Procedures for Parents and Student Athletes
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).
Situation 1: The student athlete IS COVERED under another insurance policy.
The following steps MUST be followed:
1. An insurance sports accident claim form, available in the Sports Medicine Department, must be completed and signed by the Sports Medicine Department and the student athlete or parent. This sports accident claim form must be submitted to Koster Insurance within 90 days of the injury, or you may be denied coverage. Keep a copy for your records and possible future submission.
2. 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
3. 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.
4. 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 over $5,000 Koster Insurance will then submit all remaining bills to the Excess Sports Accident Plan with a maximum of $75,000.
Situation 2: The student athlete is NOT COVERED by any other insurance coverage other than the Middlebury Mandatory Accident Only Plan and the Middlebury Voluntary Accident and Sickness Insurance Plan
A. The following steps MUST be followed for submission to the Excess
Sports Policy:
1. An insurance sports accident claim form, available in the
Sports Medicine, must be completed signed by Sports Medicine
and the student athlete or parent. This insurance sports
accident claim form must be submitted to Koster Insurance within 90
days of the injury, or you may be denied coverage. Keep a copy of
this form for your records.
2. 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
3. Submit the completed insurance sports accident claim form and
itemized bill(s) to Koster Insurance for submission to the Mandatory
Accident plan and Excess Sports Accident Policy.
a. The Middlebury Accident Only plan will coordinate
benefits with the primary insurance to pay the first $5,000 on
the claim.
b. If the claim is over $5,000 Koster Insurance will then
submit all remaining bills to the Excess Sports Accident Plan
with a maximum of $75,000.
NOTE: For either scenario, a claim for a sports-related injury can not be processed without: an itemized bill, an Explanation of Benefits statement or denial letter from the primary insurance, and a completed insurance sports accident claim form.
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.