Letter from Gallagher Koster Insurance
To: Parents of Lake Forest College Intercollegiate Athletes
From: Athletic Training/Gallagher Koster Insurance
Re: Athletic Insurance Information
Dear Parent/Participant:
On behalf of the Lake Forest College Athletic Department, I would like to take this opportunity to explain the type of Excess Athletic Sports Insurance Policy purchased by the Institution for the students that are participating in one of our sports programs. The plan is underwritten by Combined Insurance, an A (excellent) rated by AM Best, an Insurance Financial Rating Company.
The Policy provides coverage for an injury, which occurred as a result of participating in a regularly scheduled, supervised, sponsored play or practice.
The coverage is offered on an "excess" basis to the participant primary health insurance policy, such as their parent's plan or any other heath insurance plan. Under the provision the plan will always pay secondary to any other valid and collectible health insurance plan. Therefore in the event of an injury, the participant will be required to submit the medical claims directly to his/her primary insurance plan first and then if there are any remaining balances, this amount is submitted to the excess plan. Should the participant not have any other health insurance, this plan will cover the claim up to the plan maximum.
The Lake Forest Policy has a deductible of $2,500, which is considered met if the primary pays up to that amount or over. It is your responsibility to ensure that the student athlete is responsible for this amount either through primary insurance coverage or an out of pocket expense could be incurred.
If you have any questions or concerns, please feel free to contact our office.
Sincerely,
Dan Buckley
Sports and Special Risk Account Representative
Gallagher Koster
Insurance Q & A
Lake Forest College
Intercollegiate Athletic Insurance - Secondary Coverage
This information about insurance coverage is a general guide only. It in no way replaces or supercedes the information provided in the coverage policy.
Koster Insurance Company
500 Victory Road
Quincy, MA 02171
Tel. # 617.770.9889
Fax # 617.479.0860
Email: STUDENTCARE@KOSTERINS.COM
How is a student-athlete covered by the athletic insurance policy?
In order to be covered by the athletic insurance, the student-athlete must be enrolled in the Lake Forest College Student Insurance program and/or have their own personal insurance, and be a member of an intercollegiate athletics team at Lake Forest College (LFC).
Who will file a claim with LFC Athletic Insurance?
All Athletic injury claims will be filed by the Head Athletic Trainer at LFC. All injury care and referral should be initiated through the LFC Athletic Training Staff and/or the Team Physician. This does not pertain to emergencies or emergency room situations where immediate medical care is required.
Whose insurance will be the primary carrier?
Your son's/daughter's personal insurance, will serve as the Primary Insurance Coverage. This is not an option; your personal coverage will always serve on a primary basis. The Lake Forest College Athletic Insurance Policy is an "Excess" or "Secondary" policy. They will only consider bills that have been processed through your Primary Insurance Carrier first.
What is covered by the LFC Athletic Insurance Policy?
The athletic insurance policy provides coverage for injuries incurred while participating in official team play or practice of intercollegiate sports, including sponsored and authorized team travel. The coverage applies only to "in-season" varsity athletic-related injuries. It is important to note that an injury incurred in a pre or post season conditioning activity such as weight lifting will not be covered under the athletic insurance policy.
What does the LFC Athletic Insurance require to process medical bills?
- An injury claim must already be filed.
- An Itemized Bill from each service provider. An Itemized Bill details the charges for each item that makes up the total bill. A statement that only shows a "total charge" is not acceptable to process a claim.
- Explanation of Benefits (EOB) from your primary insurance carrier for each medical bill. An EOB explains what your insurance carrier covered or denied from each medical bill. Your primary insurance carrier will normally mail you an EOB from your primary insurance company.
** Unless the LFC Athletic Insurance has all three of these items, a bill will not be considered.
What if we have an HMO?
An HMO requires a referral from your primary care physician before any medical care is received (other than emergencies). If these procedures are not followed your HMO will deny all medical bills. If your HMO denies your bills for this reason, LFC Athletic Insurance will also deny these bills. It is imperative to follow the procedures established by your HMO.
HMO's are the most restrictive type of medical insurance. You are limited to physicians and medical care that is within the HMO's network. HMO's generally lengthen the time it takes for an athlete to initially see an orthopedist because a referral must be obtained before the athlete is seen for an injury. And it's also possible the primary care physician will want to see the athlete first, before a referral is made.
What if we have a PPO?
There are several types of PPO's, but all of them provide more liberal coverage than HMO's. Some PPO's do not require a referral as long as the physician who is seen is in their network or providers. For full benefits, some PPO's require a referral from you primary care physician. But all PPO's we have come in contact with, provide coverage for "out of network" services. This means if a referral is not obtained or a network physician is not used they will still provide partial coverage then the LFC Athletic Insurance will consider all unpaid balances, when the proper paperwork is received.
What if we have a "Traditional Plan"?
The "Traditional Indemnity Plan" with an insurance company provides the best of all possible worlds. Referrals are not required and coverage is open to any physician, hospital, or medical facility. These plans normally have a deductible and LFC Athletic Insurance will consider all unpaid balances, when the proper paperwork is received.
What is our responsibility in this process?
- For emergency room visits, make sure your insurance company is contacted. Make sure a claim has been filed with your insurance company for each medical service provider (many times hospitals do not do this for you, especially with emergency room visits).
- Obtain all of the required itemized bills, receipts, and EOB's required by the LFC Athletic Insurance.
** We suggest you make a folder and keep any and all of the information you receive regarding the athletic injury here for future reference.
Where do we send bills and EOB's?
Koster Insurance Company
500 Victory Road
Quincy, MA 02171
Please make a copy of all documents you send to Koster for your records .
Who can we contact with questions or problems?
Lake Forest College:
Michael Gilboe
Head Athletic Trainer
847.735.5296
Email: gilboe@lfc.edu |
Linda Alaimo
Insurance Coordinator-SHS
847.735.5050
Email: alaimo@lfc.edu |
From: Gallagher Koster Insurance Company:
Gallagher Koster Insurance
Dan Buckley
800.457.5599