son

Dear Parents/Guardians, We are pleased to have your daughter/son as a member of one of our fine athletic teams here at Missouri Western State University. It is our hope that all student-athletes find success and great enjoyment in athletics as well as academic pursuits. The Athletic Injury & Medical Policy and Athletic Medical Bill Procedure are two important documents concerning athletic policies at Missouri Western State University. If you have insurance coverage on your daughter/son, please obtain a photocopy of your insurance card. Send the Insurance Questionnaire and a photocopy of the insurance card to the Sports Medicine Office. The University’s insurance policy, while offering good coverage, has some limitations. For a claim to be valid, the student-athlete must have sustained the injury during supervised practice or competition. The insurance policy has a clause which requires the student-athlete to use personal insurance whenever possible. This means the student-athlete or the parents/guardians of the student-athlete must file a claim with their personal insurance company before the University’s policy can be utilized. If a balance remains after the personal insurance company has paid its maximum, an Explanation of Benefits from your insurance company and an itemized statement from the medical provider should be submitted to the Sports Medicine Office. The University policy covers the injured student-athlete. Common illnesses such as common colds, sore throats, respiratory infections and gastro-intestinal disorders and any off-season injuries will not be covered by the policy. It is strongly recommended that parents/guardians do carry additional health and accident insurance on student-athletes. If your daughter/son is covered by an HMO/PPO type of policy and St. Joseph is out of the network, please try to make arrangements to have a primary care physician established in St. Joseph to provide care for your daughter/son. Dr. Juan Dominguez M.D. (office phone is (816)-271-4995) and Dr. Dustin Miller, D.O. (office phone is (816-298-7997) are our team physicians. You can reach their offices to set them up as your son/daughter’s primary physician. If this is not possible, the student-athlete will be required to follow their primary insurance policy’s specific referral procedures to be able to see our Team Physician, in non-emergency situations. If at any time you change or drop your health and medical insurance policy on your daughter/son while they are participating in athletics at MWSU, please let the Sports Medicine Office know as soon as possible so that your files can be updated. If you have any questions or concerns regarding the University’s Athletic Injury and Medical Policy, please feel free to contact us. Sincerely,

Sports Medicine Staff Missouri Western State University (816) 271-4597

Missouri Western State University Sports Medicine 4525 Downs Drive, St. Joseph, MO 64507 Phone: (816) 271-4597 Fax: (816) 271-4186 www.gogriffons.com