Student Athlete Information
v. Rockford College
v. Rockford College
v. Benedictine University
North Central Last Chance Meet @ Naperville, IL
Academic Year 2007-2008
To: The Students (& their Parents) of Concordia University who are to be Intercollegiate Athletes
From: The Office of the Dean of Students
We are extremely pleased to have your son/daughter as a student at Concordia University Chicago and hope that he/she will be successful in every aspect of their collegiate experience.
The following information is very important if your son or daughter intends to participate in intercollegiate sports and/or the spirit team while a student at Concordia. Please read it carefully and call if you have any doubt regarding whether or not the following forms/copies have been submitted prior to your son or daughter's return to campus in August. He/she MUST HAVE THE FOLLOWING FORMS COMPLETED:
- Consent to Participate/Release for Treatment [download]
- Sports Physical Examination - by an M.D., D.O. PA-C or CNP after June 1st [download]
- Parent/Guardian/Student Insurance Information [download]
- Photocopy (front and back) of valid or current Insurance Card
- Health History Questionnaire - New Athletes [download]
- Health History Questionnaire - Returning Athletes [download]
- Emergency Information Card [download]
- NCAA Nutritional Supplement Disclosure [download]
All Student Athletes must have current Insurance and Medical Forms on file prior to any participation in any intercollegiate sport activity. Equipment will not be issued or practice allowed until all forms are COMPLETELY filled out/copied and turned in to the Athletic Training staff. Links to these forms are located above.
The final decision on participation is the responsibility of the Team Physician. The Team Physician also makes the decision on when an athlete may return to competition after an injury. The Dean of Students of Concordia University has the final authority to determine the eligibility of a student who wishes to participate in intercollegiate athletics.
Regrettably, injuries sometimes 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 a road trip, or by a medical vendor in his/her home area.
Concordia's membership in the National Collegiate Athletic Association does not permit any college or university to provide coverage or pay the bills incurred for expenses related to illnesses or conditions, which are not sustained as the direct result of an injury in our intercollegiate sports program.
The athletic accident insurance provided by Concordia University Chicago is for your son or daughter for injuries while participating in the play or official practice of intercollegiate athletics. This coverage is supplemental to parents' or the students' medical, HMO, or PPO coverage. If given the opportunity by your employer, we recommend a PPO, which allows greater freedom regarding treatment options.
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 your son or daughter or to your home address.
A. Please submit the bills incurred to your primary health insurance provider FIRST. They will either:
• Honor the claim and pay all or a portion of the bills incurred; or
• Reject 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 twenty-three.)
B. If a balance remains after your primary health insurance provider has contributed towards the claim, or you receive a letter of denial from your primary health insurance provider, send the attached claim sheet with a copy of the itemized bills incurred, or a copy of the denial letter with a copy of the bills to: First Agency, Inc., 5071 West H Avenue, Kalamazoo, MI 49009 .
C. In cases where the primary insurance provider has met the deductible and limits of the usual and customary charges, a separate claim will be filed from the Athletic Department with our insurance carrier, First Agency, Inc. in Kalamazoo, Michigan. They may contact you for any additional information in order to process your claim in a timely manner. We appreciate any cooperation you can offer them. It is in your best interest to have the claim settled promptly since all the bills incurred are in your name. The claim form can be downloaded here.
Layers of Coverage - Benefit Period - Maximum Medical
• $0 to $5000 - This first dollar coverage is the responsibility of the student-athlete and/or their parents. Students who do not fall under their parents' medical, HMO, or PPO coverage must either 1) enroll in an insurance program which provides a benefit for this first $5000; 2) show evidence of already having coverage that provides a benefit for this first $5000; or 3) sign a waiver in which the University is relieved of all responsibility for the first $5000 of expenses in the event of an injury or accident resulting from participation in intercollegiate athletics. There is a $35 deductible per injury when coverage is through the Concordia University Student Accident and Sickness Insurance Plan.
• Deductible $5000 to Medical Maximum $15,000 per claim. This athletic secondary coverage is through Guarantee Trust Life Insurance Company. First Agency of Kalamazoo, Michigan processes claims. This is excess coverage and covers all eligible claims up to one year from the date of injury. The bills incurred for this layer of coverage will be in the student's name and must be submitted to the family, employer group insurance or plan first, as this coverage is supplemental to any coverage your son or daughter may have through your medical, HMO, or PPO coverage.
• Deductible $15,000 to Medical Maximum $75,000 per claim. This accident coverage is through Guarantee Trust Life Insurance Company. First Agency of Kalamazoo, Michigan processes claims. This is excess coverage and covers all eligible claims up to four years from the date of injury. The bills incurred for this layer of coverage will be in the student's name and must be submitted to the family, employer group insurance or plan first, as this coverage is supplemental to any coverage your son or daughter may have through your medical, HMO, or PPO coverage.
• NCAA Lifetime Catastrophe Medical Plan
Naturally, it is our sincere hope that no Concordia student will ever be injured. Unfortunately, there is always the possibility that some might. We do believe, however, that we have taken the most prudent action possible in terms of the insurance coverage we have purchased for our intercollegiate athletes.
We respectfully request your cooperation in assisting us in the efficient processing of any claims we may have to file. If your primary insurance coverage changes in any way after you submit the form, please call us immediately to arrange for those changes to be recorded. IT IS IMPERATIVE THAT all insurance and medical information remain current and accurate.
| Allison Potaczek Student Services 708-209-3018 allison.potaczek@cuchicago.edu |
Terri Woods |
| Dawn Witz Claims Adjustor First Agency, Inc. 269-381-6630 |
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