Athletic Accident/ Illness Insurance
The Catholic University of America automatically, at no cost, provides secondary insurance coverage for all varsity student-athletes. This secondary insurance policy covers any athletically-related injury and/ or illness that the student-athlete incurs while participating in his/ her intercollegiate sport. This policy is considered an excess policy, and only covers expenses which the student-athlete's primary insurance does not.
Medical (health) insurance is required for all full-time students, all student residents and all part-time international students. The secondary insurance policy for varsity athletes, as described above, does not satisfy this requirement.
The university policy on medical insurance can be viewed by clicking the link below: http://policies.cua.edu/StudentLife/healthinsurance.cfm
Health Maintenance Organizations (HMO) and local or regional insurance present problems when trying to provide care for student-athletes. It is important to note, being insured by an HMO which has limited or no Out-of-Network provision, severely limits our ability to provide care using our physician network. Please read your HMO guidelines closely and note if they provide Out-of-Network benefits. If they do not have Out-of-Network services your child will be required to have any necessary (non-emergency) medical services provided by the HMO. Should your child require extensive medical services, most HMOs will require multiple trips to their providers which could result in substantial time missed from school and from play. Many HMOs have providers in the Washington, DC area, if so, you should look into shifting your child’s care to those providers.
Secondary Insurance Frequently Asked Questions:
Question: Who is covered by this secondary insurance policy?
Answer: All active INTERCOLLEGIATE (VARSITY) student-athletes while participating in their sport.
Question: When is the student-athlete covered by this policy?
Answer: Coverage is only effective for events and activities that are authorized by, organized by or directly supervised by an official representative of The Catholic University of America. This includes practice and games during both the traditional and non-traditional seasons.
Question: How is the secondary insurance policy applied?|
Answer: Any claims incurred will first be submitted through the student-athlete's primary insurance for payment. When these benefits have been exhausted, the process of billing the secondary policy will begin.
Question: Is there anything the secondary insurance does not cover?
Answer: If the student-athlete is required to pay out-of-pocket expenses such as deductibles, co-pays for treatment or prescription medication, etc. the secondary insurance will reimburse the student-athlete for these expenses. Appropriate documentation is required for reimbursement.
Question: What occurs if the student-athlete has a pre-existing condition prior to beginning participation at The Catholic University of America and needs additional medical care?
Answer: While the sports medicine staff will do everything to insure proper rehabilitative and follow-up care, all medical expenses for pre-existing conditions cannot be billed to the secondary insurance policy.
Question: What is the process involved in filing claims under the secondary insurance policy?
- If the student-athlete sustains an injury requiring referral to an outside medical provider, the athletic trainer will submit an incident report to the secondary insurance carrier. Parents/ guardians will be informed of this injury via mail by the athletic trainer.
- The related medical expenses are submitted to the student-athlete's primary insurance carrier.
- The student-athlete or his/ her parents receive "Explanation of Benefits" forms from the primary insurance company. The "Explanation of Benefits" form is a standard document detailing that services were submitted for insurance reimbursement, the amount that the primary insurance is willing to pay, and the amount still owed to the medical provider.
- If there are expenses still owed to the medical provider, the student-athlete or his/ her parents submit copies of the "Explanation of Benefits" and a copy of the itemized bill to the secondary insurance provider within 90 Days of the date of service. Contact information for the secondary insurance provider is contained in the letter informing parents of the initial injury. ALL original documents are retained by the student-athlete.
- The secondary insurance provider will send the student-athlete an "Explanation of Benefits" form detailing the amount paid to the medical provider once the claim is processed.
Question: Who do I contact with questions regarding secondary insurance?
Answer: Please feel free to contact Jaime Walls, Head Athletic Trainer if you have concerns regarding unpaid medical expenses. She can be reached by phone at (202) 319-6049 or by e-mail at firstname.lastname@example.org.