HEALTH INSURANCE
What does the athlete need for eligibility?
SCAD Athletics require all athletes maintain a file with the athletic training department.
Every year, the athlete and/or parent/guardian must:
1. Complete and sign the Athletic Insurance Questionnaire
2. Provide a photocopy of the front and back of the athlete's valid insurance ID card
3. Immediately report any change of health insurance coverage to the SCAD athletic trainers
4. Read and sign the Informed Consent and Medical Waiver
5. Undergo a physical examination by SCAD team physicians and athletic trainers
The completed and signed questionnaire must be on file by Aug. 1 for fall athletes and by Sept. 1 for all other athletes. No athlete will be allowed to participate without completing ALL required forms. There will be NO EXCEPTIONS!
SCAD Athletics strongly recommends all varsity athletes maintain a comprehensive medical or health insurance plan with hospital, professional and extended benefits - not a limited accident, emergency or catastrophic health insurance plan providing low limits and/or marginal benefits. Acceptable coverage is normally provided by an employer group health insurance plan through the athlete's parent or guardian, or by an individual health insurance plan purchased by the athlete with similar benefits. Either is acceptable, but it should be comprehensive and it is important to verify the coverage applies to intercollegiate sports-related injury or illness.
If the athlete is covered by a parent/guardian's employer group health insurance plan, what does the athlete need to do?
The athlete needs to verify coverage is provided in Chatham County, Georgia. If not, the athlete needs to resolve that problem with the insurance company before the Athletic Insurance Questionnaire is submitted to SCAD athletic trainers. Failure to do so may jeopardize the athlete's health insurance coverage and participation. It is important to verify the plan covers intercollegiate sports-related injury or illness as well.
if the athlete currently maintains or needs an individual health insurance plan, what does the athlete need to do?
For information on comprehensive health insurance plans within Chatham County, Georgia, the athlete can contact the athletic training staff. Upon purchasing a policy, the athlete needs to verify coverage is provided in Chatham County, Georgia. S/he must also verify the coverage is a comprehensive medical or health insurance plans, and not limited to accidents, emergencies or catastrophic injuries/illnesses. In addition, it is important to verify the plan covers intercollegiate sports-related injury or illness as well.
If the athlete does not have insurance, what does the athlete need to do?
The athlete is strongly recommended to purchase an individual health insurance plan. SCAD provides a secondary - or excess - policy for athletes. This policy is an accident only policy, and is limited to injuries occurring during practices or competitions for intercollegiate athletics. Furthermore, the SCAD secondary policy has a $250 deductible that must be met by the athlete and his/her parent/guardian prior to payment of any benefits. Injuries that take place outside of the athletic arena and illness are the SOLE RESPONSIBILITY of the athlete and his/her parent/guardian.
What if the athlete belongs to an HMO or other limited provider insurance plan?
If the athlete belongs to a Health Maintenance Organization, s/he is limited to the HMO's physicians and facilities. S/he must send us specific instructions, requirements and/or limitations, which may be included with the policy. The information is necessary for the athlete's appropriate referral and treatment. Failure to follow the appropriate procedures may result in voided eligibility for coverage by the primary and/or secondary insurance policies, or full responsibility for the deductible on the secondary insurance policy.
When is an athlete referred to a hospital, physician or other medical facility?
The athlete will be referred to a hospital or other medical facility in case of injury requiring advanced medical treatment. If the athletic trainers are of the opinion that consultation would facilitate/improve the care of an injury, arrangements for a visit will be made. Whenever possible within insurance constraints, the SCAD team physicians will be utilized for athlete care. Coaches do not have the authority to refer an athlete to any physician except for emergency medical care when the SCAD athletic trainers are not available.
How does the SCAD Athletics Health Insurance program work?
Coverage for the athlete is provided by two sources. The most important source of coverage is the athlete's personal primary health insurance plan. This must be maintained by the athlete, either by a parent/guardian employer group health insurance plan, or through a comprehensive individual health insurance plan purchased by the athlete. For more information, please refer to What does the varsity athlete need for eligibility question above.
The second source of coverage is the SCAD athletics health insurance policy. This policy is underwritten by CIGNA and coverage applies to SCAD student-athletes who incur injury during participation in practice or competition for an intercollegiate sport, or travel to practice or competition. The policy is an accident-only policy and does not apply to preexisting injuries, conditions or illnesses.
MEDICAL CLAIMS
What happens when an athlete is injured?
As soon as possible following an injury, the athlete must report to an athletic trainer for evaluation and appropriate treatment. If necessary, the athlete will be referred for appropriate medical care and follow up treatment. If the athlete is unable to see the athletic trainer prior to seeking treatment, or emergency care is warranted, the athlete must inform the athletic trainer about the injury and treatment received. It is the athlete's responsibility to assure the athletic trainer is informed of the injury as secondary insurance coverage is contingent upon notification.
What is the medical claims process?
1. Athlete reports injury to the athletic trainer as described above
2. Appropriate care is arranged for the injured athlete. If necessary, athlete is referred for advanced medical care according to specified primary insurance policies
3. Athlete receives advanced medical care. Athlete is responsible for filing claims with primary insurance company
4. Athlete receives secondary insurance claim form from the athletic trainer certifying the occurrence of athletic-related injury
5. Athlete is responsible for collecting itemized bills and explanation of benefits from consulting physicians and primary insurance companies and submitting the claim to the A-G administrators
6. Athlete deals with A-G Administrators thereafter. A-G Administrators will coordinate benefits and reimburse provider for any covered medical expense
Toward which bills can the secondary insurance coverage be applied?
The SCAD Athletics secondary insurance can be applied only to bills resulting from an injury during practice or competition for an intercollegiate sport, or travel to and from a practice or competition. Other policy restrictions include:
1. Approval for or the referral must come from the athletic training staff
2. Care must be coordinated through the athletic training staff
3. Care must be rendered within 52 weeks from the date of injury
4. The primary insurance company must have responded to and resolved all claims
What are the athlete's responsibilities?
The athlete is financially responsible for all charges for the care of an athletic injury and resolution of all claims. The procedure described below must be correctly followed for payment of claims. If the threat of collection arises from an unpaid bill, the athlete or parent/guardian is encouraged to pay all balances to avoid to his/her credit rating. The insurance company will then reimburse the athlete or parent/guardian for covered expenses.
Will I have to pay for any health care costs that arise due to an athletic injury?
The secondary insurance policy carries a $250 deductible per year that must be met by either a) the primary insurance or b) the athlete and his/her parent/guardian. Furthermore, any balances or charges that are not met after all insurance benefits are exhausted are the responsibility of the athlete.
Last revised: May 2006
