New & Transfer Athlete Argo Packet Due by July 15th

1. AthleteConnection Instructions Page, The following information will be needed:

Identification number (Social Security Number/International Athletes will use Passport

Number)

Home Phone, Cell Phone, E-mail Address, Date of Birth & Home Address

Primary & Secondary Emergency Contact information such as Name, Relation to Athlete,

Home Phone, Cell Phone, E-mail Address, & Home Address

Primary Insurance/Secondary Insurance information such as Name of Insurance

Company, Phone Number, Provider Address, Type of Coverage, Policy Type, Policy

Number, Group Number, Deductible, Policy Owner, Relation to the Insured, Date of

Birth and Identification number (Social Security Number)

***Copy of Primary Insurance Card will be necessary & very helpful in this process***

Primary insurance is a required field to submit your forms, so the sign & submit button will not

work if the required fields aren’t filled out. Both international and regular athletes who may not

know this information yet can click the save button on right hand side (looks like a floppy disc)

and all the information will be saved until you can gather the proper insurance information. This

will work for all of the other fields as well.

2. New & Transfer Athlete Insurance Letter

3. Policy pages:

University of Providence Athletic Insurance Policy

Consent for Treatment

Authorization for Release of Medical Information

Assumption of Risk

4. History Form & Physical Examination Form

Fill these forms out and take them to a Doctor, Nurse Practitioner, or Physician Assistant

to receive clearance to participate in college athletics.

The policy page, medical history, and physical examination pages must be signed and returned to the

Athletic Training Room along with an up to date copy of a Primary Insurance card. You can mail (1301

20th St. S Great Falls, MT 59405 C/o Brad Beffert LAT, ATC), scan/e-mail

(brad.beffert@uprovidence.edu), or fax (406-791-5994 attention Brad Beffert LAT, ATC).

AthleteConnection Instructions for New or Transfer Athletes

AthleteConnection is an online system through SIMS the medical data management computer

software/company used by the University Sports Medicine Staff. This new system allows us to have

athletes input data and stores that data automatically into SIMS.

All New or Transfer athletes must register and fill out all necessary information due by July 15th.

Please follow the instructions below:

1. Go to the AthleteConnection website address: https://www.athleteconnection.net

2. Click the Register link to create a new account, using the Account Group: 10732 and the Account

Code: 3853320. You will be asked for first name, last name, and email address. You will be

asked to create a Username and a Password. Once this is done click on the Register button.

USERNAME: ALL LOWERCASE FIRST & LAST NAME WITH NO SPACE (EXAMPLE: bradbeffert)

PLEASE CHOOSE AN E-MAIL ADDRESS YOU CAN REMEMBER. I WOULD CHOOSE AN E-MAIL

ADDRESS YOU KNOW YOU USE & CHECK REGULARLY.

3. Once your account has been created you will be taken to your profile page. Please complete the

information on this page and click the Sign and Submit button when you’re finished.

ID number means Social Security Number/ all international athletes should use Passport

Number as the ID number unless you have a federal ID number.

4. You can update your profile at any time by logging into your account at

https://www.athleteconnection.net

5. In addition to the online information any new or transfer athlete must click the links section on

your profile page and click on the link provided. This will pull up the New or Transfer Athlete

Argo Packet, print and return signed forms to the Athletic Training Room either by mail (1301

20th St. S Great Falls, MT 59405 C/o Brad Beffert LAT, ATC), scan/e-mail

(brad.beffert@uprovidence.edu), or fax (406-791-5994 attention Brad Beffert LAT, ATC).

*Forgotten User Names and Passwords*

You can recover user names and passwords via the website https://athleteconnection.net as long as you

know the e-mail address that was used to create your account. From the logon page of the website you

can simply click the Forgot your Password? link and enter your e-mail address, and you will be sent an

email containing the user name and password.

