Department of Intercollegiate Athletics, Athletic Medicine Department

Dear Student-Athlete and Parent/Guardian You are receiving this letter because after reviewing your medical profile, we noticed an anomaly with your reported personal primary medical insurance. We have specific requirement for personal primary insurance needs of our studentathletes at UCCS, please see attached “Insurance Letter”. Below I will try and outline the restrictions and potential consequences of your specific insurance issue. Please note that your situation will be highlighted with a checkmark in the box to the left. ☐ Out-of-Network HMO Coverage – You have reported that you are a member of a Health Maintenance Organization (HMO). This type of insurance usually requires you to choose a Primary Care Provider (PCP) that all of your referrals must go through. This can make providing any type of extended care difficult at UCCS, if a referral is needed for orthopedics, or any other specialty it must go back through the PCP and usually has to stay in-network. This simply means for any extended medical issues, potentially that service will not be able to be provided in the Colorado Springs area and/or the cost for receiving services are significantly higher. ☒ Indigent Care Coverage – You have reported that you are only covered under indigent care services, most of these services run though the government and need to be seen at specific facilities/clinics. If this is the only type of personal primary insurance you have, we are not able to help facilitate most types of appointments, and this must be done through your policy regulations to make sure that financially the issue is paid for. We will help with as much as we can in-house with our athletic trainers, however physician visits, diagnostics, and/or surgeries must all go through the indigent care services to assure payment for your situation. Our secondary/excess insurance provider will help with cost over and above what indigent care pays in most, not all, cases. ☐ High Deductible Insurance Coverage – After reviewing your file, we noticed that you have a high deductible insurance coverage for either your individual and/or family. With the cost of insurance constantly rising and ability to maintain low deductible policies for families is a challenge. However, for the University to maintain some type of insurance help for our student-athletes, we need to also control costs. We define a high deductible policy as one that has a higher deductible than what our secondary/excess insurance is ($500/incident). In these cases our secondary/excess insurance will only start payments after your individual and/or family deductible on your personal primary insurance is met. ☐ Health Savings Accounts – You have reported on your medical paperwork that you have a Health Savings Account (HSA) as a primary source of medical insurance. As with high deductible individual/family personal primary care policies, the HSA is a unique way of funding health care needs for student-athletes. With this in mind, we will need to discuss on an individual basis how this is going to work within the realm of our secondary/excess insurance policy. The ability to provide coverage to potentially replenish all HSA payments for physician visits, diagnostics and/or surgeries would be limited. This will be discussed on a case by case scenario prior to any non-emergent medical care is needed. ☐ Tricare and Tricare Prime Insurance Plans – You have reported that you have Tricare and/or Tricare Prime as your personal primary insurance coverage. Tricare is a great option for coverage of athletic injuries, however is difficult to gain post visit information. There should be little to no issues with use of our secondary/excess insurance with tircare due to the nature of how it uses its providers. I would highly suggest that before you utilize on-base care that you inform the Athletic Medicine Department so that we can put a plan in place to share information with you Tricare provider and maintain consistency of care for you injury situation. ☐ International Insurance Coverage – After reviewing your file, we noticed that you have international insurance as you primary coverage. It is mandatory to have full term medical coverage that includes both championship season as well as non-championship season. This coverage must not have an athletic injury exclusion to the policy, and/or critical care and general care must be covered in the United States. If these criteria are not met, our secondary/excess insurance will not cover any bills associated with your care.

