College Baseball and Medical Insurance.

If you purchase school provided insurance make sure to check for coverage ceilings (daily, annual, individual event) that would cost you a lot with a serious illness or injury. I've seen plans that max at $500 per day.

We kept son on our family coverage, which is "primary" coverage.  We did not purchase the optional school plan.

The school has team medical coverage (possibly in addition to the catastrophe coverage) that is the "secondary" coverage with a $250 deductible that is no cost to the player.  The team coverage covered two surgeries, in addition to some other issues.  We (or the dr/hosp/etc) file first with our family plan, and then what is not covered is filed with the school policy, after the $250 deductible.

I have lots of files with notes to keep it all straight.  

I suggest you or your son ask the coach or trainer about coverage during play/practice.  

I agree with Keewart to check with the school. In my son's first year it was cheaper for us to get a school policy for him which we did, but it had $100K limit, so I also purchased a high deductible high value policy that was very inexpensive. Mr Obama has stuck his finger in the insurance process and I understand these policies may not be available now, but you will have to check. Later we put him back on our plan and dropped the other policy.  His school also provided specific team insurance and when my son broke his finger in a game they paid for all of the Dr's costs. 

It is good that you are looking into these details in advance as it can be a rabbit hole and it is good that you are planning as many don't. 

I'm surprised that there is a specific exclusion under your family coverage for an injury during a game.  I'd ask UHC again and ask them to point to specific language that provides it would not be covered.

(If he is out of state, it may be out of network and subject to different rates - but not completely excluded.)

Slightly off topic but for anyone who is reading.....I am putting a plug in for team medical insurance for the 9u-17u set.  Not only does it cover liability for coaches, but for injury during games.  It is CHEAP CHEAP CHEAP and should be included in player costs.  Divided by 12-15 it is like $9/pp for the year.  USAAA has a plan the son's team purchased when playing 10-12u.   At 16, team insurance covered my son's tooth when it got knocked out at a showcase.   

I agree with JDFARMER - I have worked in the employer healthcare/insurance world for over 20 years never heard of any specific exclusions to sports related injuries for students away at college.  If your policy covers dependent students (which it should until age 25 - although I may have the age wrong) then they would cover sports related injuries like any other treatment related to injury or illness.  

To echo what Keewart stated, I strongly suggest you contact the head athletic trainer at the college your son is headed to and ask about insurance coverage for your son.   In fact, some of the major Division I universities in the Power 5 conferences have an administrative assistant in their Sports Medicine office who specifically handles the processing of insurance claims for the student-athletes.

I agree with JDFarmer and MKBaseballDad.  Ask again. That doesn't sound right.

I have more experience in this area than I desired to obtain. Son had surgery at two different schools.  First time, I was still on active duty and primary insurance was Tricare. Second time, primary insurance was UHC through my job. Both times, the school's training staffs were excellent: they filed all the paperwork, and the school or its secondary policy picked up all or nearly all deductibles and co-pays. If we paid anything at all it was too trivial to recall--maybe a co-pay on pharmacy or something, but nothing significant.

Surprised to hear UHC might have an exclusion for sports injuries. Seems like exactly the sort of risk their actuaries can cook into the premium price. Baseball isn't skydiving.

When we used UHC as primary, not only did nobody mention the possibility of an exclusion, but James Andrews was in network. We picked up the tab for travel to Florida, but never wrote a check to him.

Best wishes,

I'll echo everybody else. Contact the Sports Medicine department and discuss it with them. Our high school carries a secondary policy, so I've gotten a little bit of experience dealing with some of these insurance issues. It is normal that your insurance acts as a primary insurance and then the school policy comes in secondary so that you normally do not have any type of out of pocket costs. It doesn't cover things 100% of the time, but it comes pretty close!

We kept our insurance on him as it was inexpensive with my husbands job(before Obama care)

We were fortunate my sons school took care of everything. He had a injury that required surgery and they paid for the surgery, the rehab(at home) The ice machine, meds ,everything. He had a top notch surgeon, one of the best.

