Virginia Tech Departmental Policy 20
Sports Medicine
Key Function:
Review: Yearly Title: Medical Expenses and Insurance S-A Safety
Compliance Director
Section: S-A/Staff Safety
POLICY STATEMENT: This policy is designed to identify coverage and payment options to insure medical benefits for all varsity athletes and spirit squad.
PURPOSE: To provide patients information on payment of medical expenses and identifies insurance coverage.
ENTITIES TO WHOM THIS POLICY APPLIES: Virginia Tech Athletes. PROCEDURE:
Medical Insurance Coverage
The Virginia Tech Athletic Department will provide secondary medical insurance coverage to Virginia Tech student-athletes participating in supervised and scheduled practice sessions or competition. The department will not be responsible for pre-existing conditions, injuries, or other ailments you sustain while participating in unsupervised or non-departmental sponsored athletics. All expenditures for health care must be according to standards set forth by the NCAA and are subject for review.
Virginia Tech carries a major medical insurance policy on all student-athletes. Athletic Department insurance procedures mandates the filing of all athletic injury claims against your, or your
parents’/guardians’ insurance policy. Once the insurance company responds, the Athletic Department policy will be utilized to complete payment of the bills related to your injury. If no primary insurance exists, the Athletic Department policy assumes all coverage.
When a student-athlete requires medical procedures or care which can not be provided by the team physicians, this care must be pre-authorized by the team physician. If this care is required during the summer, the student-athlete must contact the athletic trainer or the team physician for his or her sport in advance to receive authorization. The athletic department will not assume financial responsibility for any outside medical expenses which were not pre-authorized by the sports medicine staff.
By letter, the Athletic Department will outline for you and your parents or guardians the insurance policies of the department. An insurance questionnaire is included for you and your parents or guardians to complete and return to the Athletic Department. This form will ask you to list the insurance company information and indicate if you are covered for athletic competition.
All non-scholarship student-athletes are required to have insurance as a condition of their participation.
All athletes must have proof of insurance in order to participate in practices, conditioning or games. All outside medical expenses must be pre-authorized by one of the staff athletic trainers.
1. Patient has primary coverage with coverage for athletic participation. a. Injury occurs and a referral is generated.
b. Expenses are applied to primary plan and an EOB is generated.
c. Virginia Tech Athletics pays excess amount from Sports Medicine Medical Providers Budget up to $10,000.
e. NCAA Catastrophic Insurance Plan pays $75,000 and beyond. 2. Patient does not have primary insurance and is on scholarship.
a. Injury occurs and a referral is generated.
b. Virginia Tech Athletics pays up to $10,000 from Sports Medicine Medical Providers Budget. c. Virginia Tech Athletics Insurance pays up to $75,000.
d. NCAA Catastrophic Insurance Plan pays $75,000 and beyond.
3. Patient has primary coverage through GM Southwest @ $92 per month without coverage for athletics. a. Injury occurs and a referral is generated.
b. Virginia Tech Athletics pays up to $10,000 from Sports Medicine Medical Providers Budget. c. Virginia Tech Athletics Insurance pays up to $75,000.
d. NCAA Catastrophic Insurance Plan pays $75,000 and beyond.
4. Patient has primary insurance through Southern Health purchased by the Athletic Department for $116 per month.
a. Injury occurs and a referral is generated.
b. Expenses are applied to Southern Health Plan and an EOB is generated.
c. Virginia Tech Athletics pays excess amount from Sports Medicine Medical Providers Budget up to $10,000.
d. Virginia Tech Athletics Insurance pays up to $75,000. e. NCAA Catastrophic Insurance Plan pays $75,000 and beyond.
* The Athletics Department will only provide Southern Health Insurance for PELL Grant eligible athletes. (PELL Grant eligibility is a measure of “need”)
Eligibility for Insurance Coverage:
Scholarship Student-Athletes and Recruited Walk-ons: All returning scholarship student-athletes, new incoming scholarship student-athletes and recruited walk-ons are automatically covered under the Virginia Tech Athletics Excess Insurance Plan when they arrive on campus.
