Athletes are asked to provide their personal insurance
information on the Athletic Insurance Form. Additionally, a
copy of the insurance card (front and back) is required.
*Please note this policy is seperate from the insurance policy available through student health.
The Chapman University Athletic Department provides secondary insurance coverage through Mutual of Omaha for all injuries sustained while participating in intercollegiate athletics. If you require medical attention the injury must be reported to and a claim form must be completed by the Athletic Training Staff at Chapman University documenting the injury. Please make sure that all providers of care receive a copy of this claim form, as well as a copy of your primary insurance information, prior to services being rendered. In order for this policy to cover the care you receive for an athletic injury certain steps must be followed:
1. Your primary insurance must be billed first. They must provide an explanation of benefits (EOB) to the provider and the patient.
2. A copy of the EOB and all bills must be provided to the Head Athletic Trainer/ Benefits Coordinator at Chapman University.
3. Any and all information requested by the provider, the insurance company, and/or Chapman University must be provided upon request.
4. All treatment must be completed no later than one year from the date of injury.
5. Failure to follow these steps could delay payment or alter your eligibility for benefits.
As the patient you and/or your parent, guardian, or spouse are ultimately responsible for the payment of all medical bills resulting from an athletic injury. Additional information is available by contacting (714) 997-6640 or firstname.lastname@example.org.
Pamela Gibbons, MA, ATC
Head Athletic Trainer
Athletics Insurance Benefits Coordinator