of your request we will tell you if, in fact, we complied with your request. If we do not agree with you, we will notify you of our refusal, give you our reasons, and give you the opportunity to file a concise statement of dispute with us. Your statement will be sent with any future disclosure of the information that we make to others.
You may also submit a written request for the identity of persons or companies to whom we have disclosed protected information. To the extent we are required to maintain a record of disclosures, we will provide you with the names and addresses within 30 business days of the receipt of your request.
To request any of the information mentioned in this Privacy Notice, or if you have questions about our privacy policies, please contact:
Guarantee Trust Life Insurance Company
1217 Milwaukee Avenue
Glenview, Illinois 60025
The NCAA provides catastrophic athletics injury insurance coverage for all active member institutions. This policy has a $90,000 deductible. It covers student-athletes who are catastrophically injured while participating in a covered intercollegiate athletic activity (subject to all policy terms and conditions). This coverage does not qualify as the basic coverage required for participation in athletics at DePauw University. It is supplemental coverage in the event of a catastrophic injury. A complete policy brochure appears on the NCAA online website, www.ncaa.org. Look for the "insurance" category on the homepage.