Written By: Juanita Sheely, NCAA Director of Travel and Insurance

The topic of benefits provided to student-athletes consumes sports media today. In these discussions, injuries and insurance are regularly brought up. Unfortunately, the insurance programs currently provided are often reported inaccurately, or not at all. In one example, after a student-athlete experienced a particularly bad injury, Twitter exploded with claims that the student-athlete would not have any medical coverage. Tweets claiming the student-athlete would be responsible for large medical bills were re-tweeted and quoted tens of thousands of times – every single one of those tweets was wrong.

So what medical insurance coverage is provided by the NCAA? And what do NCAA bylaws require of member institutions? Let’s first talk about the distinction between health care insurance programs and accident insurance programs. Health care insurance for student-athletes refers to coverage for non-sport related injuries and illnesses. Accident insurance covers injuries and illnesses that occur while playing sports. This article will be discussing accident coverage.

What does the NCAA require of member institutions? NCAA bylaws require that member institutions verify student-athletes have insurance coverage for athletically related injuries, with limits up to the deductible of the NCAA Catastrophic Injury Insurance Program (currently $90,000), before they can practice or play. This layer of coverage is known as basic accident coverage. Members are permitted to provide that coverage, but they are not required to do so. Coverage can be provided through the school, a parent/guardian policy or a policy student-athletes have on their own. If coverage by some source is not in place, the student-athlete cannot practice or play. Violations of the bylaw are considered institutional violations and do not affect student-athlete eligibility.

The NCAA provides all student-athletes at all active member institutions coverage under the catastrophic program, and the NCAA pays 100 percent of the current $13.5 million premium. This program provides $20 million in lifetime benefits to student-athletes who become totally disabled while practicing or playing[1]. These benefits include medical expenses as well as disability benefits. Disability benefits include monthly cash payments, funds to modify a home to accommodate wheelchairs, accessible vehicles, etc., in addition to funds to complete an undergraduate or graduate degree. The NCAA’s Catastrophic Program is one of the most comprehensive sport-related programs of its kind.

While the catastrophic program has been in place and fully funded by the NCAA since 1992, confusion persists about the benefits provided. Many in the membership believe you have to be permanently injured in order to receive benefits, which is not correct. An injured student-athlete is eligible to receive medical benefits after the policy deductible (currently $90,000) is met. This means that any injury, regardless of severity, is eligible for coverage of medical costs. For example, if a student-athlete has a torn ACL as a result of sport participation, and medical costs exceed $90,000, the catastrophic program provides for coverage of those additional costs.

In addition to the catastrophic program, the NCAA also provides coverage for student-athletes participating in NCAA championship events through our Participant Accident Program. This accident program provides $90,000 in coverage for athletically related injuries that occur during championship events, essentially covering the entire deductible of the catastrophic program. So any injury occurring during an NCAA championship event would be covered by NCAA insurance policies from the very first dollar of expense to the last.

So what’s left? If the NCAA, the institution or a personal policy are in place to cover injuries, why all the media attention regarding what is not covered? Although NCAA Bylaws require that a student have insurance limits up to the deductible of the Catastrophic policy to help provide continuity of coverage, the Bylaws do not set other requirements of the accident insurance. For example, student-athlete or parent policies may not cover all tests or procedures necessary to evaluate an injury. Or there may be situations where medical services provided on or near campus may be out of network for that policy. In addition, even if a school provides the coverage, the terms of that accident policy  may require the parent/guardian or the student-athlete to cover any out-of-network costs or even some co-pays or deductibles. There are as many ways of providing – or not providing – coverage as there are accident insurance plans or even member institutions in the NCAA, which causes some inconsistency in how student-athlete injuries are covered.  Students, parents, and institutions should become familiar with the scope of their accident insurance before an injury takes place to avoid surprises.  For example, knowing a policy’s deductible and the medical providers that are in network may avoid unnecessary, personal expense if an injury does occur.

Perhaps the largest gap, and the area that has the most media attention at the moment, is the issue of long-term care. An athlete may require medical care for sport-related injuries years or even decades after his or her college career is over. Such care should normally be covered by the student-athlete’s individual or family health insurance policy, which every person in this country is required to have with the implementation of the Affordable Care Act. The inconsistencies in level of care stem from the lack of any uniform health insurance standards in the United States, an issue that the membership may address further.

If you need more information on the insurance programs discussed, please see our web page. There you will find a benefit summary for the catastrophic program, as well as information and material on the insurance requirements for institutions. If you need further information, please contact the NCAA National Office at 317-917-6222 or jsheely@ncaa.org.