Trainers worked with him for months as it took about 6 mos. to get back on field.

We consider ourselves very fortunate for the care he received.

We did not have school insurance but being an athlete they paid.

My best advice was echoed earlier. Ask the coach, they will know as injuries happen. It did to my son this year. What we were told was my family insurance (thru my employer) was primary and then secondary (our out of pocket vs school paying)  depended on if we went with the schools doctors or went on our own. We attempted to go with school doctors but got very bad advice and then excellent advice from coaches to get 2nd opinion (out of network and deductibles on our dime). After hearing the result of 2nd opinion school decided to add who we went to as someone in their network and paid for everything. 

I'm glad that I live in europe were almost everything gets paid for. College is about 1000 Dollars a year and the public health insurance covers everything except some small part that you have to contribute yourself. I can't imagine to have to pay for a surgery.

Random thoughts on this (we have been burned by some of these):

Your kid may not be covered by your insurance if he's out of state.

If you get school coverage, is he covered over the summer if he's hurt at home?

Your coach/AD may be a jerk and say the injury was pre-existing and not pay.

Your kid's deductible may be limited by your overall family deductible, so the family plan may be better.

I don't see how your family plan could deny coverage for a sports injury.

I'm not sure the school will cover your kid during summer league ball, off-season, instructor lessons, etc.

If your kid is hurt in a game or on-field practice, the school will likely pay for PT and more anyway.

Who pays for Tommy John surgery, the PT for 6-9 months, and the instructor training for 3-6 months?  Could this be pre-existing?  What if he's hurt in summer ball?  What if he's hurt in a 3rd state (not home and not school)? 

Dominik85 posted:

I'm glad that I live in europe were almost everything gets paid for. College is about 1000 Dollars a year and the public health insurance covers everything except some small part that you have to contribute yourself. I can't imagine to have to pay for a surgery.

Too funny.  You pay for everyone else's surgery every time you pay VAT.  We only pay when we have our own surgery.

Dominik85 posted:

I'm glad that I live in europe were almost everything gets paid for. College is about 1000 Dollars a year and the public health insurance covers everything except some small part that you have to contribute yourself. I can't imagine to have to pay for a surgery.

You may not be paying for it directly, but you are paying for it in other taxes and fees.   Nothing is truly free.

SultanofSwat posted:

Dominik85 posted:

I'm glad that I live in europe were almost everything gets paid for. College is about 1000 Dollars a year and the public health insurance covers everything except some small part that you have to contribute yourself. I can't imagine to have to pay for a surgery.

Too funny.  You pay for everyone else's surgery every time you pay VAT.  We only pay when we have our own surgery.

And VAT is absurd!  How the heck do you guys get anything done over there?  I tried to get a formula blended and bottled in England for a UK customer and it turned out, due to VAT, to be cheaper to make the product here in the US and send it on a slow boat....I say again, how do you get ANYTHING done over there?

CaCO3Girl posted:

And VAT is absurd!  How the heck do you guys get anything done over there?  I tried to get a formula blended and bottled in England for a UK customer and it turned out, due to VAT, to be cheaper to make the product here in the US and send it on a slow boat.

I think UK VAT is 20% (based on sales price) and the US Federal corporate income tax rate is 34%+ (based on 'profit'), so it should work out roughly the same (plus shipping and state taxes).

We kept son on our policy which saved us $ by waiving school insurance. It's been a good plan, though costs have gone up w/the "Affordable" Act. He injured his hand in the fall which resulted in a few visits to health care. At first we were due the deductible for each visit, then it was waived to be in line w/ either hockey or football team.

FoxDad posted:

Dominik85 posted:

I'm glad that I live in europe were almost everything gets paid for. College is about 1000 Dollars a year and the public health insurance covers everything except some small part that you have to contribute yourself. I can't imagine to have to pay for a surgery.

You may not be paying for it directly, but you are paying for it in other taxes and fees.   Nothing is truly free.

