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Sports Injury Excess Insurance Policy

Lehigh Sports Medicine

Lehigh University Sports Excess Policy

What is a sport excess policy?  Colleges and Universities nationwide purchase sport excess policies as a method of containing the spiraling costs of medical insurance without sacrificing benefits.  Although sport excess policies require close communication between student-athletes, parents and staff, they also help to provide quality insurance coverage at reasonable rates.

The benefit s provided under Lehigh University’s  sport excess policy include only those expenses not paid or payable by other medical coverage of the student-athlete.  All student-athletes MUST have coverage through a primary health insurer to avoid possible, significant out of pocket expenses in the event of an injury.  If a significant injury does occur, however, Lehigh’s sport excess policy may help cover expenses after a $2,000 deductible has been met.

Note: If student-athlete’s only insurance coverage is the Lehigh Student Injury and Sickness Plan, all claims under $2,000 are first submitted to the student plan.  Once the $2,000 deductible has been reached, the remaining balance will be entirely covered by the sport excess policy if all terms are met.

Put simply, the student-athlete’s primary insurance coverage (usually the parent’s insurance plan or the Lehigh University Student Injury and Sickness Insurance Plan if purchased) pays first, and the sport excess policy pays second, only after the deductible has been met. 

What are eligible expenses?  Athletic injury insurance policies are designed to pay medical expenses resulting from accidental injuries that occur while participating in or traveling to or from supervised, regularly scheduled varsity games or practices.  Sport excess insurance policies are not comprehensive medical policies and the following requirements must be met:

1. The injury must be the result of an accidental injury.
2. The accidental injury must occur while the athlete is participating in regularly scheduled, supervised and sponsored play, practice or travel.
3. The expenses incurred must be for accidental injuries, which first occur while your policy is in force.

What are eligible benefits under Lehigh’s sport excess policy?  In order to be eligible for benefits under the sports excess policy, the student-athlete must meet a $2,000 deductible. This deductible can be paid either by the student-athlete’s primary insurance policy, or out of pocket.  After the first $2,000 of the expenses has been paid, Lehigh’s sport excess policy will pay 100% of the covered expenses up to $90,000.  If expenses exceed $75,000, a separate Catastrophic Policy provided by the NCAA will take over and pays up to 20 million of an eligible claim.

Under the sport excess policy, a claim may be denied if the requirements of the primary policy are not met.  This is where parents can help by assuring that claims are submitted quickly and properly under the student-athlete’s primary plan.

How do I submit a claim?

1. When an eligible injury occurs, the Lehigh University Sports Medicine staff will submit a claim form to Consolidated Health Plans (claims payer for CHUBB).
2. Submit all bills from providers of medical service to your primary carrier as soon as possible, making certain to complete all necessary claim forms and to fulfill all other submission requirements of your primary carrier.
3. When you receive any explanation of benefits (EOB’s) of what was paid by your primary insurance company and/or any bills from providers of medical service, please forward them to University Health Plans or to Lehigh University Sports Medicine.
4. If you receive any checks in payment of claims directly from the insurance company, forward these checks (or write your own) to the proper doctor, hospital, or medical facility.  Send University Health Plans a copy of your paid receipt or explanation of benefits paid.
5. If you receive requests from your insurance company for additional information, please respond as quickly as possible.  This will speed up the payment of the claim.

Contact information:

If you have any questions you may email Steve Grabowski at University Health Plans at:
Email: sgrabowski@univhealthplans.com

Overview of Athletic Injury Claim Submission

Expenses less than $2,000

• Bills are submitted to student-athlete’s primary insurance policy first
• Any balances left over are submitted to the Lehigh University Student Injury and Sickness Plan if purchased
• Any remaining unpaid balances will have to be paid out of pocket

Expenses between $2,000-$75,000

• Bills are submitted to student-athlete’s primary insurance policy first
• Balances left over are submitted to Lehigh University Student Injury and Sickness Plan
  if purchased
• Any remaining balances are submitted to the CHUBB Sport Excess Policy after the $2,000 deductible has been met

Expenses over $75,000

• Bills are submitted to student-athlete’s primary insurance policy first
• Any balances left over are submitted to the Lehigh University Student Injury and Sickness Plan if purchased
• Balances are submitted to the CHUBB Sport Excess Policy
• Any remaining balances are submitted to the NCAA Catastrophic Fund

Points of Interest:

1. Every athlete must be covered by a primary insurance company and provide proof of insurance coverage (i.e. online pre-participation questionnaire or insurance information form) prior to participation.
2. We (Lehigh University Athletic Department) do NOT pay for any medical expenses.  There is NO 100% coverage by our department.
3. In most cases, all bills must go through parent’s (ie primary) insurance first.
4. Parent’s Insurance as Primary:  Explanation of benefits and copies of bills can be sent to the sport excess policy (if bills exceed $2,000) after parent’s insurance is done paying their share.
5. Lehigh University Student Injury and Sickness Plan as Primary:  Explanation of benefits and copies of bills can be sent to Consolidated Health Plans.  (If the student plan acts as secondary coverage, bills should be applied to the parent’s primary insurance first, then submitted to Consolidated Health Plan’s Student Plan) If the bill exceeds $2,000, the expenses can then be submitted to the sport excess policy.
6. If your current insurance policy does not provide coverage in the Bethlehem area, we encourage you to consider adding an “away from home” rider to your current insurance plan, or to consider purchasing a local plan, such as the Lehigh University Student Injury and Sickness Plan mentioned above.