If an athlete (or malicious user) attempts to log on multiple, sequential, times using the wrong

password, the account will be locked. One of the Sports Medicine Staff will have to unlock the account

before it can be used. If this happens please notify Brad Beffert LAT, ATC (406-791-5923) or

brad.beffert@uprovidence.edu

Dear Argo Athlete & Family,

My name is Brad Beffert and I am the Head Athletic Trainer at the University of Providence. I would like to update

you on a policy change in regards to how the university is handling primary insurance. We want every student

athlete to have adequate insurance in the event of an athletic injury. In the past this coverage consisted of primary

insurance purchased by the student athlete/family and secondary insurance provided by the university to cover

costs left by the primary.

To help us provide an adequate and affordable secondary insurance, it’s important that our student athletes have

an adequate form of primary insurance. The university will continue to recommend that athletes and families

make sure that their primary insurance: (1) covers college athletics; (2) provides as close to 80/20 coverage, i.e.

covers 80% of any bill; (3) be applicable in the Northwest region of the country, and (4) has a manageable

deductible.

There are concerns that student athletes who don’t have an adequate primary insurance are shifting costs to the

university and our secondary insurance policy. It’s also impossible to evaluate every insurance policy and catch all

the stipulations. Many policies will seem more than sufficient to participate in college athletics at the university

and then have a disclaimer that negates the coverage of an athletic injury. This shifts the entire cost to our

secondary plan. With so many unknown variables the university is concerned about the rising costs in the

secondary insurance premium. If this trend continues we will be unable to provide any additional coverage.

In order to keep costs down for both families and the university, assure that every student athlete has adequate

coverage and take the guesswork out of insurance plan coverage, the university is now making it mandatory that

all full-time enrolled students on campus purchase a Student Accident Plan. This plan only covers accidents and

provides $5,000 worth of coverage for injuries including athletics with no deductible. The estimated cost is $125

for a full school year and this will increase the athletic fee from $223 to $250 per year. This fee will continue to be

charged to the student athlete/family bill and no paperwork is necessary to receive this coverage. Coverage begins

when the student athlete arrives on campus. To clarify, this insurance plan will only cover accidents and athletic

injuries and it will not cover healthcare expenses experienced while on campus.

The athletic training department will manage the student accident insurance, and the university secondary policy

in the event of an injury. The athlete and family is responsible for providing primary insurance information to

healthcare providers, filing claims, paperwork, and satisfying all deductibles. Both the student accident plan and

the secondary plan only cover athletic accidents/injuries. These plans will not cover healthcare needs such as

(cold/flu/strep/mono, lab work, inhaler, medication refills, etc.) It is the responsibility of the athlete and family to

cover these expenses.

This policy change allows the University of Providence to ensure adequate primary athletic accident insurance to

all levels of athletics and student athletes. I have tried to be as transparent as I can, please don’t hesitate to

contact me if you have any questions. I am very much looking forward to another great year. Go Argos!

Brad Beffert LAT, ATC Head Athletic Trainer University of Providence Office: 406-791-5923 or Email: brad.beffert@uprovidence.edu

University of Providence Athletic Insurance Policy

It is the recommendation of the University that all student athletes have a primary form of insurance

that covers athletic injuries, is good in the northwest region of the country, & covers as to close to 80/20

i.e. pays 80% of any bill as possible. Primary insurance is the responsibility of the athlete/family which

includes contacting providers, filing claims, paperwork, and satisfying all deductibles.

All full-time students on campus will be automatically enrolled in the student accident insurance plan

and the $125 will be reflected in the athletic fee of the university bill for student athletes. This policy

covers accidents and athletic injuries for university eligible events for up to $5,000 with no deductible.

Please note that each injury and accident will be treated individually and there can always be exceptions

to care based on extenuating circumstances or stipulations of coverage within the plan.

The secondary insurance policy provided by the university will only provide coverage for injuries that

occur during official athletic events. These athletic injuries must occur while the student athlete is

participating in regularly scheduled practices, competitions/games, and strength/conditioning sessions.

*ALL VISITS TO MEDICAL FACILITIES MUST BE AUTHORIZED BY THE UNIVERSITY SPORTS MEDICINE STAFF

TO BE CONSIDERED ELIGIBLE FOR PAYMENT BY THE STUDENT ACCIDENT INSURANCE & THE UNIVERSITY

SECONDARY INSURANCE. CLAIM FORMS MUST BE FILLED OUT AND FILED IN THE ATHLETIC TRAINING

ROOM WITHIN 90 DAYS OF THE INJURY.

