Welcome to the insurance page of GoSycamores.com. This web page is designed to serve as a quick reference for student-athletes to help with ISU Insurance. If you have further questions, please contact ISU Athletics insurance Coordinator, Pati Smith via phone at 812-237-4072, via email at
Pati.Smith@indstate.edu or by fax at 812-237-4041.
Insurance Policies and Procedures
Please take a few moments to review the following information regarding our policies and procedures for the upcoming season concerning athletic-related injuries and medical insurance.
We have purchased an Insurance Blanket Plan that covers athletic injuries for all of our student-athletes. This will assist those parents who have a very high family deductible to meet each year and those on an HMO, State Medicaid plan or a plan specific to the area in which you live.
The Blanket Plan is a secondary policy that has a
$750 deductible per injury. It will not be an issue if you have a high deductible, an HMO or State plan that will not cover the claims submitted.
The most a parent/guardian will have to pay is $750 per injury. After the $750 deductible has been met the Blanket Plan covers at 100% any remaining balances that are usual and customary charges.
This plan does not cover personal physician or facility visits. If the student-athlete’s primary coverage is a State Medicaid, an HMO or a policy that does not cover them while here at Indiana State University, you may want to consider purchasing an individual policy that would cover him/her in case of an emergency or illness that would not be considered an athletic-related injury.
Student-Athlete Insurance Information
For your protection, in the event of an injury during supervised practice, competition or travel to and from the same, Indiana State University has acquired certain
supplemental, excess and catastrophic insurance coverage. The ISU Athletic Department has adopted the policy of parent insurance as primary coverage with ISU as the secondary source to cover medical expenses. Please understand that Indiana State University will pay what is usual and customary.
The information included on this website and in the student-athlete handbook is essential to your understanding of the policies and procedures regarding any bills you may incur in the event of such an injury. If the appropriate forms are not completed, with signatures, and returned to the address as listed below, you will not be eligible for practice or competition, including "suiting up."
In order to assure you have completed all of the necessary insurance forms, please use the Checklist below as a guide.
For student-athletes that are returning to an ISU team, you still must turn in all new information forms and insurance cards for the new school year.
Insurance Forms
The following forms and necessary documentation must be completed and presented to Pati Smith
AS SOON AS POSSIBLE. Please review the checklist to make sure you have completed all the necessary forms.
Make sure to complete items 1-9.
1.
Master Insurance Information Form (PDF)
(This form must be typed and filled out completely and signed by both parent/guardian if the student-athlete is under the age of 18. Do not leave any questions blank.)
2.
Acknowledgement of Responsibility signed by parent/guardian and student-athlete Form (PDF)
3.
Acknowledgement of Insurance Requirements form signed by student-athlete Form (PDF)
4.
Acknowledgement of Insurance Requirements for signed by parent/guardian Form (PDF)
5.
Summer Workout form signed by parent/guardian and student-athlete Form (PDF)
6.
Student Athlete Authorization/Consent Form for Insurance and Medical Information Release (PDF)
7.
Consults with Outside Physicians Form signed by parent/guardian and student-athlete Form (PDF)
8.
Acknowledgement of Policies and Procedures (PDF)
9. Copy of Insurance card(s) include both the front and back.