☐ International Insurance Coverage with Athletic Injury Maximum Payments – You have reported that you have international insurance coverage that may have an athletic injury maximum payment. In the State of Colorado most of these plans have an athletic injury maximum of $5000. If this is the case then our secondary/excess insurance will help between your personal primary insurance deductible (see “High Deductible Insurance Coverage” section) to $5000, anything over that amount will be paid for personally and there is no commitment from our secondary/excess insurance for payment. Please check your policy if you don’t know what your athletic injury maximum is. Please check to see if what you of reported on your on your insurance tab in ATS is appropriate, if you don’t feel that the category was checked above fits your particular insurance profile, please let me know. If you have any other questions associated with what our secondary/excess insurance covers and doesn’t cover please review the attached document, and/or look at the Excess Insurance webpage at www.gomountainlions.com. Also if you have any questions about insurance coverage for student-athletes, please don’t hesitate to contact me directly. There are some reasonably priced alternatives to healthcare that student-athletes can obtain, that might increase their ability to get quick, cost-effective services provided to them.

Sincerely,

Brian Hardy, MSc., ATC Assistant Athletic Director, Athletic Medicine

Department of Intercollegiate Athletics, Athletic Medicine Department

Dear Parent(s), Guardian(s) and Student-Athlete As the Athletic Medicine Staff at University of Colorado Colorado Springs (UCCS) we are very excited about the upcoming athletic season, as well as your son or daughter’s interest in Mountain Lion Athletics. We wish the best for your athlete and hope that the upcoming years at UCCS are successful both academically and athletically. Our athletic department goes to great lengths to provide the best medical coverage possible for our student-athletes. This includes not only helping to increase their potential for success, but also attempting to minimize the risk of injury at our institution. Although we also realize that the capacity of a student-athlete to become injured in competition or practice is still a possibility. The remainder of this letter is to explain the policies and procedure that are in place for insurance claims that are associated with these injuries. The NCAA discourages any college or university from providing coverage or paying bills incurred for expenses related to illnesses or conditions which are not sustained as a direct result of an accident in our intercollegiate sports program (this include pre-existing conditions and non-athletic injuries). At UCCS we do carry a secondary / excess insurance policy on all of our student-athletes to help defray the cost of a major injury. This policy has a deductible of $500, which can be met through primary insurance payment and/or out-ofpocket expenses. The NCAA also has a catastrophic insurance for all of its member institutions that cover over $90,000 of medical expenses. So our coverage bridges the medical bill gap of $500 to $90,000. This policy also has its own conditions that must be met before they assume cost of any injury. These conditions are: Covered entities: The plan covers student-athletes, cheerleaders, student managers and student trainers of the University of Colorado Colorado Springs for bodily injury sustained by any such person while participating in intercollegiate sports including scheduled games, supervised practice sessions, conditioning and authorized group or team travel to and from such events. Uncovered Entities: Injuries or charges resulting from, or during the following are NOT covered: Documented pre-existing conditions, intoxication or otherwise “under the influence”; criminal activity, brawling, fighting or rioting; Self-inflicted injury; employment related activity; and sickness. Addendum to Uncovered Entities (updated fall 2009): After long deliberation we have decided to initiate the following policies, due to the increasing cost of health care and our want to continue to provide support for injuries. We have elected to go with a five hundred dollar deductable per instance for our excess athletic insurance. However, with this lower deductible we are no longer able to provide support for high deductible primary insurance policies (family provided policies) until the higher of the two deductibles is met. An example of this is if a family has a $2500 deductable for their primary (family provided) coverage, UCCS will not be able to cover the difference in deductibles (i.e. $2000). The UCCS Athletic Department’s secondary / excess insurance policy will help with costs once the $2500 primary (family provided) insurance deductible has been met. Addendum to Uncovered Entities (updated fall 2012): To make sure that medical service provided for student-athletes are consistent. We need to make sure that our team physicians are involved in the process at some level. If student-athlete sees an outside medical provider for an injury/illness that directly affects their participation in athletics, they need to inform the UCCS Athletic Medicine Staff prior to that happening. If this is not done, and there is no communication, prior to seeing an outside physician, the student-athletes claims for those particular visits and any follow-up care, including diagnostic appointments, will not be covered by the University's secondary/excess insurance policy. For those individuals that have insurance coverage, but it doesn’t cover any athletic participation (i.e. international travelers, UCCS student health insurance, etc.) the University Athletic Department will not be able to use their secondary / excess insurance policy to help with medical costs, however we will assist in identifying insurance brokers locally that can

