WELCOME Season 13-14 freshmen and returning STUDENT-ATHLETES!

As your Student-Athlete Insurance Coordinator, should you become injured with an athletic-related injury, I am here to guide you and your parents/guardian through the athletic injury insurance claim filing process. I will help facilitate the exchange of information between your medical providers, your primary insurance company and the athletics secondary (accident/athletic-related injury) insurance company, Mutual of Omaha.

Below you will find four topics which will explain: (click on each topic)

• Primary Insurance requirements
• Secondary Accident (athletic-related injury) Insurance
• Your responsbilities in the insurance claims process
• Will I have to pay for any healthcare costs that arise due to an athletic injury
• Frequently asked questions

Please take time to carefully read this information which is provided for your benefit.

Also below you will locate forms which you are required to complete and return promptly to my office. Please read the information carefully. Note: Student-Athletes will be withheld from athletic participation until all forms are completed and returned. It is your responsbility to ensure that I am receipt of your forms.

On behalf of the Office of Student-Athlete Insurance, thank you for your cooperation in these important matters. I encourage you and/or your parents to contact me if you have any questions. My contact information is below.

Barbara B. Kidd, Insurance Coordinator
910-962-7218/910-962-3002 (Fax)
kiddb@uncw.edu

REQUIRED INSURANCE FORMS (4 Forms) TO COMPLETE (Freshmen and Returners)

1. Insurance Information Form (include front/back copy of your primary insurance card)
2. Medical Informaton Release Form (HIPAA and FERPA)
3. Assumption of Liability and Responsbility Agreement
4. Acknowledgement of Insurance Requirements and Procedures