Dear Athlete/Parent/Guardian:
We would like to welcome you to the San Joaquin Delta College Athletics program. In order to make your participation more enjoyable and fulfilling, we are attaching a general information sheet explaining athletic insurance procedures. The College would like to notify you that athletic insurance coverage provided to athletes of San Joaquin Delta College is in compliance with the California Education Code Sections 322220-24. Coverage is provided on an “excess” or secondary basis to your own private insurance coverage. Health maintenance or similar organizations (such as Kaiser, Blue Cross, etc.) are considered private coverage. If your athlete is covered through an HMO or similar organization, he/she must utilize those services if injured. The College policy is not intended to nor will it pay medical bills covered by other insurance or for services that could have been obtained at an athlete’s health maintenance organization.
Limit of coverage for intercollegiate accidents is $25,000 accident medical expense, and $7,500 accidental death and dismemberment. The policy has limitations; one hundred percent coverage is not available in all cases. The insurance policies are on file in the Human Resources Office and can be made available for review by any athlete/parent/guardian.
Notification of injury must be filed with the Athletic Trainers within 24 hours of the time of injury, whether you do or do not have your own insurance coverage. The claim form and HIPAA Form must be completed, signed and submitted to Student Insurance, Inc. as well as to your own private insurance carrier. (It is the responsibility of the athlete or parent/guardian to furnish the hospital and/or physician with proper insurance identification and/or claim form from the parent’s insurance carrier. Failure to do so will cause needless delay in the settlement of the claim). When your private insurance carrier has made payment, please send a copy of their notification, usually an Explanation of Benefits (EOB) to Student Insurance, Inc., so that any balance due can be considered. If the athlete has no other valid and collectible insurance coverage, the College carrier will respond for the full eligible amount.
To assist the insurance company in processing the claims, we attach your completed Other Insurance Verification Form (which you will be requested to complete upon notification of injury). It is important to bear in mind that the College cannot be responsible for medical treatment or hospitalization not previously referred by officials of the College. In addition, the College does not assume responsibility for any pre-existing conditions or any other conditions not directly related to intercollegiate sports competition at San Joaquin Delta College. To guard against accident in travel, all members of athletic teams must use district transportation provided by the College in going to and from athletic contests.
No liability on the part of the College exists or may be assumed for any amount beyond the limits of any policy carrier by the College. No liability on the part of the College exists or may be assumed to exist for off-campus medical or dental treatment or hospitalization of any kind, or athletic injuries without prior referral by the team doctor, or in his absence, the athletic trainer or athletic director.
Yours very truly,
Tony Espinoza
Athletic Director
This is to acknowledge that I/we have read and understand the above statements and agree to abide by their provisions as they pertain to competing in the intercollegiate sports program at San Joaquin Delta College.