*PRIOR EXISTING INJURIES WILL NOT BE COVERED. ALL STUDENT ATHLETES MUST PROVIDE MEDICAL

RECORDS AND AN ACCURATE MEDICAL HISORY FORM FOR ALL PREVIOUS INJURIES.

In the event of an athletic injury the billing process would be:

1. Primary insurance of athlete/family will always be billed first & all deductibles are the

athlete/family responsibility.

2. After the primary insurance has been exhausted the student accident insurance will be billed for

up to $5,000

3. The University secondary insurance will pick up any remaining bills up to $25,000. Rodeo (NIRA)

and Wrestling (HSR) have a separate secondary policy that will have different stipulations.

*THE ATHLETE/FAMILY IS RESPONSIBLE FOR ANY BILLS LEFT AFTER ALL INSURANCE HAS BEEN

EXHAUSTED.

*NEITHER THE STUDENT ACCIDENT INSURANCE NOR THE UNIVERSITY SECONDARY INSURANCE COVERS

GENERAL HEALTHCARE LIKE SICKNESS, ASTHMA, OR APPENDICITIS ETC. THIS IS THE RESPONSIBILITY OF

THE ATHLETE/FAMILY. NEITHER OF THESE PLANS ARE ACA COMPLIANT.

University Student Athlete signature: _______________________________________ Date: __________

Policy Holder Signature: _________________________________________________ Date: ___________

Sport: ______________________ ***Please provide front/back copies of Primary Insurance Card(s)***

Consent for Treatment

I grant permission to the medical personnel (Licensed/Certified Athletic Trainers & Team Physicians) of

the University of Providence to seek, initiate, and/or coordinate emergency medical treatment,

hospitalization, and/or any other medical treatments as may be necessary for the immediate welfare of:

____________________________________________________________ Date of Birth: ____________ Printed Full Name of Student Athlete

____________________________________________________________ Date: ____________ Signature of Student Athlete or Parent/Legal Guardian

***IF A STUDENT ATHLETE IS NOT 18 YEARS OF AGE, A PARENT OR GUARDIAN MUST SIGN***

Authorization for Release of Medical Information

I hereby authorize any physician, nurse, physical therapist, or athletic trainer who has attended to me or

any hospital or infirmary at which I have been treated or admitted to furnish the University through its

designated medical personnel (licensed/certified athletic trainers & team physicians) copies of any

information, notes, hospital records, concerning the attendance upon, treatment, care, confinement of

the student athlete undersigned. This authority extends to all records including history, diagnostic tests,

and findings related to the examination/treatment of the student athlete undersigned. Also included is

the billing process as far as statements and EOB’s from the student athlete’s primary insurance carrier.

_____________________________________________________________ Date of Birth: ___________ Printed Full Name of Student Athlete

______________________________________________________________ Date: ____________ Signature of Student Athlete or Parent/Legal Guardian

***IF A STUDENT ATHLETE IS NOT 18 YEARS OF AGE, A PARENT OR GUARDIAN MUST SIGN***

Assumption of Risk

I understand that while I am participating in intercollegiate athletics, there is a risk of injury. I

understand that there is always the possibility of injuries when you place extra demands on the muscles,

bones, joints, and ligaments in a competitive environment. Injuries that can occur in varsity athletics

include but are not necessarily limited to the following: blisters, muscle strains, ligament/joint sprains,

joint soreness, abrasions, contusions, stress fractures, broken bones, head/neck, and spinal cord injuries

involving paralysis and even death. However, if you exercise care for your safety of your teammates,

and your opponents, the likelihood of such injuries can be greatly reduced.

I hereby accept and assume the risk of injury and understand the possible consequences of such injury.

_____________________________________________________________ Date: __________________ Printed full Name of Student Athlete

_____________________________________________________________ Signature of Student Athlete or Parent/Legal Guardian

***IF A STUDENT ATHLETE IS NOT 18 YEARS OF AGE, A PARENT OR LEGAL GUARDIAN MUST SIGN***