The Impact of PPACA on Intercollegiate Sports Coverage

RCM&D’s Intercollegiate Sports coverage is a form of excess insurance that covers medical expenses that result from an injury sustained while participating in a game or practice that are not paid by the student-athletes’ insurance plan. The Patient Protection and Affordable Care Act (PPACA) has made a significant impact on this line of coverage, both positive and negative. 

The PPACA changes that positively impact the Intercollegiate Sports insurance coverage are:

1. Individual Mandate:  All US citizens are required to have health insurance.  This will decrease the number of student-athletes that are not insured, which could decrease the number of claims paid under the Intercollegiate Sports insurance plan.

2. No Maximum Benefit Limit: In the past, if expenses exceeded the plan limit, the Intercollegiate Sports insurance plan would have been responsible for the expenses.

3. Dependents Covered Until Age 26: Similar to the Individual Mandate, this change should decrease the number of student-athletes that are uninsured.

4. No Limitation for Pre-existing Conditions: In the past, claims that were denied based on a pre-existing condition required the Intercollegiate Sports insurance plan to pay for those claims, but now those claims will be covered under the student-athlete’s own insurance.

Although it has had some positive impacts, PPACA has caused the health insurance marketplace to develop new plans with higher deductibles, lower co-insurance reimbursement rates, and implement other plan changes to keep insurance premiums from rising.  The Health Exchange also resulted in eligibility for Medicaid to be expanded.  How do these items negatively impact the Intercollegiate Sports coverage?

1. Medicaid Expansion:  The Medicaid program will not pay for expenses if there is any other insurance program that may pay expenses.  This forces the Intercollegiate Sports insurance program to act as primary insurance.  

2. Plan Changes:

   1. High Deductible Plans: The Intercollegiate Sports insurance must pay expenses up to the deductible.

   2. Lower Co-insurance Reimbursements: The Intercollegiate Sports insurance will pay any portion not paid by the individual’s personal health insurance.

   3. Increase in Health Savings Accounts: HSA plans add a new wrinkle to the Intercollegiate Sports coverage because they are not an insurance plan, but they act as one.  Claim administrators are being asked to reimburse HSA account holders for the expenses, which creates a tax issue because they are reimbursing someone that used pre-tax dollars for the payment.

3. Increased Costs:  Parents are closely reviewing the cost of adding their child to the student health plan.  A majority of the student health insurance plans do not cover expenses for injuries resulting from participation in intercollegiate sports.

As you can see, the changes that have resulted from PPACA have had both positive and negative affects on Intercollegiate Sports Insurance.   RCM&D’s team of experts is available to assist your administration with reviewing your Intercollegiate Sports Insurance available to your athletes. Please contact Paige Fritze at (410) 512-4607 or Tim Cummons at (410) 583-5452 to set up at time to review your coverage and options.