Fifth Year Student-Athletes on Scholarship: Student-athletes who have completed their eligibility, are enrolled in classes, and are on scholarship are included in the department insurance plan. Insurance benefits for this group will only be considered in circumstances where an injury or illness was sustained as a direct result of performing duties specific to a Virginia Tech sponsored event. All such participants must complete all departmental medical and release forms required of regular student-athletes. Any new injury sustained after the conclusion of their athletic eligibility will be the responsibility of the student-athlete. Managers, Student-Trainers, Cheerleaders and Dance Team: Students who are affiliated with the department in either of these capacities are covered under the department insurance policy. Insurance benefits for this group of participants will only be considered in circumstances where an injury was sustained as a direct result of performing duties specific to a Virginia Tech Athletic Department sponsored event.
Virginia Tech Students or former Virginia Tech Student Athletes who are training with a member of the Virginia Tech Coaching Staff or Practicing with Virginia Tech Teams: Non-student-athletes in this category will not be eligible for coverage under the Virginia Tech Athletics Insurance Plan. Prior to working out with teams, participants under this category must show proof of possessing their own medical insurance and have a pre-participation physical prior to participation.
Permissible Medical Expenses Identified medical expense benefits incidental to a student athlete’s participation in intercollegiate athletics that may be financed by the institution. (NCAA Bylaw 16.4.1). These medical expenses include:
• Athletics medical insurance
• Death and dismemberment insurance for travel connected with intercollegiate athletics competition and practice
• Drug-rehabilitation expenses
• Counseling expenses related to the treatment of eating disorders
• Special individual expenses resulting from permanent disability that precludes further athletics participation. The injury or illness producing the disability must involve a former student athlete or have occurred while the student athlete was on an official paid visit to the institutions’ campus. An institution or outside agency, or both, may raise money through donations, benefits or like activities to assist the student athlete or a prospective student athlete. All funds secured shall be controlled by the institution, and the money shall be used exclusively to meet these expenses • Glasses, contact lenses or protective eyewear (e.g., goggles) for student-athletes who require visual correction in order to participate in intercollegiate athletics.
• Medical examinations at any time.
• Expenses for medical treatment (including transportation and other related costs). Such expenses may include the cost of traveling to the location of medical treatment or the provision of actual and necessary living expenses for the student athlete to be treated at a site on or off the campus during the summer months while the student athlete is not actually attending class. Medical documentation must be available to support the necessity of the treatment at a location in question.
• Medical expenses (including surgical expenses, medication, rehabilitation and physical therapy expenses and dental expenses).
Impermissible Medical Expenses An institution may not finance student health insurance if the insurance is provided or offered to the general student body only on an optional basis. However, if such insurance is required for a particular group of students (e.g., foreign students), such expenses may be paid for student athletes who are members of such a group. Only required fees may be paid as part of an institutional grant-in-aid for student athletes. (NCAA Bylaw 16.4.2)
*Medical expenses resulting from extended allergy/asthma, dermatological, gynecological (hormonal therapy) or psychosocial related care are not the responsibility of Virginia Tech Athletics. Expenses from these conditions should be applied to the athlete’s primary care insurance plan. If the athlete does not have insurance for this coverage, the department will review the case and assume responsibility only if the medical care is necessary to maintain health status for safe athletic participation and payment of expenses are permitted under NCAA rules.
*Medical expenses related to certain personal devices such as orthotics, braces and other orthopedic appliances will be covered only if the medical care is necessary to maintain health status for safe athletic participation and payment of expenses are permitted under NCAA rules.
Pre-Existing Medical Conditions: It determined during the initial PPE that a student-athlete requires follow-up care for an injury or illness sustained prior to their enrollment, the medical expenses incurred from such care will be the responsibility of the patient and/or their parents.
Non-Athletic Related Injuries/Illness: The Virginia Tech Athletic Department cannot assume responsibility for emergency room visits, hospital stays, diagnostic teats, laboratory studies, physician evaluations or medications for out of season illnesses or injuries that are not athletically related (intramurals, workers
comp injuries, motor vehicle accidents, PE classes or housing related injuries. Payment of these expences are the sole responsibility of the student-athlete and/or their parents
If the medical services incurred by the student athlete are not reasonably incurred or medically necessary, or if the student athlete departs from the procedures and regulations outlined in this policy, the athletic department may elect not to cover the incurred expense(s).
Dental Care:
• Virginia Tech Athletics will assume the financial responsibility for payment of dental repairs only when the student-athlete sustains an injury while participating in a formal practice, conditioning session or competitive contest.
• In compliance with NCAA regulations, student-athletes must assume the financial responsibility for routine dental care that is not related to athletic participation such as temporary fillings due to dental caries, cleaning, gum infections or any other dental problems not related to an athletic injury.
