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Penn State Scranton

Athletic Injury Insurance Program

The Pennsylvania State University

WHO’S COVERED

Coverage is extended to all scheduled and registered student...

  • athletes
  • trainers
  • managers
  • coaches
  • mascot
  • cheerleaders*
  • dance team*

*includes “club” cheerleading and dance team if their activities include performing during the varsity team’s scheduled games.  

COVERED ACTIVIES

  • Scheduled conference & non-conference games
  • Sanctioned playoffs and tournaments
    • Supervised practices including tryouts
    • Sponsored University event

COVERAGE PROVIDED

 Coverage is excess of any and all primary health insurance including dental and vision.

  • $90,000 maximum benefit per injury
  • Pays reasonable and customary
  • Reimbursement of co-pays with receipt
  • Coverage will pay benefits for related medical expenses incurred within 104 weeks from the date of the injury
  • AD&D of $250,000     
  • Catastrophic Cash Benefit of $250,000

 

HOW TO FILE A CLAIM

  1. Notify Athletic Trainer of Injury
  2. Complete a claim form
    1. Claim forms are available in the Assistant Athletic Directors office in the Multi-Purpose Building or online.
    2. The claim form must be completed in full.  Please be sure to detail accident information, include part of the body injured, how the injury occurred and the particular sport.  Students who are covered under their parent’s or legal guardians’ insurance must provide all requested information on the claim form under Parent/Guardian Information and Sections A and B.  If the student carries their own insurance that information goes in Section A.  A separate claim form is required for each injury.
  4. Submit all fully ITEMIZED bills to the Assistant Atheltic Director in person or via email (slr5003@psu.edu).
    1. Submit itemized copies of all applicable bills, including those bills under any deductible your plan may have.  Also, include those bills paid partially or in full by other insurance.  Bills showing “Balance Forward” or “Balance Due” are not acceptable
    2. An itemized bill indicates the provider of service’s full name and mailing address, type of service, date of service, fee charged and diagnosis.  To assure quick processing, please be sure that the bill and the insurance statements submitted are for the same item.
    3. Along with the itemized bill, included a copy of the explanation of benefits statement from the other insurance carrier.  If any or all benefits are denied by other insurance, we will need a copy of the denial showing the reason charges were denied.

  

Injury Forms:

Please promptly print out the following documents and return them completed to the athletic office in 102 Multi-Purpose Building in the event of a student-athlete injury. Coaches and on-site trainers will also have injury report forms availble during PSU sponsored events.