DePauw University

EXCESS INSURANCE COVERAGE PROVIDED BY DEPAUW

The excess athletic accident insurance at DePauw University provides coverage for student-athletes who are injured in an accident while participating in a DePauw intercollegiate varsity sport.  Accidents which occur during participation will be considered for coverage by the secondary insurance.

An accident is defined as an unexpected, sudden and definable event, which is the direct cause of a bodily injury, independent of any illness, prior injury or congenital predisposition.  Conditions which result from participation in sports do not necessarily constitute an accident but are considered under the policy. Accidents must occur in official practices or games, as defined by the NCAA playing and practice season, and there must be direct coaching supervision.  Injuries from voluntary strength and conditioning training activities are not covered.

This coverage is in excess to the student-athlete's primary group insurance or plan(s), which all must contribute their maximum benefit, before the excess policy has any liability. If the claim is otherwise payable and the deductible of the student's primary insurance has not been met, this coverage will apply. The excess coverage has a deductible of $1,000 and a medical maximum of $90,000 per claim.  Coverage is underwritten by the United States Fire Insurance Company.  This policy also contains a $10,000 Accidental Death Benefit and a $2,500 - $10,000 Dismemberment Schedule depending on the circumstance.

EXCESS INSURANCE CLAIM PROCEDURE

All medical bills resulting from an accident in the intercollegiate sports program should be sent directly to your home address or primary insurance company.  In some cases the athletic office may get a copy of the bill, but in no case will the athletic office be the primary place for the bill incurred to be sent. When filing a claim, please check the following:

Submit the bills incurred to your family, employer group coverage or plan first; you must follow all provisions of your primary insurance plan for the excess policy to consider/pay on a claim. Each charge must be submitted to your insurance before it can be processed by NAHGA Insurance even if you know it will be applied to your deductible. NAHGA Insurance is unable to contact your insurance company for this information.  If there remains a balance after your family, employer group insurance or plan has contributed towards the claim:

• Your son or daughter should inquire on excess coverage and the desired intent to file should be made to their staff athletic trainer for their sport. The staff athletic trainer can then submit an accident report to NAHGA Insurance for those accidents/injuries that appear to meet the policy provisions and for further coverage consideration. 
• Once these documents are completed and signed, please send them to Kara Campbell, MS, LAT, ATC.
• Collect all itemized bills from the provider and the explanation of benefits from your insurance company for these services.  Send all EOB's and itemized bills to: NAHGA Claim Services PO Box 189 Bridgton, ME 04009. (Phone- 877-497-4980 and Fax- 207-647-4569).  If NAHGA needs any additional information, they will contact you. 
• The DePauw University coverage underwritten by the United States Fire Insurance Company and administered by NAHGA is EXCESS coverage and does contain an exclusion for those bills incurred that were "payable" by the family insurance or plan. It will not duplicate benefits.
• It is strongly suggested that anyone who is a member of an HMO (Health Maintenance Organization) or PPO (Preffered Provider Organization) follow the proper procedures outlined by the plan.  For you to have payable coverage, when a member of these organizations, proper procedures outlined by that plan must be followed, and authorized medical vendors from the list provided to you by your HMO/PPO must be used.  The DePauw University coverage underwritten by the United States Fire Insurance Company will honor these bills incurred that were payable by your HMO/PPO should they be denied for not following the proper procedures as long as your staff athletic trainer was notified in advance and you recieved prior approval from NAHGA to use providers other than the authorized medical vendors from the list provided to you by your HMO/PPO.
• Treatment by a licensed practitioner of medicine must begin within 90 days of the accident.
• Accident claim forms must be submitted no later than 1 year from date of accident.  Explanation of benefits from primary insurance, itemized bills(including provider's name, address, tax ID number, diagnosis, and procedures codes), and all information required to process charge must be submitted no later than 1 year from date of service.  Only expenses incurred within 104 weeks of the original date of the accident are considered.
• There are policy exclusions.  Full plan details can be found here.  Please contact EIIA at 888-255-4029 or NAHGA at 877-497-4980 directly if you have any questions.