General Insurance Information
*Accident medical expense insurance is required by each athlete prior to participation.
Primary Health Insurance Coverage
On an annual basis, all student-athletes will need to provide a copy of his/her current primary insurance card to the Athletic Training Staff. Student-Athletes willNOT be allowed to participate in team activities, which include games and/or practices, until this requirement has been met. It is the student-athletes’ responsibility to notify the Athletic Training Staff immediately of changes to their health insurance coverage.
Secondary Health Insurance Coverage
The University’s liability for medical expenses resulting from injuries and illnesses sustained by the student-athlete is defined as follows:
Liability is extended through a university secondary insurance plan to assist in covering costs and premiums for medical billings. This insurance policy is secondary and is utilized after the student-athlete’s personal primary insurance has been billed. Liability is further restricted to those injuries and illnesses received that, in the opinion of the Team Physician and Certified Athletic Trainer, are directly attributable to participation in intercollegiate athletics while the athlete is a full-time student at Lindenwood University - Belleville. The athlete must report all injuries and illnesses to the athletic training staff in a timely manner for appropriate evaluation and referral, and a claim must be filed within one year of the date of injury.
Claim Filing Procedures
The secondary health insurance policy has a $1,000 deductible; eligible medical expenses payable under any other insurance policy or service contract will be used to satisfy or reduce the deductible.
After the $1,000 deductible has been met, the secondary health insurance policy provides up to $25,000 worth of benefits per accident.
- An Accident must be reported to the Athletic Training Room within a timely manner following the Accident. Accidents incurred during supervised practice or play should be reported to the Athletic Trainer or Athletic Department Official immediately following the injury.
- All eligible charges submitted must be accompanied by an Explanation of Benefits (EOB) from the primary insurance carrier(s). The Claim Form must include information for BOTH parents if the student is less than 23 years of age or a spouse if he/she is married. Blank lines or N/A are not acceptable.
- Incomplete Claim Forms will result in a processing delay. Allow up to 4-6 weeks for processing after all information is received.
- Please ensure that all bills are itemized, listing the patient’s name, date of service, diagnostic code, service code, and the provider’s tax identification number. (HCFA 1500 and UB92 forms are preferable)
- File only one Claim Form per loss (Accident). Once the initial Claim Form has been filed, additional information submitted should be identified with the school’s name, the student’s name, ID#, and the initial date of loss.
Please mail all claim forms to: (This will ensure that duplicate claims are not sent in as this will delay the claim process)
Attn: William Dill, Head Athletic Trainer
Lindenwood University Belleville
2600 W. Main St., Belleville, IL 62226
General Insurance Information
Acknowledgement of Insurance
Emergency Contact/Insurance Information
Parent/Guardian/Student Information Form
Claim Sheet for Intercollegiate Claims