This letter provides information regarding responsibility for medical expenses and insurance in the event a student-athlete sustains an injury while participating in an intercollegiate sport. In keeping with the voluntary nature of NCAA Division III programs, the primary source for the payment of costs associated with the treatment of the injuries incurred by student-athletes while participating in an intercollegiate sport is the student-athlete or his or her family. However, the NCAA does require that all institutions certify the existence of insurance coverage for medical expenses resulting from athletically related injuries sustained by a student-athlete during NCAA-sanctioned competition or supervised practice. To that end, Bridgewater College carries an excess insurance plan through the Arch Insurance Group and administered by BMI Benefits, LLC.
The excess insurance plan carried by the College is designed to cover only those eligible expenses remaining that have not been reimbursed after a student-athlete’s other insurer(s) have made payment. Coverage under the excess plan is subject to specific policy terms and conditions and includes certain restrictions and exclusions of which you should be aware. The policy covers only new injuries that are sustained during NCAA-sanctioned competition or supervised practice. Pre-existing injuries, off-season (any period not specified by the NCAA as sanctioned practice or weight lifting in the off-season) injuries, and injuries incurred during the season that are not directly related to in-season competition or a supervised practice are not covered. The policy will pay covered, unreimbursed expenses up to $90,000. After total costs reach $90,000, whether paid by the insurance of the student-athlete or his or her family or by the excess plan, the NCAA provides a catastrophic health insurance plan for injuries incurring costs greater than $90,000.
The excess plan is subject to a deductible of $2,000, for which the student-athlete or his or her family will be responsible. Please note that the College assumes no responsibility for any uninsured expenses and does not assist with or cover deductibles or co-payments. We strongly recommend that the student-athlete have coverage through a primary health insurer to avoid possible, significant out-of-pocket expenses in the event of an injury.
Coverage by the plan carried by the College is only in excess of any family or employer group coverage or plan. It will not duplicate benefits, and it excludes those bills incurred that were “payable” by the family health insurance plan. The student-athlete and his or her family must follow proper procedures for filing claims with the primary insurance plan. If parents or students choose not to use the authorized medical providers of their plan, they should be aware that the excess insurance plan will not pay the bills incurred that would have been honored had they used the proper providers or procedures. For example, if the primary insurance is an HMO, a referral may need to be obtained for the student-athlete to see a physician in our area that may be outside of the HMO coverage area. The excess insurance plan is only responsible for medical charges that would have been payable had the proper procedures been followed and the proper vendors used. Please note that the College’s sports medicine staff generally refers student-athletes to local area healthcare providers for the provision of medical care. It is the student-athlete’s responsibility to confirm that the healthcare provider is in the student-athlete‘s insurance network and to obtain any pre-authorizations required by the student-athlete‘s insurance. Student-athletes are encouraged to check with their primary insurance plans for information regarding Guest Memberships. Many carriers offer Guest Memberships when you or any of your dependents will be staying temporarily outside of the service area for more than 90 days.
In the event that a student-athlete is injured and generates medical expenses, he or she can help the excess plan provide better service by following these steps and providing the following information:
• The student-athlete should present his or her primary insurance company address and policy number to the attending health care provider. (This is the student-athlete’s insurance company.)
• File the claim with your insurer(s) as soon as possible. Retain copies of itemized bills for use when submitting the claim to the excess insurance plan (NOT BALANCE DUE STATEMENTS).
P.O. Box 511
Matawan, NJ 07747