Middlebury

Athletic Insurance Policy

Procedures for Parents and Students Athletes

Middlebury College requires its student athletes to carry adequate health insurance. Most families rely upon their home coverage, which in most cases provides the needed benefits. Parents or students who don’t feel their coverage is adequate or need insurance can purchase it through the College. The link provided describes in detail the available insurance options. studentcare@kosterins.com. On top of the parent’s home insurance the College provides on all its students a $5000.00 accident policy which is secondary to the parent’s home insurance. Beyond the College’s accident policy, the College also carries a sports rider for all its intercollegiate sport teams up to the $75,000.00 NCAA minimum. This policy as well is secondary to any home insurance and only pays after the College accident insurance mentioned previously has been exhausted.

The Sports Accident Insurance Policy (Sports Policy), provided by Middlebury College, is offered on an "excess"basis to any other health insurance policy, such as the parent's plan. This means that the Excess Sports Policy will always pay secondary to any other valid and collectible health insurance plan.  It is the student athlete's responsibility to initially submit his/her medical claims to the primary insurance policy.  Once payment is completed, the remaining balance of expenses not covered by the primary insurance is then submitted to the Excess Sports Policy, and will be based on outstanding amounts (including/excluding applicable deductible).

Middlebury College Athletics Excess Insurance Information:

Insurance Company: Gallagher Koster c/o Sports, 500 Victory Rd. Quincy, MA 02171, Phone: (877) 345-8928, Fax: (617) 479-0860.  The ID number for the student is their school ID number and the Group Number on the Policy is Middlebury Athletics.

For any athletic injury the athlete should provide the college excess insurance information to their provider as their secondary insurance to speed the process of payment to the provider.  If unable to give the information to provider at the time of service then you should follow the scenarios below to file any claims with the insurance company for payment.  The athlete must report any athletic injuries to Sports Medicine in order for the injury to be covered by the athletic insurance.

Situation 1: The student athlete IS COVERED under another insurance policy.

The following steps MUST be followed:

1.        Obtain an itemized copy of your bill for service(s) relating to the sports injury, usually a HCFA or UB92 form. Keep a copy of this bill for your records. The bill must contain all of the following:

a.       Provider's Name

b.       Provider's Address

c.       Tax Identification Number

d.       Date of Service(s)

e.       Type of Service(s) Rendered

f.        The Fee for Each Procedure

2.        Submit the itemized bill(s) to the primary insurance carrier for processing.  Do not make any payments directly, or send bills to the College for payment.

3.        Once the primary insurance carrier has made payment, you will receive a copy of their Explanation of Benefits (EOB) statement that identifies what was paid/denied.

a.       If there is a balance still due, then you must send the Explanation of Benefits and copies of all the itemized bill(s), along with the completed insurance sports accident claim form to Koster Insurance.  Koster Insurance will submit all of these documents to the Claims Company for the charges to be paid under the Mandatory Middlebury Accident Only plan

b.       The Middlebury Accident Only plan will coordinate benefits with the primary insurance to pay the first $5,000 on the claim.

c.       If the claim is the over $5,000 accident policy, Koster Insurance will then submit all remaining bills to the Excess Sports Accident Plan with a maximum of $90,000.

Situation 2: The student athlete is NOT COVERED by any other insurance coverage other than the Middlebury Mandatory Accident Only Plan and/or the Middlebury Voluntary Accident and Sickness Insurance Plan

A.       The following steps MUST be followed for submission to the Excess
Sports Policy:
1.        Obtain an itemized copy of your bill for service(s) relating to the
sports injury, usually a HCFA or UB92 form. Keep a copy of this bill
for your records.  The bill must contain all of the following:
a.        Provider's Name
b.        Provider's Address
c.        Tax Identification Number
d.        Date of Service(s)
e.        Type of Service(s) Rendered
f.         The Fee for Each Procedure
.
2.        If the claim is over the $5,000 accident policy, Koster Insurance will then
submit all remaining bills to the Excess Sports Accident Plan 
with a maximum of $90,000.

NOTE:  For either scenario, a claim for a sports-related injury can not be processed without:  an itemized bill, and an Explanation of Benefits statement or denial letter from the primary insurance.

Do not send cash receipts, balance due, balance forward, or past due statements for claims processing or payment.

Incomplete submission of information will result in claim processing and payment delay.

An insurance carrier can require some verification that demonstrates whether or not the participant was eligible for any other insurance before the claim is processed under the Excess Sports Policy. These plans include; coverage under all group and/or individual, and health maintenance organization plans.