Eye Care:
• Visual acuity will be checked during the student-athletes PPE.
• Virginia Tech Athletics will pay for all medical expenses resulting from eye injuries sustained during formal practice, conditioning or competitive contests after the appropriate primary insurance coverage has assigned payment.
• The Virginia Tech Athletics Department will assume the responsibility for the expenses associated with a 6 month supply of contact lenses per academic year.
• Corrective lenses, contacts or glasses worn for general use will be the financial responsibility of the student-athlete, and will not be furnished or paid for by the department.
• Any contacts for non-medicinal purposes must be purchased by the athlete or their sports budget.
Second Opinions:
• If a member of the Virginia Tech Sports Medicine Department refers a student-athlete for a specialty consult, the care provided by that specialist shall be considered a “ referral” and shall not be considered a “second opinion”. The athletic department can pay the transportation and medical expenses that are required for the “referral” in accordance with the athletic department’s medical insurance plan.
• A “second opinion” occurs when a student-athlete is not satisfied with the primary care and/or subsequent referrals arranged by the sports medicine staff, and through the Director of Athletic Training, arranges for a referral to a physician of the student-athlete’s own choosing.
• If any student-athlete wishes a “second opinion” regarding the evaluation, treatment and rehabilitation of an injury or illness, the following procedures and policies apply:
o A member of the sports medicine staff must make the referral appointment.
o Student athletes are expected to select a “second opinion” in close enough proximity to the University to ensure ease of follow-up without incurring excessive transportation costs or missing classes.
o The athletic department will cover all associated medical expenses resulting from clinical examinations, diagnostic tests, surgical procedures, etc., involved in “second opinions” only if the referral was arranged by a member of the sports medicine staff.
o Athletes receiving a second opinion from an outside provider will not be eligible to participate until cleared by both the outside physician as well as one of the Virginia Tech Sports Medicine physicians.
The NCAA Special Assistance Funds are available but not guaranteed to the following students: • Pell-eligible students;
• Students receiving athletic scholarships who have unmet financial need; • Foreign students who have unmet financial need.
Permissible uses of the funds are:
• Medical and dental costs not covered by another insurance program (e.g. hearing aids, contact lenses, glasses, off-campus psychological counseling);
• Costs associated with student or family emergencies;
• Costs of expendable academic course supplies (e.g. notebook, pens) and rental of non-expendable supplies (e.g. computer equipment and cameras) that are required for all students enrolled in a course;
• Cost of clothing and other essential expenses. To find out if you are eligible;
• Pell-eligible students - get an application in Athletics Student Services; • Other students - file a FAFSA with the Office of Student Financial Aid; • Foreign students - contact the Director of Athletics Student Services.
NCAA Student-Athlete Opportunity Fund
The Student-Athlete Opportunity Fund (SAOF) is intended to provide direct benefits to student-athletes or their families as determined by conference offices. The fund shall be used to assist student-athletes in meeting financial needs that arise in conjunction wit participation in intercollegiate athletics, enrollment in an academic curriculum or that recognize academic achievement.
All student-athletes may receive SAOF benefits regardless of whether they are grant-in aid recipients, have demonstrated need or have either exhausted eligibility or no long participate due to medical reasons. No prospective student-athlete shall be eligible to receive SAOF benefits regardless of the receipt of summer financial aid the summer prior to their full-time enrollments.
Prohibited uses for the fund:
Monies of the fund may not be used for salaries and benefits, grants-in-aid (other than summer school for student-athletes with remaining eligibility), capital improvements, or stipends.
ACC Conference offices are solely responsible for the administration and oversight of the SAOF monies and uses.
30.12 Student-Athlete Health Insurance Portability and Accountability Act (HIPPA) Authorized/Buckley Amendment Consent Form-Disclosure of protected Health Information The active member institution shall administer annually, on a form prescribed by the
Academics/Eligibility/Compliance Cabinet, a statement for each student-athlete to voluntarily sign that provides information prescribed in Bylaws 14.1.5 and 30.12.
Administrative Requirements. The statement shall be administered individually to each student-athlete by the athletics director or the athletics director's designee before the student-student-athlete's
participation in intercollegiate athletics each academic year. The authorization/consent by the student-athlete is voluntary and is not required for the student-athlete to be eligible to participate. Any signed statement(s) shall be kept on file in the office of the athletics director." (Compliance Coordinator 2006)
