Insurance Coverage for Athletics

Insurance Brochure

Athletic–Related Injury or Illness

• Reporting Procedures: It is the responsibility of the student athlete to report all injuries and illnesses Certified Athletic Trainers as soon as possible.  The Sports Medicine Staff will make ALL of the necessary medical referrals as indicated.  In the event of an emergency due to an athletic injury or illness, the athlete will be transported to a prearranged hospital or medical facility.  The athlete should at NO time seek outside medical attention for an athletic related injury or illness without prior written authorization from the Head Athletic Trainer and/or the Health Center Staff, unless the injury/illness results in a medical emergency.

Medical treatment must begin within 90 days from date of Accident and have an Insurance Claim Form completed within 180 days from start of treatment.

• Referrals to Off-Campus Physicians or Medical Specialist: All student athlete ‘off-campus’ medical referrals MUST have prior written authorization from the University’s Team Physician and the Head Athletic Trainer.  The appropriate referral forms MUST be completed by the Health Care Provider and returned to the Sports Medicine Office for review before clearance for participation in athletics is given.  In case of a Managed Care Insurance Policy (HMO/PPO), the student athlete will be required to follow their primary insurance policy’s specific referral procedures.                                                                                       

All medical tests, treatments and/or procedures rendered by Off-Campus Physician(s) or Medical Specialist(s), other than those approved and performed during the initial visit, MUST again have prior written approval by the University’s Team Physician and Head Athletic Trainer.

Willamette University and the Athletic Department are not responsible for any charges incurred due to examinations, tests, treatments, and/or surgeries by physicians, consultants, and/or hospitals if these procedures are not followed.

• Dental Care: Willamette University’s Supplemental Athletic Accident Insurance shall be responsible for injuries incurred to the mouth and to sound natural teeth while participating in an official practice or game.  Teeth that have had any dental work are often not considered sound and so we recommend a mouthguard be worn.

Non-Athletic Related Injury or Illness

• Reporting Procedures: Injuries or illnesses sustained outside of Willamette University Athletics MUST be reported to a Certified Athletic Trainer at the student’s earliest convenience.  If the student-athlete chooses to be seen by someone other than the University’s Health Center Medical staff or the Sports Medicine Staff, they MUST provide written documentation regarding the condition prior to return to athletic activity.  The final decision whether a student athlete may participate in any varsity sport activity rests with the University’s Team Physician.

• Please Note: Willamette University’s Supplemental Athletic Accident Insurance provides coverage for those injuries or illnesses that are incurred during a scheduled and supervised  intercollegiate sport event sponsored by the Institution.

• Willamette University offers a Health & Accident Insurance plan which can be purchased by students yearly.  This plan is recommended for student-athletes if they do not carry private health insurance for coverage of non-athletic related injuries, illnesses and events not covered by the university intercollegiate athletic accident insurance policy.  If you are interested in this additional plan, please contact the University Health Center.

Previously Existing Injury or Illness

• A  Sports related injury or illness that occurred prior to your participation in a Willamette University sponsored intercollegiate sport event or without the medical clearance of a Health Appraisal Screening is considered a  pre-existing condition.  Though the Sports Medicine Team will provide treatment for a pre-existing injury, the Intercollegiate Athletic Accident Insurance Plan does not provide coverage for these conditions.  The student-athletes’ primary insurance would be responsible for any expenses incurred while receiving treatment.

Intercollegiate Athletic Accident Insurance Coverage

• Athletic Accident Insurance is provided by Willamette University for the benefit of our student athletes.  This coverage is offered on a “Full Excess” basis only.  Under the terms of the policy, the coverage is considered secondary payor to all other valid and collectable medical insurance policies.  Most notable would be parental insurance coverage through place of employment under which the student athlete is covered as an eligible dependent.

The medical benefits otherwise payable under this Plan may be reduced by 50% if the Insured student athlete fails to utilize their HMO, PPO or similar arrangement.  Due to the restrictions of most HMO/PPO’s for students out of a service area, you may want to consider changing primary care physician designation for the school year or purchasing the University’s Health & Accident Insurance Plan.  If you have Kaiser or Group Health Insurance, we would recommend that you get an Oregon Kaiser number assigned to your son or daughter.

• The Athletic Accident Insurance is comprehensive, but is has standard limitations.  It does not cover expenses due to illness or non-athletic-related injuries.  It does not cover expenses incurred from “Off-Campus Physicians/Medical Specialists” without a written referral, pre-approved by the University’s Team Physician and/or the Head Athletic Trainer.  All surgical treatments must have prior written authorization.  Only bills incurred within a period of two years from the date of the injury are covered.  Catastrophic insurance is provided through the NCAA and must be initiated within the same two year period.

Filing a Claim

• For insurance coverage to take effect, certain minimal requirements are necessary.  The injured athlete MUST:
• File and sign an athletic accident claim form following the injury.
• Submit all bills to the Wellness Center, and provide your insurance carriers’ explanation of benefits (E.O.B.) for submission to the Willamette University Athletic Insurance carrier.  It is the student-athlete’s responsibility to secure all bills and payment receipts for submission.
• Submit only those bills incurred within two years of the date of the accident.

If you have any questions or concerns regarding our Athletic Accident Insurance and its process, please refer to the brochure on Athletic Accident Insurance Plan.  This brochure is available in the Sports Medicine Treatment Center, the University Wellness Center, or call Julie Prieto, the Insurance Services Specialist, at (503) 370-6972.

Willamette University will not be responsible for payment of any medical bills if the above procedures are not followed.  This includes the student athlete’s failure to follow their personal primary medical health insurance procedures for filing a claim.  Any questions about a claim should be referred to the Insurance Services Specialist without delay.

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