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Calvin University

Insurance

Insurance
Health insurance is a wonderful resource that can help you access high-quality care and protect your finances when medical issues arise. But like other resources, if you don’t understand correct usage, it may not work as well as it could. This can result in frustrating and time-consuming claims navigation and lead to you receiving preventable medical bills. Reviewing the following information will help you develop a better understanding of your insurance coverage and ensure that you are better prepared to use it correctly if the need arises. We recognize that there are diverse levels of experience when it comes to working with insurance and are more than happy to help you find answers if questions come up along the way.
 
Primary Insurance Requirements
There are specific health insurance requirements that you must meet as a student at Calvin University. By meeting the general health insurance requirements, you also ensure that you meet the Calvin Athletics primary health insurance requirements for National Collegiate Athletic Association (NCAA) and American Collegiate Hockey Association (ACHA) student-athletes. You must provide your primary insurance policy information to Calvin University’s Sports Medicine Office AND Calvin University Health Services, and it is your responsibility to update that information with both offices if it changes in the future.
 
If You are from the Grand Rapids Area
You should review your primary insurance coverage and confirm any specific procedures you must follow to access medical care while you are at Calvin University. If you need medical care, knowing these things in advance will help you access care quickly and avoid preventable bills. If there are specific procedures you must follow (i.e., primary care referrals or seeing specific in-network doctors), you should review them with Calvin University’s Sports Medicine Office prior to any referral for billable medical services. Due to our partnerships with University of Michigan Health-West and Orthopaedic Associates of Michigan, we primarily make referrals to our team physicians and their colleagues, but we are more than happy to refer to other providers if required by insurance to maximize your benefits.
 
If You are NOT from the Grand Rapids Area
Even though your primary health insurance provides adequate coverage when you are at home, coverage may (or may not) look different when you are in other places. This is most common when your insurance is classified as a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO), but it can also occur in other situations. In these cases, seeking medical care while you are away from home could result in medical bills that are not covered by your insurance like they would be if you received the same care at home.
 
You should review your primary insurance coverage and confirm any specific procedures you must follow to access medical care while you are at Calvin University. If you need medical care, knowing these things in advance will help you access care quickly and avoid preventable bills. If there are specific procedures you must follow (i.e., primary care referrals or seeing specific in-network doctors), you should review them with Calvin University’s Sports Medicine Office prior to any referral for billable medical services. Due to our partnerships with University of Michigan Health-West and Orthopaedic Associates of Michigan, we primarily make referrals to our team physicians and their colleagues, but we are more than happy to refer to other providers if required by insurance to maximize your benefits.
 
Everyone is unique and you and your family should review your specific situation to determine what makes the most sense if you do not have great insurance coverage away from home. Some insurance companies will allow you to change your existing policy or add additional coverage while you are away from home. You can also choose to travel home to maintain coverage for non-emergency care, but this option can be inconvenient and result in significant travel expenses, depending on your situation. If you’re uncomfortable with the coverage provided by your current primary health insurance, we would encourage you to consider switching to a medical insurance plan that provides better coverage in Grand Rapids, Michigan, such as the United HealthCare Student Plan offered through Calvin Health Services.
 
United HealthCare Student Plan
The United HealthCare Student Plan offered through Calvin Health Services meets the primary insurance requirements for Calvin University and for Calvin University Athletics.
 
NCAA Student-Athletes
If you have the United HealthCare Student Plan, please notify Calvin University’s Sports Medicine Office that this is your primary health insurance and report all athletic-related injuries to the Sports Medicine office immediately. Knowing this will help us ensure that you follow the specific procedural requirements of the policy and avoid preventable medical bills. The plan itself does not cover NCAA athletic-related injuries (directly related to participation in official, NCAA-sanctioned practices/contests), but comes with a separate Intercollegiate (IC) Sports policy for NCAA student-athletes at no additional charge. This IC Sports policy provides up to $25,000 of primary insurance coverage per person, per policy year. We will help you file an IC Sports injury claim and provide you with a separate IC Sports insurance card that MUST be presented when checking in for all billable medical care stemming from your athletic-related injury.
 
AHCA Student-Athletes
If you have the United HealthCare Student Plan, please notify Calvin University’s Sports Medicine Office that this is your primary health insurance and report all athletic-related injuries to the Sports Medicine office immediately. Knowing this will help us ensure that you follow the specific procedural requirements of the policy (i.e., getting a referral from Calvin Health Services for off-campus medical services) and avoid preventable medical bills. The plan does cover ACHA athletic-related injuries and so the IC Sports policy mentioned for NCAA student-athletes above does not apply to ACHA student-athletes.
 