That is true it actually does cost a lot of money. Nothing is for free of course.

still I feel it is a lot easier if that stuff is taken care for, can't imagine having to worry to pay for college and medical bills.

the downside is of course higher taxes. Here 39% of my paycheck get deducted for taxes, health insurance, Public retirement fond and other fees so I got only 61%. That would be a little more if I was married or had kids but still that is a lot of money.

the downside is that there are no serious college sports in Europe, everything serious here is club sports.

Thank you for all the comments and suggestions. I contacted my HR department and asked them to verify the information provided by the Insurance Company

(“According to your Health Plan benefits there is no coverage if an injury occurs during participation in NCAA college sports. 

We apologize since we are unable to provide such coverage requirement however this plan is designed according to mutual agreement with your Employer Group and United Healthcare. “)

In the standard UHC Choice Plus Advantage Plan there is the following exclusion.

SECTION 8 - EXCLUSIONS AND LIMITATIONS

All Other Exclusions

1. Physical, psychiatric or psychological exams, testing, vaccinations, immunizations or treatments when:  Required solely for purposes of education, sports or camp, travel, career or employment, insurance, marriage or adoption; or as a result of incarceration.

I’m happy to hear that others have not run into this problem and I might suggest everyone check their policies for hidden exclusions.   I have a couple more questions to ask before I purchase the school insurance or find an additional supplement for him.  I wonder if I have now "flagged" the account because I asked this question and everything and anything that is submitted will be reviewed for sports related injuries.

SDR, the list of exclusions you referenced doesn't list injury.  Hummm....

The good news is, once claims are filed with your employer  insurance (primary) and then denied, the school team policy should pick it up, possibly less a deductible.  Did you ever find out from the coach/trainer if the team had insurance other than the NCAA catastrophic policy?

(The trainer is the guy who has signed the paperwork for my son's injuries.  We are on our third now.)

I am not a lawyer but you should PM one of the many on here.  To me this does not exclude sports injuries.  It doesn't say it won't cover injuries sustained from sports it says it won't cover treatments required specifically FOR sports.  A broken arm doesn't need treatment so he can play sports.  

SDR posted:

Thank you for all the comments and suggestions. I contacted my HR department and asked them to verify the information provided by the Insurance Company

(“According to your Health Plan benefits there is no coverage if an injury occurs during participation in NCAA college sports.

Thank you for posting this.  I've never heard of this before.  I can hear hundreds of HSBB webbers flipping through their policies now.

SultanofSwat posted:

SDR posted:

Thank you for all the comments and suggestions. I contacted my HR department and asked them to verify the information provided by the Insurance Company

(“According to your Health Plan benefits there is no coverage if an injury occurs during participation in NCAA college sports.

Thank you for posting this.  I've never heard of this before.  I can hear hundreds of HSBB webbers flipping through their policies now.

Since it is in quotes, someone told you this?  Have them direct you to where it doesn't "cover NCAA injuries", specifically, in writing. 

I received that information via email from UHC when I submitted the question:

 Are there any restrictions to coverage if an injury occurs during participation in NCAA college sports?

 According to your Health Plan benefits there is no coverage if an injury occurs during participation in NCAA college sports. 

We apologize since we are unable to provide such coverage requirement however this plan is designed according to mutual agreement with your Employer Group and United Healthcare.

I sent another email requesting UHC provide where it states in our policy that an injury from participating in NCAA sports is not covered..  

Son spoke with the one of the trainers and was told that she was unaware of a secondary insurance for athletics. They then transferred him to the insurance coordinator for the school who after hearing about our limited coverage recommended that we either find some secondary insurance coverage or pick up the school insurance. The school insurance does cover everything with a $250.00 yearly deductible and unlimited coverage. It can be used anywhere within the Cigna network (and will cover him outside of the US).  The school does have an extensive sports medicine department along with a medical school and hospital, maybe that is why they don't have "team insurance"

Son has calls into coaches for additional clarification.