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Calvin University

Insurance

Insurance
Health insurance is a wonderful thing and, when used correctly, it can help minimize out-of-pocket costs for medical care. Unfortunately, navigating insurance coverage and claims can sometimes be frustrating and confusing, especially if you don’t understand how it works. Because of this we encourage you to take a few minutes and read this important information to help you have a better understanding of your medical insurance coverage as a student-athlete. We’re also available and able to help you find answers if you have questions along the way.
 
Primary Insurance Requirements
As a Calvin University student and student-athlete, you are required to have your own primary insurance coverage and you must provide that policy information to both Calvin University Health Services and Calvin Sports Medicine. Calvin University has insurance requirements for its students and Calvin Health Services can answer any specific questions you have about those requirements. If your insurance changes during the academic year, it is your responsibility to update that information with Calvin Health Services and Calvin Sports Medicine.
 
If You’re Not from Grand Rapids
Even though your primary insurance provides adequate coverage when you are at home, it may only provide limited coverage in other locations like Grand Rapids, Michigan or other cities you may travel to with Calvin University Athletics. This scenario is most common if your insurance is classified as a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), or if you are from another country and hope to use your insurance from home or travel insurance while you are at Calvin University. If your insurance has limited coverage in Grand Rapids, you may need to return home to receive coverage for non-emergency medical care. Some insurance companies will allow you to change your policy to allow for coverage while you are away at school. Because of this we highly recommend that you contact your primary insurance company to confirm your coverage while you are at Calvin University.
 
United HealthCare Student Plan
The United HealthCare Student Plan offered by Calvin University does meet your primary insurance requirement for Calvin University and Calvin University Athletics, but you should know that it does not provide unlimited coverage for injuries that United HealthCare deems “athletic-related.” The policy will provide up to $25,000 of coverage for “athletic-related” injuries related to Calvin University Athletics. Additionally, any injuries related to official Calvin University Athletics activities are also eligible for coverage by the Secondary/Excess Insurance Program (see below) and you should not see any out-of-pocked expenses for injuries directly related to Calvin University Athletics. If you are injured and have the United HealthCare Student Plan, make sure you report your injuries immediately and confirm that we know you have this insurance plan. This will help us ensure that some necessary steps for your claim with United HealthCare are completed to ensure your medical expenses are covered as they should be.
 
Secondary/Excess Insurance
As a student-athlete, Calvin University does not directly pay your medical bills for you, but it provides you with a secondary/excess injury insurance plan that provides coverage for medical care if you sustain an injury during athletically related activity. Athletically related activity is defined as official and supervised activities sponsored by Calvin University Athletics and include coach-supervised official practices/conditioning sessions, competitions, and team travel. It does not cover unsupervised activities, open gym/field, drop-in, or summer conditioning activities. The plan is intended to cover co-pays, deductibles, and co-insurance that aren’t covered by your primary insurance so that you don’t incur out-of-pocket expenses for athletic-related injuries. It has a $0 deductible (per injury) and provides up to $90,000 of coverage for NCAA student-athletes and $3,500 for ACHA student-athletes. Please see the Catastrophic Injury Insurance section (below) for more information about additional coverage beyond these policy maximums. In most circumstances, the secondary insurance plan provides coverage for 1 year (365 days) from the original date of injury.
 
HMO/PPO Requirements
The terms of the Calvin University Athletics Secondary Insurance Plan require you to follow the terms of your primary insurance policy to receive maximum primary 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 payable through the Calvin University Athletics Secondary Insurance Plan. 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 secondary insurance benefits.
 
Secondary/Excess Insurance Limitations/Policy Exclusions
For an injury to be covered, the injury must be reported within 30 days and treatment must begin within 60 days of the injury occurring, so it is vital that you report all injuries in a timely manner. Because of this, it is extremely important that you report an injury as soon as possible after it occurs. You should talk to Calvin Sports Medicine if you believe you need to see an outside healthcare professional or if you would like a second opinion. Calvin University will not assume responsibility for medical expenses that you incur on your own without the prior approval of Calvin Sports Medicine.
 
It is important to note that, because the policy is 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
  5. occupation.
  6. parasailing, bungee jumping, heli-skiing, scuba diving or any other extra-hazardous activity.
  7. 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.
  8. travel or flight in any aircraft except as a fare-paying passenger on a regularly scheduled charter or commercial flight.
  9. 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.
  10. Alcoholism or drug addiction.
  11. participation in any team sport or any other athletic activity unless mentioned in the Covered Activities.
  12. any condition for which the Insured is entitled to benefits under any Workers' Compensation Act, No Fault Auto Coverage or similar law.
  13. 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.
  14. 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 also 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 Secondary Insurance Plan.  
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 making sure that your qualifying medical bills are submitted to your primary insurance and the Calvin Athletics Secondary Insurance Plan. Failure to report injuries in a timely manner or failure to follow required claims procedures may negatively impact your claim. If you have any questions about your medical bills or insurance, ask us and we’d be happy to help you find an answer.
 
Secondary/excess insurance claims process:
  • You should report a qualifying injury to Calvin Sports Medicine and have it evaluated as soon as possible. Injuries must be reported within 30 days and treatment must start within 60 days in order to retain secondary/excess insurance benefits.
  • If medical services are needed outside of Calvin Sports Medicine, we will make referrals for you and will help you file a secondary/excess 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 secondary/excess insurance card. Medical providers should bill your primary insurance first and then bill the secondary/excess insurance. If it is an eligible expense the secondary/excess 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 any special procedures that need to 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 Calvin University Athletics Secondary/Excess Insurance Plan.
  • After receiving medical care, you should pay close attention to your mail 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 secondary/excess insurance. If it was not submitted to both, call the billing department and review your insurance coverage with them.

 
Contact Information
Submit all 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: jhd7@calvin.edu