Club Sports Supplemental Insurance
NIRSA Insurance
Catastrophic Injury Program for Club Sports
Eligibility: All colleges/universities who are Institutional Members of the National Intramural-Recreational Sports Association are eligible for the insurance plan.
Who is Covered: The plan covers all student participants in an institution approved Club Sport as listed on the Activity Information Form for Club Sports. (A student/participant name list is not required.)
What is Covered: The plan covers injuries that occur during the play or practice of an insured Club Sports game, contest or match which is scheduled and under the direction and supervision of an authorized coach, director or other advisor of the school. Covered travel is team or individual travel for purposes of representing the Sponsoring Organization, that is to or from the location of a Covered Event and is authorized by the Sponsoring Organization, provided the travel is paid for or subject to reimbursement by the Sponsoring Organization.
Definitions
Hospital means an institution which meets all of the following requirements: It is licensed (if required) as a Hospital by applicable licensing authorities; It is open at all times; It is operated mainly to diagnose and treat illnesses and Injuries on an inpatient basis; It has a staff of one (1) or more Doctors on call at all times; It has twenty-four (24) hour nursing services by registered nurses; It is not mainly a skilled nursing facility, clinic, nursing home, rest home, convalescent home, or like place; and It has organized facilities for major surgery or provides for such facilities for its patients through formal written agreement with other Hospitals.
"Injury" or "Injuries" means bodily Injury which results directly from an accident and which is independent from disease, sickness or other bodily functions.
"Partial Disability" or "Partially Disabled" means the inability as the direct result of Total Disability of an Insured Person who, following a period of Total Disability for which Total Disability Benefits were paid under this policy, is engaged in an occupation, to perform all of the important duties of such occupation, and to earn a Partial Disability Gross Earnings Amount per month, or more, as shown in the Plan of Insurance.
"Reasonable and Customary" means an expense that is determined by Us not to exceed the amount usually charged by most providers in the same geographic area for similar treatment, service or purchase, taking into account the nature and severity of the illness or injury. The same geographic area means the same city or town in which the treatment, service or purchase occurs, if the city or town is large enough to obtain a representative charge. In large cities, it may be a section or sections of the city. In smaller urban or rural areas, the geographic area will be expanded as necessary to obtain a representative charge.
"Total Disability" or "Totally Disabled" means for the first 12 months: the inability of the Insured Person, due to a Covered Accident, to engage in substantially the same activities as the Insured Person had engaged in immediately prior to the Covered Accident; and the irrecoverable loss suffered by the Insured Person, due to a Covered Accident, of: speech; hearing of both ears; sight in both eyes; use of both arms; use of both legs; use of one arm and one leg; or severely diminished mental capacity due to brain stem or other neurological Injury such that the Insured Person is unable to perform normal daily functions.
For any period thereafter, Total Disability or Totally Disabled means the inability of the Insured Person, due to a Covered Accident, to engage in any gainful occupation or employment for compensation or profit for which he or she is or may become reasonably fitted by education, training, or experience; and the irrecoverable loss suffered by the Insured Person, due to a Covered Accident, of: speech; hearing of both ears; sight in both eyes; use of both arms; use of both legs; use of one arm and one leg; or severely diminished mental capacity due to brain stem or other neurological Injury such that the Insured Person is unable to perform normal daily functions.
Medical/Dental/Rehabilitation Benefits (Play, Practice, and Travel)
The Deductible: The Deductible is 25,000; $30,000 or $50,000 as selected by the school, for medical, dental and or rehabilitation expenses incurred within TWO years from the date of injury. Eligible medical expenses payable under any other insurance policy or service contract will be used to satisfy or reduce the Covered Accident Deductible.
The Maximum: There is a maximum benefit of $5,000,000 and benefits will continue for the LIFETIME of the injured student as long as treatment is certified medically necessary by the attending physician.
The plan will pay for expenses, subject to the maximums within the policy; for a hospital, physician or surgeon, physical rehabilitation, medical services or supplies, confinement in an extended care facility, repair of sound natural teeth and professional ambulance service to and from a Hospital; physical therapy procedures or prosthetic devices.
Monthly Benefits for Total Disability
The plan will pay $1,500 per month while the injured student remains "totally disabled."
Monthly Benefits for Partial Disability
If an injured student who was totally disabled becomes engaged in some occupation, but is unable to perform all the important duties of that occupation, the plan will pay $1,000 per month less 50% of any earnings in excess of $2,500 per month. After the first 12 months of Partial Disability the payment will be increased by 4% annually.
Additional Benefits
Housing adaptations and the purchase of a special vehicle, if necessary, to accommodate the injured student’s physical disability. The maximum amount payable shall be $100,000 during the first ten years and $50,000 during each subsequent ten year period.
Since it may be difficult for the disabled student to obtain standard health insurance, the plan will pay for medical expenses incurred for subsequent unrelated sicknesses or injuries. Benefits will begin once the medical expenses exceed $5,000 during any calendar year. The combined maximum benefit for all such injuries and illnesses during the injured student’s lifetime shall be $100,000.