help find the appropriate medical coverage’s as well as try to talk to medical providers to potentially help cut some costs if appropriate. These policies are not meant to deny coverage to any student-athlete; however within the Universities constraints we are trying to manage coverage to insure longevity for Mountain Lion Athletics. Medical coverage for all student-athletes is our number one concern at UCCS; however the ability to provide some type of medical insurance will be limited without these policies in place. Due to the increasing cost of health care across the country, we at UCCS are trying to guarantee adequate medical coverage for all of our student-athletes for years to come. Just to review, before your student-athlete is eligible for participation at University of Colorado at Colorado Springs there are four conditions that must be clarified. 

Each student-athlete must be covered on a primary insurance plan either under a parent/guardian’s name or their own name.

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Secondly, that policy must NOT exclude intercollegiate athletics participation (the general student insurance offered University of Colorado Colorado Springs DOES NOT cover intercollegiate athletic participation).

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Thirdly, the insurance coverage must be for the entire school year, championship season, out-of-season as well as non-traditional seasons MUST be covered.

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And lastly, if the coverage is an HMO then the rules and regulations governing that policy must be followed. If the student-athlete does not meet these circumstances then they forfeit the right to claim benefits under University of Colorado Colorado Springs insurance policy.

Secondary / Excess Insurance Claim Procedures All billing of injuries sustained from participation in an intercollegiate competition or practice will be sent directly to either the parent/guardian or student-athlete’s address unless the college instructs the medical provider’s office otherwise. In some instances the college will receive a copy of the bill; however the primary bill will not be sent to the University. Policy and Procedure  Submit all bills incurred to your family employer group or plan first. There will be two possible outcomes: 1. The company will honor the claim and pay all or a portion of the bills incurred. An explanation of benefits (EOB) will be mailed to you, please forward a copy of this to the athletic department for filing with other medical records. 2. The company will not honor it and send you a letter of denial. Please forward this to the athletic department also. 

If the balance remains after your family employer group insurance or plan has contributed toward the claim, send the claim sheet from the insurance company and a copy of the itemized bill incurred to the college’s athletic department as soon as possible, there is a 90 day window to file a claim with our insurance provider.

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If you receive a letter of denial from your family employer group insurance or plan administrator, send the letter of denial and a copy of the bills incurred to the college’s athletic department. If no coverage is available, a letter from your employer with verification will be necessary. Any claim(s) needs to be submitted to the athletic department within 90 days of the original claim having been denied by your insurance company.

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If the bills incurred are not paid by your family employer group insurance or plan the claim will be sent from the athletic department to our insurance carrier’s office for processing. There will be no payment if the $500 deductible is not met in the billed charges. If they need any additional information, please cooperate with them. And they will process the claim in the least possible amount of time. It is in your best interest to have the claims settled promptly since all the bills incurred are in your name.

Please Note: If the primary family coverage is through an HMO (health maintenance organization), you must follow the proper procedures required by your plan in order for the university’s insurance to satisfactorily complete its portion of the claim. This is especially important if your plan requires pre-authorization to have your son/daughter treated out of your plan’s service area. To insure that the best interests of your son/daughter are being met, the Athletics’ Department at University of Colorado Colorado Springs has decided on the following course(s) of action.

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A current copy of the insurance card for your son/daughter must be in their medical records, so have them bring it with them to the physical dates. If you have any questions and/or concerns about this please don’t hesitate to contact me at the information below. I know that insurance information is sometimes difficult to work through, however through my experiences I would be more than happy to help in whatever way that I can. Thank you for your patience and welcome to the Mountain Lion Family.

Sincerely,

Brian Hardy, MSc, ATC Assistant Athletic Director, Athletic Medicine University of Colorado Colorado Springs Office: (719) 255-3004 Fax: (719) 255-3029 Email: [email protected]