Insurance Information & Forms
ATHLETE PRE-PARTICIPATION INFORMATION
The Wake Forest University Sports Medicine Staff welcomes you to Wake Forest University. We are looking forward to another exciting year of Demon Deacon Athletics. Each sports team has an assigned certified athletic trainer and he/she will coordinate your medical care. We have team physicians from Family Medicine, Orthopedics, and Podiatry who come to campus and see our student athletes daily. We also work closely with Wake Forest University Baptist Medical Center; a well respected tertiary care hospital in Winston-Salem to provide additional care for our student athletes.
Prior to your arrival on campus and before participating in any athletic activities, all student athletes must download and submit the required medical forms and releases. You have the option of submitting the forms via email (suggested), but if this option is unavailable to you, please print out the forms and fax them to us, or simply drop them in the mail and we will take care of the rest. Please include copies (front and back) of insurance cards for health, prescription, vision, and dental policies.
Please return all forms to:
Mrs. Robin Godwin
Insurance Coordinator
WFU Sports Medicine
Winston-Salem, NC 27109
Office: (336) 758-4188
Fax (336) 758-6149
Email: godwinrs@wfu.edu or smforms@wfu.edu
IMPORTANT INFORMATION
If any of your insurance or demographic information changes or lapse during the school year, you must notify WFU Sports Medicine immediately.
Subscribers are responsible for complying with all insurance company requests for Student Status Verification. This information can be obtained from the WFU Registrar's Office at (336) 758-5207.
Also, the subscriber is responsible for responding to all insurance company requests for Coordination of Benefits information (that is, information about "Other Insurance"). Failure to supply this information in a timely manner to your insurer will result in claims not being processed and could result in collection notices.
PRE-PARTICIPATION PHYSICALS
A pre-participation athletic physical is required for all freshman, or first time WFU athletes. Physicals will be done in either Student Health Services in Reynolds Gym or in the Sports Medicine Athletic Training Room in 106 Reynolds Gym. Check with your athletic trainer to find out where you need to report. If you are a returning athlete, you will not need to undergo another physical exam unless requested to do so by the Sports Medicine Staff.
If you have a current injury, please bring a CD or hard copies of x-rays, MRI's or other diagnostic tests that have been done; as well as pertinent doctor's notes/reports with you to the physical.
This pre-participation physical is separate from the physical required by Student Health Services.
As a reminder, the Student Health Service forms (Health Information Summary and Immunizations) for athletes are separate from the Sports Medicine forms and must be retuned to Student Health Services. Student Health requires immunization records for enrollment from all students. You should send in updated immunization records to Student Health Services. These forms are available online at http://newstudents.wfu.edu.
HEALTH INSURANCE INFORMATION
Health insurance is required as a condition of enrollment for full-time, degree seeking students. Visit www.wfu.edu/sip for complete eligibility requirements and plan details including criteria for coverage that must be met by your health insurance. This website also includes information about the WFU Student Blue Plan, which provides excellent coverage and meets the health insurance criteria.
WFU Student Blue Plan: The premium rate for 2012-13 is $1,524 for students less than 25 years old, and is automatically charged to your student account unless you waive out of the requirement because your insurance meets the criteria for comparable coverage. This insurance is available for purchase on the above website on June 1, 2012. The effective date is Aug. 1, 2012. If you desire enrollment, please actively enroll yourself. We recommend you give them the address of WFU Sports Medicine (P.O. Box 7329, Winston-Salem, 27109) on your enrollment form so that your insurance card will be sent directly to us. We will copy it for your medical record and then give it directly to you.
Waiving Coverage: If you wish to waive coverage, you MUST complete a waiver by Monday, August 27, 2012. Because your insurance information is required for completion of the Sports Medicine forms, you will want to complete either enrollment or the waiver prior to filling out the Sports Medicine forms.
Deductibles: If you have a high deductible plan, you are strongly encouraged to consider purchase of the Student Blue plan as it is very affordable, has a zero deductible, and provides much better insurance coverage.
HMO'S: Criteria for students with HMO's have changed from last year. Students with this type of health insurance must apply for guest privileges to be in-network in NC. If your HMO does not offer this option, enrollment in the Student Blue plan will be required. For more information about HMO criteria, www.wfu.edu/sip.
Sports Medicine Insurance Forms: It is very important that you include all information requested on the Sports Medicine forms, including social security number and date of birth of the subscriber for the primary insurance. Please include the deductible amount. This is the amount that the subscriber must pay out of pocket before insurance coverage begins. Note that this amount is different from the co-pay amount for physician visits, specialist, etc. (It may not be printed on the insurance card.)
If you, your parents or guardians have any questions concerning the Sports Medicine Program or insurance coverage, please contact Robin Godwin, Administrative Coordinator, at (336) 758-4188.
FACTS ABOUT WFU ATHLETIC INSURANCE
WFU Athletics maintains athletic-related health insurance on all athletes; however this is a secondary insurance policy only for injuries or accidents which occur during supervised intercollegiate practices and games. All claims for athletic injuries are first submitted to your primary insurance and then are submitted to our secondary insurance to pay the balance. In addition, the NCAA has athletic catastrophic injury and disability coverage on all student athletes.
If you receive a bill or collection notice, do not assume that it has been paid. WFU Sports Medicine may not have received the bill. Please e-mail or fax a copy to us of what you have received. Failure to provide us with the bills in a timely manner can result in collection notices and/or damage to your credit rating.
In some cases, particularly with some dental claims, insurance companies will only reimburse the subscriber. If this happens, please send the payment on to the provider and send us a copy of the receipt from the provider along with the explanation of benefits (EOB). The balance of the invoice cannot be paid by WFU until the provider receives this primary insurance payment.
Should you desire a second opinion regarding an athletic injury, you may request that consultation from one of our physicians or athletic trainer. Any additional testing will need to be approved separately. A member of the Sports Medicine Team must approve any referrals to be paid by our secondary insurance.
Remember that you are responsible for notifying Sports Medicine immediately of any change or lapse in your health insurance coverage during the school year. January 1st is a popular time for insurances to change so be sure that we have a copy of any new insurance that you enroll in during the school year.
The Athletic Department assumes no financial responsibility for:
Injuries or conditions received prior to matriculation into Wake Forest (i.e. pre-existing conditions or injuries)
Injuries or conditions not incurred in a supervised practice or during intercollegiate contests (including injuries sustained while playing intramurals, inside your dormitory and campus events, or injuries sustained while not enrolled in the academic semester).
Any medical expenses for which you were not referred by a member of the Sports Medicine staff or Team physician.
Required or elective surgery where an injury or illness is not the direct cause of athletic participation (i.e. appendectomy, bone tumor, wisdom teeth extraction, tonsillectomy, etc).
Injuries or illnesses that are not reported as noted above. Retroactive injuries occurring after graduation or early departure from the University will not be considered.
Sports Medicine Home Page
| 
