Dear Student-Athlete and/or Parent/Guardian:
St. Joseph’s College requires all students to have primary health insurance. Most student-athletes are covered by a parent or employer. All student-athletes must provide proof of their coverage in two ways: first they must complete the Insurance Information section on page two of the Athletic Physical form and provide a copy of the front and back of all insurance cards; second they must opt-out of the mandatory student health insurance plan if they have private insurance. Information on how to do this is located on the web page www.sjcny.edu/studentinsurance. It is recommended that all athletes do this prior to the beginning of the semester. If a student does not opt out, they will be billed for the mandatory student health insurance plan.
In addition to the student-athlete providing proof of medical coverage St. Joseph’s College has purchased insurance coverage to protect all of our intercollegiate/club athletes from accidental injury during your participation in all school sponsored and supervised athletic events, whether at the school or away.
This insurance plan is excess coverage: i.e. medical bills will be submitted to your own primary insurance first, and the school’s secondary policy will pick up the unpaid balances, deductibles, and co-insurance amounts, up to the limits of the policy, for covered services.*
Although this coverage is very broad, there are restrictions, limitations, and exclusions in any insurance policy. In some situations, medical bills may not be covered in full. Athletes should understand that medical expenses are their own responsibility, not those of St. Joseph’s College, although we are certainly here to help. Some of the important benefits and limitations of the plan are:
1. The Maximum Medical Benefit is $90,000, after which the claim would be submitted to the NCAA Catastrophic Insurance carrier.
2. Treatment must commence within 90 days of the date of injury, or there is no coverage.
3. Benefits are payable for up to 2 years from the date of injury.
4. Student-athletes must first obtain care from the Sports Medicine Department, if they choose to obtain care from a physician outside of our sports medicine team; the student-athlete must have primary insurance coverage accepted by that physician. **
All injuries must be immediately reported to a St. Joseph’s College Certified Athletic Trainer. Claim forms will be completed and filed by the Head Athletic Trainer, but it is the student-athletes’ (or parents’) responsibility to submit the appropriate paperwork to the Head Athletic Trainer for payment. This includes the following:
1. All itemized bills (monthly statements will not do). These are called UB92’s for facility charges and HFCA1500’s for professional charges.
2. All statements (EOB-Explanation Of Benefits) received from your own insurance company showing amounts paid and balances due, or, a letter of denial stating the claim is not covered. One of these letters is required for any payments to be made.
*St. Joseph’s College mandatory student health insurance plan, if not opt out; will serve as the students primary insurance coverage.
**If you want to see a physician other than one referred by our staff, please consult the Head Athletic Trainer for approval; it is imperative that if you are not using our physicians that you use a physician who is in your own network. This is to aid in insuring that you have appropriate insurance coverage and minimal out of pocket expenses.
It is your responsibility, and to your benefit, to submit the necessary papers to St. Joseph’s College Sports Medicine Department as soon as possible, as the claim cannot be paid until all papers are submitted. All claim forms, bills, and the letters from other insurance companies are to be forwarded to the Head Athletic Trainer.
When first seeking care, if you provide the medical provider with your private insurance card, and tell them that you have a secondary policy, the provider will send their bills to both insurance carriers. Please tell them your secondary insurance is handled by:
Administrative Concepts, Inc.
994 Old Eagle School Road
Wayne, PA 19087
Payor ID 22384