Family adjustment expenses for spouse or parents include:
- Round trip scheduled airline, rail or bus tickets from the spouse’s or parent’s residence to the place where the injured student is confined in a hospital or nursing facility up to the maximum of $2,000 per family member.
- The Reasonable and Customary charges of a physician or physical therapist for training of the spouse or parents to assist the injured student to a maximum of $2,500.
- The Reasonable and Customary charges of a physician for counseling the spouse or parents up to $50 per visit for 20 visits.
- Subject to an overall benefit maximum of $150,000. $10,000 Accidental Death and Dismemberment Benefit if Loss occurs within 365 days from the date of the Injury.
Loss of: Benefit Amount
- Life or Both Hands or Both Feet or Entire Sight of Both Eyes: Principal Sum
- Speech and Hearing (both Ears): Principal Sum
- One Hand and One Foot or One Hand and Entire Sight of One Eye or One Foot and Entire Sight of One Eye: Principal Sum
- Loss of One Hand or One Foot or Entire Sight of One Eye: One-Half the Principal Sum
- Loss of Speech or Hearing (both Ears): One-Half the Principal Sum
- Loss of Thumb and Index Finger of the Same Hand: One-Quarter the Principal Sum
Loss of a hand or foot means complete Severance through or above the wrist or ankle joint. Loss of sight means the total, permanent loss of sight of the eye. The loss of sight must be irrecoverable by natural, surgical or artificial means. Loss of a thumb and index finger means complete Severance through or above the metacarpophalangeal joints (the joints between the fingers and the hand). Loss of speech or hearing means their total and irrecoverable loss. Loss of hearing that can be corrected by the use of any hearing aid or device shall not be considered an irrecoverable loss.
Other Insurance/Excess Coverage
This insurance coverage is excess over any valid and collectible insurance or similar benefit program available to the Insured Person for a covered loss.
General Exclusions
No benefits are payable for:
- Illness or disease or medical or surgical treatment thereof, including diagnosis, except:
- as may be specifically provided for in the policy;
- as may result from an Injury sustained in a Covered Accident;
- A cardiovascular accident, stroke or other similar traumatic event caused by exertion while participating in a Covered Event;
- Infection, except bacterial infection which results from the accidental ingestion of a contaminated substance or pyogenic infection which results from an accidental bodily Injury;
- Suicide or intentionally self-inflicted Injury while sane;
- An act of declared or undeclared war;
- Participation in a riot or engagement in or attempt to commit a felony or being engaged in an illegal activity;
- Travel or flight in or descent from any aircraft, unless the Insured Person is a passenger for authorized group or team travel on a regularly scheduled flight on a commercial airline; or is a passenger on an aircraft chartered solely for the purpose of travel which has a valid airworthiness certificate from the jurisdiction in which operated and which is being operate by a duly licensed pilot;
- Charges which exceed the Reasonable and Customary charges;
- Charges Incurred for dental work unless the Insured Person sustains a Disablement which results in damage to his or her natural teeth;
- Charges Incurred for television, telephone, water pitcher, and other personal convenience items, or expenses for other persons, except as may be specifically provided for elsewhere;
- Charges Incurred for services or supplies not specifically provided for in the policy;
- Charges which would not have been made in the absence of insurance or which the Insured Person is not legally obligated to pay;
- Charges Incurred for cosmetic procedures, unless made necessary by a Disablement;
- Charges Incurred for eyeglasses, contact lenses or hearing aids or for any examination or fitting related to these devices unless made necessary by a Disablement;
- Charges Incurred for care, treatment or service, which is not Medically Necessary to the diagnosis or treatment of a Disablement;
- Charges incurred for the professional services of a person who either resides with or is an Immediate Family member;
- Charges Incurred for experimental or investigational treatment or procedures;
- Charges Incurred for articles of clothing which are intended for use more than once;
- Treatment of a Disablement sustained as a result or consequence of being Intoxicated, as specifically defined in the policy, or under the influence of any controlled substance unless administered on the advice of a Doctor;
- The use by the Insured of drugs or narcotics unless used as prescribed by a Doctor for a condition other than drug addiction;
- Routine medical examination and related medical services;
- Charges which are recoverable from any other insurance policy, service contract, Workers’ Compensation or other arrangements of insured or self-insured group coverage;
- Elective treatment or surgery, health treatment or examination where no Injury or Sickness is involved;
- Drugs that promote fertility, treat infertility, enable sexual performance or provide sexual enhancement.
This document summarizes the provisions of policy form SB20CC. Should there be any discrepancy between this outline and the policy, policy provisions will prevail.
For further information; please contact Carol Malouf or Kathy Polanshek at:
NIRSA Insurance Division
Summit America Insurance Services, L.C.
2180 South 1300 East, Suite 520
Salt Lake City, UT 84106
Phone (801) 412-2626
Fax (801) 412-2625
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