MEDICAL INSURANCE INFORMATION
STONY BROOK UNIVERSITY SPORTS MEDICINE DEPARTMENT
Dear Student-Athlete & Parent/Guardian,
On behalf of the Stony Brook University Department of Athletics I would like to inform you of the athletic insurance provided for all participants on SBU intercollegiate athletic teams. It is essential that all policies and procedures are followed in order for any claims to be processed. Delay in payment and/or loss of coverage may result if these guidelines are not followed. Please review this document carefully.
Type of coverage
The Stony Brook University Department of Athletics provides an Excess (Secondary) Policy for its student-athletes. Whenever a student-athlete is referred for health care services related to a covered athletic injury or condition, the athlete's personal health insurance must be used as the primary financial coverage. Following this primary insurance settlement, the Athletic Department will assume co-payment responsibility for the unpaid portion of the claim. Student-athlete medical expenses are not "automatically taken care of" by the Athletic Department or the University. Student-athletes who do not comply with these procedures put themselves and their families at a serious financial risk, which may jeopardize their credit rating.
About the Athletic Accident Insurance Policy
1. The policy only covers intercollegiate athletic injuries, which occur during participation in coach supervised intercollegiate activities (i.e. practice, games, and travel);
2. The policy DOES NOT cover general illnesses; SBU assumes no responsibility whatsoever for any non-athletic related medical expenses including illnesses/conditions and/or non-athletic injuries.
3. All off-campus medical referrals (i.e. physical therapy, diagnostic tests, doctor appointments, etc) must have prior approval from the SBU Sports Medicine Staff, before reimbursement is considered;
4. Please notify SBU Sports Medicine Staff of any policy changes or cancellations. Failure to do so will void secondary athletics insurance coverage.
5. If you choose to go outside the Stony Brook Sports Medicine network for medical evaluation or surgery the physician must be in network with the student-athlete’s primary insurance or the secondary coverage will be void.
6. Dental injuries ARE NOT covered if the sport requires that a mouth guard be worn and the student-athlete was not wearing one properly at the time of the injury.
Procedures to Follow When an Injury Occurs
If any of the following procedures are not followed, the SBU Department of Athletics will not be responsible for any charges incurred due to examination and/or treatment:
1. All athletic injuries must be reported to the SBU Sports Medicine Staff within one day of occurrence;
2. The SBU Sports Medicine Staff will coordinate all medical referrals;
3. All bills must first be submitted to the student-athletes primary carrier. SBU Athletics insurance information will be provided to the provider for his/her office to submit to once primary insurance has been processed. In the event the office does not/will not submit to secondary, it is your responsibility to submit any outstanding itemized bills, Explanation of Benefits (EOB’s), and/or letter of denial to your respective athletic trainer.
4. If you choose to go outside the Stony Brook Medical Network you are required to notify your athletic trainer before and follow the procedures outlined by them. All clearance and progression must be done by that same outside physician before Stony Brook Sports Medicine services can be utilized again. **Any costs incurred for visits that are not reported to the SBU Sports Medicine Staff are YOUR RESPONSIBILITY**
5. If seeking a second opinion, you must first inform your Athletic Trainer. Secondly, ensure that the provider (doctor AND facility) accepts your insurance and is in-network prior to obtaining any and all services from them.
Exclusions to Secondary Insurance Coverage
The Stony Brook Athletics Department secondary medical insurance policy will not apply to the situations indicated below. Please note this list is not all-inclusive.
1. Injuries/illnesses that are not the direct result of a covered event, including but not limited to: pre-existing injuries, injuries that are a result of intramural, club sports, and recreational activities, and injuries incurred after completion of the student-athlete’s intercollegiate athletic eligibility.
2. Doctor office visits and testing that are required for an injury/illness that is not the direct result of a covered event, pre-existing injury/illness, or a congenital illness.
3. Benefits for a loss resulting from being intoxicated or under the influence of a narcotics unless it is administered on the advice of a doctor.
4. Benefits for a loss resulting from participation in a scheduled competitive event by a person who has not been medically cleared to participate by Stony Brook Sports Medicine Staff.
5. Cosmetic surgery or procedures unless directly related to an athletics related injury, with the exclusion of tissue avulsion from piercings.
6. Hospital room & board charges in excess of the semi-private room rate unless hospitalized in an intensive care.
7. Second opinions not approved by the Stony Brook Sports Medicine.
8. Injuries / illnesses that are recurrences of old injuries/ illnesses which were sustained before participation in the intercollegiate sports program
9. Expenses for athletic injuries incurred after completion of the student-athlete’s intercollegiate athletic eligibility
10. Medical expenses beyond the limitations and exclusion of, or not covered by the Limited Accident Ins. Program
The NCAA’s Catastrophic Injury Insurance Program covers student-athletes who are catastrophically injured while participating in a covered intercollegiate athletic activity (subject to all policy terms and conditions). The policy is supplemental coverage in the event of a catastrophic injury. More information can be found at www.ncaa.org.
1. Every semester you must waive or enroll in the Stony Brook University student health insurance plan on your SOLAR account;
2. Notify your insurance carrier once you/your child becomes age 19 as a full time student status.
a. You can obtain student verification through your SOLAR account if needed for insurance purposes.
3. If you are not from the Long Island area (Suffolk/Nassau County), please check with your insurance provider to determine whether the student is available for benefits/coverage while at school. Some insurance plans may have an out of state option to enroll in. They should guide and inform you of what options are available in order to receive your maximum benefits and avoid unnecessary delays in access to medical services.
a. If the student-athlete is covered by an HMO or other Managed Health Care plan, you should contact your employer’s benefits provider or your insurance company and notify the carrier that your son or daughter will be enrolled as a full-time student at SBU.
b. Request “Guest privileges” or “Away from Home Care” while enrolled as a full-time student at SBU, including identifying a primary care physician (PCP) within the Stony Brook area, who is within your network or will be considered to be in your network.
c. If your insurance cannot locate a PCP within our area, (zip codes 11790, 11733, or any others in a 5mi radius of campus) request that your insurance carrier submit to you in writing that they will pay the maximum benefits allowed for services provided as they would have if they provided your son or daughter with a PCP in this area.
All questions or correspondence should be addressed to:
Stony Brook Sports Medicine Phone: (631) 632-6448 Fax: (631) 632-3231
Stony Brook University
Indoor Sports Complex
Stony Brook, NY 11794-3500