Supplemental Insurance
If you are injured during official athletic-related activities and need medical care, Calvin Athletics provides you with a limited supplemental insurance policy that can help cover the co-pays, deductibles, and co-insurances which aren’t covered by your primary insurance. For each qualifying injury, there is a $0 deductible and a maximum benefit of $90,000 of coverage for NCAA student-athletes and $3,500 for ACHA student-athletes. In most circumstances, the supplemental insurance plan provides coverage for 1 year (365 days) from the original date of injury. Please see the Catastrophic Injury Insurance and NCAA Post-Eligibility Insurance sections below for information about additional coverage you may have beyond these policy maximums.
 
While this supplemental insurance is provided to you by Calvin Athletics, you are still the legally responsible party when it comes to your medical billing. This means that it is your responsibility to monitor your accounts, respond to written or electronic requests from medical providers or insurance companies, and pay your medical bills that will not be covered by insurance. We recognize that this is a big and potentially unfamiliar responsibility and are more than happy to answer questions or provide advice if you need help along the way. If you are uncomfortable with this responsibility, we highly recommend asking a parent or guardian for help.
 
Covered Activities

  • Official practices, training, strength and conditioning, and competition (considered countable athletic activities) that are supervised by a coach or Calvin University Athletics strength and conditioning coach and occur as part of your traditional or non-traditional athletic season.
  • Team travel if as part of the official travel party and supervised by a Calvin University Athletics coach/staff member.
  • Voluntary offseason strength and conditioning programming run by a Calvin University Athletics strength and conditioning coach during the traditional academic school year (fall and spring semesters only).
Uncovered Activities
  • In-season activity that is not supervised by a coach.
  • Voluntary off-season unsupervised activities such as open gym, open field, or “drop-in” play.
  • Voluntary strength and conditioning activities completed during the school year without the supervision of a Calvin University Athletics strength and conditioning coach.
  • Voluntary strength and conditioning activities occurring outside of your season AND outside of the traditional academic school year (i.e., summer), even if the workout was recommended by a Calvin University Athletics coach or a Calvin University Athletics strength and conditioning coach was serving as a safety monitor.

 
HMO/PPO Requirements
The terms of the Calvin University Athletics supplemental insurance policy require you to follow the terms of your primary insurance policy to receive maximum primary insurance benefit. Failure to follow the terms and conditions of your primary insurance policy will result in a benefit reduction for eligible expenses that would be otherwise covered by the insurance policy. This means that if you are required to get pre-approval before certain procedures or if your primary insurance requires you to utilize specific providers, you must do that just as you would for any non-athletic-related medical care. Unfortunately, if those specific providers are not in Grand Rapids, you may need to travel home or to another city to maintain your insurance benefits. The supplemental insurance policy does not provide any reimbursement for travel expenses, even if associated with seeking medical care for an athletic-related injury.
 
Supplemental Insurance Limitations and Policy Exclusions
It is vital that you report all injuries in a timely manner. For an injury to be covered, it must be reported to Calvin University’s Sports Medicine Office and receive documented treatment within 30 days of the injury occurring. You should notify the Sports Medicine office if you believe you need to see an outside healthcare professional or if you would like a second opinion for an athletic-related injury. The supplemental insurance policy will not extend to medical expenses that you incur on your own without the prior knowledge and approval of Calvin University’s Sports Medicine Office.
 
It is important to note that, because the supplemental policy is classified as secondary/excess, it will generally not provide coverage for medical services that are not eligible for coverage by your primary insurance policy. This could include procedures that are deemed as experimental in nature or not medically necessary.

 
Exclusions
Per the exclusions of the policy, a loss (injury) will not be covered if it is caused by, contributed to, or results from:

  1. war or any act of war, whether declared or undeclared.
  2. involvement in any type of active military service. For purposes of this exclusion, orders to active military service for sixty (60) days or less will not be considered involvement in active military services. This exclusion does not apply to the first sixty (60) consecutive days of active military service.
  3. illness or disease, regardless of how contracted; medical or surgical treatment of illness or disease; or complications following the surgical treatment of illness or disease; except for Accidental ingestion of contaminated foods.
  4. commission of or attempt to commit a felony or the Insured’s being engaged in an illegal occupation.
  5. parasailing, bungee jumping, heli-skiing, scuba diving or any other extra-hazardous activity.
  6. Operating a vehicle while intoxicated in violation of section 625 of the Michigan vehicle code, 1949 PA 300, MCL 257.625, or similar law in a jurisdiction outside of this state.
  7. travel or flight in any aircraft except as a fare-paying passenger on a regularly scheduled charter or commercial flight.
  8. release, whether or not Accidental, or by any person unlawfully or intentionally, of nuclear energy or radiation, including sickness or disease resulting from such release.
  9. Alcoholism or drug addiction.
  10. participation in any team sport or any other athletic activity unless mentioned in the Covered Activities.
  11. any condition for which the Insured is entitled to benefits under any Workers' Compensation Act, No Fault Auto Coverage or similar law.
  12. the Insured riding in or driving any type of motor vehicle as part of a speed contest or scheduled race, including testing such vehicle on a track, speedway or proving ground.
  13. any loss incurred while outside the United States, its territories or Canada.
 
