Letter to the Student-Athlete

To the Student-Athlete: 
Greetings from Dan Runkle, Director of Athletics,

University of Dubuque Athletic Department is pleased to welcome you as a student-athlete.  We are hopeful the opportunity presented at UD will be a rewarding experience and that you will achieve academic, social, and athletic success.  We have provided you with information regarding mandatory forms and requirements needed for you to begin physical activity with the team.  As part of being cleared to participate in athletics there are certain required forms that MUST be completed.  If these forms are not completed the student-athlete will not be permitted to practice or compete.  Student-athletes and parents must acknowledge that there is an inherent risk of injury during intercollegiate athletic participation.  UD provides a medical staff of certified athletic trainers and team physicians for prevention, management, and care for the student-athlete. 

We remind you that to participate in athletics at the UD is a privilege and not a right.  Welcome to the athletic program and I hope you will be very successful.

Additional information for the student who will be involved in an intercollegiate team:

Please return all forms by Aug 1st or prior to your registration date.

Athletic Medical History/Health History/Physical Examination Form:
Physical examinations must be completed, per UD and NCAA, no earlier than June 1^st or no earlier than six months prior to date of first practice (which ever is first) and completed by a licensed physician, nurse practitioner, or physician's assistant.

Athletic Insurance & Injury Claim General Information:
If a student-athlete is not covered under adequate health insurance program, he/she must obtain coverage prior to athletic clearance.  UD is not financially responsible for any medical bills incurred by students involved in any UD athletic program.  The NCAA requires a student-athlete to have a minimum coverage of $75,000 and cover athletic related injuries.

UD athletic insurance is a "secondary policy" and has a $500 deductible (subject to change).   Only injuries sustained in practice, supervised in-season condition/weight training, and competition will be covered.  Illnesses and medications will not be covered.  For better coverage it is important to stay on your parent's insurance.  Please contact your insurance carrier and inform them that you will be attending UD and inquire as to type of coverage plan available for out-of-network physicians/medical facilities/hospitals.  This is important information to have with you.  UD Student Health Service, Finley Occupational Health, is connected with The Finley Hospital, Iowa Health System and UD.  Team Physicians are also associated with Medical Associates Clinic-Musculoskeletal Department and Finley Occupational Health.

Student Health Plans Medical Insurance:
If the student-athlete does not have personal medical insurance, UD offers all students with the option of purchasing medical insurance coverage.

Athletic Accident Insurance Policy Overview:
1^st Agency Insurance Co. (subject to change).  UD provides athletic accident insurance, through 1^st Agency Insurance Company, for your son/daughter in the event of athletic injury while participating in supervised intercollegiate practice or competition, including team travel. This coverage is a secondary policy to the student-athlete's primary personal medical insurance policy. This policy covers medical bills in excess of $500.00 after the student's personal insurance company has been billed, Explanation of Benefits (EOB's) received, and all other requirements completed and received.  Injury will only be covered if the athlete is evaluated by a UD Certified Athletic Trainer and medical appointment is scheduled through the Medical Coordinator.

Athletic Insurance Claim Procedure Overview: In the event of an athletic accident resulting in charges for medical services, all medical bills will be sent directly to the patient.  Please follow the following claim procedures:

          1)  Submit bills incurred to your family's personal/employer group insurance plan (insurance company will return an EOB)

          2)  If a balance remains after your insurance has contributed toward the claim, submit the itemized bills along with your insurance EOB's to Debra Runkle, Medical Coordinator

          3)  If the medical charges are greater than the $500.00 deductible amount, the claim will then be filed with the athletic accident insurance carrier

Required Forms for Student-Athletes:
Forms will be sent to all students in specific mailings.

(If under 18 years of age, please have your parent or legal guardian sign and date all forms).

• UD Athletic Medical History/Health/Physical Examination Form (PPE) (Current LINK on the website does not work)
• UD Assumption of Risk & Waiver and Release Consent (backside of PPE)
• UD Emergency & Medical Insurance/Waiver Information Form
• UD Meningitis & Vaccination Requirements Form