Additional Accident Medical Expense Benefit Exclusions
In addition to the General Exclusions stated above, the insurance policy will not cover injury expenses for:
  1. Cosmetic, plastic or restorative surgery unless Medically Necessary for the treatment of the Covered Injury.
  2. Any medical expenses related to pregnancy unless Medically Necessary for the treatment of the Covered Injury.
  3. Covered Injury for which the Insured is entitled to benefits under Workers Compensation Benefits, Employer Liability Law, or any statutorily mandated coverage.
  4. Personal comfort or convenience items, such as but not limited to Hospital telephone charges, television rental, guest meals, or internet charges.
  5. Treatment by any immediate family member or member of the Insured's household.
  6. Expenses incurred for dental care, treatment including dental implants, repair or replacement of sound natural teeth unless Medically Necessary for the treatment of the Covered Injury.
  7. Expenses incurred for eye examinations, contact lenses or the fitting, repair or replacement of these items unless Medically Necessary for the treatment of the Covered Injury.
  8. A hernia of any kind unless the direct result of a Covered Injury.
  9. Routine physical examinations and related medical services, elective treatment or surgery, or experimental or investigative treatments or procedures.
  10. A Medical Repatriation.
  11. Expenses incurred for psychological or psychiatric counseling of any kind or any expense for treatment of mental or nervous diseases or disorders.
  12. Expenses which the Insured is not legally obligated to pay.
  13. Expenses for Custodial Services or services provided by a private duty nurse unless such expenses are incurred as a result of a Covered Injury, as prescribed by a Physician.
  14. Expenses related to the repair or replacement of existing artificial limbs, eyes, or other prosthetic appliances, or rental of existing medical equipment unless for the purpose of modifying the item because the Covered Injury has caused further impairment of the underlying bodily condition.
 
Catastrophic Injury Insurance
As a Calvin University student-athlete you are automatically covered if you are catastrophically injured while participating in official athletic-related activity (subject to all policy terms and conditions). The policy has a $90,000 deductible for NCAA student-athletes and a $3,500 deductible for ACHA student-athletes, which is met by the Calvin University Athletics supplemental insurance policy.  
NCAA Post-Eligibility Insurance Program
As of August 1, 2024, the NCAA began offering a post-eligibility insurance program to support student-athletes beyond their collegiate athletic careers. The program is available to all NCAA student-athletes at all institutions in all divisions and will help to cover excess accident medical expenses for properly documented athletically related injuries sustained during participation in an NCAA qualifying intercollegiate sport. For more information, including instructions on how to file a claim, see: Post-Eligibility Insurance Program - NCAA.org
 
Claims Procedures
We are happy to assist you, but ultimately you are responsible for ensuring that your qualifying medical bills are submitted to your primary insurance and the supplemental insurance policy provided to you by Calvin University. Failure to report injuries in a timely manner, or failure to follow required claims procedures may negatively impact your claims. We recognize that this is a big and potentially unfamiliar responsibility and are more than happy to answer questions or provide advice if you need help along the way. If you’re uncomfortable with this responsibility, we highly recommend asking a parent or guardian for help.
 
Supplemental insurance claims process:
  • You should report a qualifying injury to Calvin University’s Sports Medicine Office and have it evaluated as soon as possible. Injuries must be reported and documented treatment must begin within 30 days to retain supplemental insurance benefits.
  • If medical services are needed outside of Calvin University’s Sports Medicine Office, we will make referrals for you and will help you file a supplemental insurance claim.
    • Please monitor your Calvin University email for important information about your claim and follow up on any requested action as soon as possible.
  • When checking in at medical provider you must provide your primary insurance card and the supplemental insurance card. Medical providers should bill your primary insurance first and then bill the supplemental insurance. If it is an eligible/covered expense, the supplemental insurance plan will pay the balance, up to the maximum of the policy, but only after your primary insurance has processed the claim.
    • Note: If there are special procedures that must be followed to retain maximum benefit from your primary insurance (common with HMOs and certain PPOs), you must follow them for the claim to be eligible under the supplemental insurance policy.
  • After receiving medical care, you should pay close attention to your mail/email for information or requests from medical providers and insurance companies. Delayed responses can result in collections and other negative consequences.
    • If you happen to receive a bill from a medical provider, you should ensure that the bill was submitted to your primary insurance and the supplemental insurance. If it was not submitted to both, call the medical provider’s billing department and review your insurance coverage with them.

 
Contact Information
Direct insurance questions to:
Joe Dykstra – Athletics Healthcare Administrator
3195 Knight Way SE
Grand Rapids, MI 49546
Phone: (616) 526-7630
Fax: (616) 469-1378
Email: joe.dykstra@calvin.edu