Franklin & Marshall College

Student-Athlete, Parents, and/or Guardians,

Please see below regarding medical insurance at Franklin & Marshall College as it relates to varsity and club athletics. It is important that you understand what you are not purchasing if you opt-out of the college-sponsored insurance plan. 

Health Services Fee:

All students are charged a Health Services fee as part of their tuition. This fee is assessed to all students to cover LG Health/F&M Student Wellness Center visit co-payments. This standard fee is separate from the Student Health Insurance Plan (SHIP), it is not a form of health insurance and it cannot be waived.  

Student Health Insurance Plan (SHIP):

Health insurance coverage is required for all full-time undergraduate students enrolled at Franklin & Marshall College. College policy requires students to maintain health insurance coverage that covers them every day of their higher education career. This includes summer and breaks. The College's student health insurance policy is administered by QM Services and the policy runs August 1 to July 31. This plan acts as your primary insurance during that time frame. Giving you coverage for illness, accident, or athletic injury. This policy is also recommended for students intending to participate in varsity, club, or intramural sports or as a primary supplementary policy for those with managed care insurance whose away-from-home benefits provide insufficient coverage. Please visit www.qmservicesinc.com for more information. 

If your private health insurance provides comparable coverage while you are attending school in the Lancaster, PA area, you may waive the College insurance coverage during the open enrollment period. You must enroll in the College's student health insurance program if you do not have private health insurance or your insurance does not provide comparable coverage to the school-sponsored plan. 

Students will be charged for the SHIP coverage on the first Fall eBill of the year. As waiver information is received by the College from QM Services, the charge will be reversed on the student's account. If you do not respond with waiver information, or you do not have private health insurance coverage, the student health insurance charge will remain on the student's account. You may opt out of the student health insurance (SHIP) charge if you have commensurate coverage on a personal health insurance plan. You will have to reach out to QM Services at 800-273-1715 ext. 2 or go to their website at www.QMServicesinc.com. They will ask you for your insurance information to make sure it meets the requirements. You must go through the process of opting out of the insurance every year.

The cost of the College's health insurance coverage for the academic year 2025-26 is $2,676. Please visit F&M's Student Wellness Center website at https://www.fandm.edu/health-wellness-and-safety/student-wellness-center/ for more information regarding this policy and other student health services. 

(EXTREMELY IMPORTANT INFORMATION FOLLOWING) By not purchasing the SHIP plan, the basic athletic accident coverage is also waived. This means that in the event an injury is sustained during participation with a varsity athletic event, the student will be relying on the insurance that was used to waive the college-sponsored plan to pay for his/her medical bills.  The college does not pay for health insurance bills for athletes even though an injury may have been sustained during an official practice or contest. We rely on the insurance information provided. In the event that bills go in excess of $5,000 for any one athletic injury, the college has a secondary policy set up for athletes to access once the $5,000 deductible is reached for that one injury. That deductible can be reached either through their Primary Insurance or out-of-pocket expenses. This secondary policy is provided through a different company than the one that provides the college-sponsored plan.  The $5,000 deductible occurs per injury sustained.

Students should know basic information about their insurance coverage and have an insurance card to present if the need for emergency or outpatient care arises. A copy of both sides of the card should be provided to the Sports Medicine Department and the LG Student Wellness Center AND updated every semester. Those who have decided not to purchase the supplementary policy and are insured by managed care or an HMO should know the approval process required if services not available on campus are needed. It has been our experience that some students have been forced to return home to receive non-emergency outpatient care. Others have needed to identify a primary care physician in Lancaster. Some managed care companies participate only with specific laboratories or outpatient facilities. The need to investigate coverage requirements at a time when the doctor recommends outpatient procedures often results in unfortunate delays in treatment.

 Secondary Intercollegiate Athletic Insurance:

The College provides Excess Intercollegiate Athletic Insurance for all varsity sports to assist in covering expenses incurred as the result of injuries sustained while the athlete is engaged in a sponsored practice or competition.  Below is information to help you understand both the coverage available and the procedures for processing claims. 

BASIC POLICY: 

All bills should be submitted first to your primary insurance carrier. If there is a remaining balance, these bills should be submitted to the College's excess insurance carrier (A-G Administrators). As an excess plan, benefits from the College's plan administrator will be paid only for those expenses not paid or not payable by the athlete's personal health care plan. Put simply, the athlete's personal coverage pays first, and the sports policy pays second.  

Please note: the College's insurance plan has a $5,000 disappearing deductible, meaning either you or your primary insurer must make an actual payment of $5,000 before our insurance plan will pay any bills. 

On a covered claim, if the athlete's personal medical insurance:

1. Has a valid reason for denying payment of a claim and states their denial in writing, or, 

2. If limits of the personal medical insurance are exceeded; or, 

3. If no other insurance exists

The College's insurer will assume up to the policy limits ($90,000.00) for usual, customary, and reasonable medical expenses. The benefit payment period is 104 weeks from the date of the injury, meaning all medical treatment for the covered injury must occur within 104 weeks of the date of injury.

ELIGIBLE EXPENSES:

Excess Athletic Injury Insurance Policies are designed to pay medical expenses which arise due to accidental injuries that occur while the athlete is participating in or traveling to or from supervised regularly scheduled games or practices. Athletic Injury Insurance Policies are not comprehensive medical policies, and the following requirements/restrictions apply: 

1. There must have been an accidental injury. Sicknesses are not covered. 

2. The accidental injury must occur while the athlete is participating in regularly scheduled, supervised practices, games, or travel. 

3. The first treatment of the injury must be within 90 days of the accident. 

4. No more than 30 visits of physical therapy will be covered per injury 

5. The benefit for durable medical equipment is limited to $7,000 every two years, unless prescribed as medically necessary by a physician 

For more information regarding coverage and exclusions, please see a member of the Athletic Training staff or contact our plan administrator, A-G Administrators, by phone (610-933-0800) or e-mail (customerservice@agadm.com).

PLEASE BE AWARE

In order to maximize the benefits under the sports insurance plan, we ask that you acquaint yourself with the terms and conditions of your personal health care plan.  Special attention should be given to understanding the rules and regulations pertaining to seeking medical attention and the filing of claims under your personal health care plan. 

A claim may be denied by the sports policy carrier if the requirements of the athlete's personal policy are not met. This is where you can help by assuring that claims are submitted quickly and properly under the athlete's primary plan. 

Experience has shown that occasionally expenses occur that are not covered by an athlete's primary insurance or the College's insurance. This can result when the deductible has not been satisfied or the expenses were in excess of the policy's limitations and will be the responsibility of the individual, not the College. 

Frequently, family health care plans contain restrictions or special conditions that the insured must comply with before their carrier will consider payment of the claim. Examples of such restrictions are:

1. HMO requirements of written referrals from the primary care doctor before treatment can be rendered by an outside physician.

2. Pre-certification for hospital admissions 

CLAIMS PROCEDURE:

When an athlete sustains an injury in a game or practice, it is very important that they comply with the following claims procedures:

1. The athlete is to contact the Athletic Trainers or coach immediately and inform them of the injury. Emergency medical care will be rendered to evaluate and stabilize the condition. 

2. If the athlete needs to be referred to a physician or hospital an accident claim form will be completed by the Athletic Training Staff and submitted to A-G Administrators. 

3. The athlete should submit all bills from providers of medical services to his/her primary insurance carrier as soon as possible. Make sure to fulfill all other submission requirements of your primary carrier. When a provider requests insurance information for billing purposes, the athlete should provide their primary insurance information and, if possible, request the secondary plan be billed as well (F&M's Policy # ICIL00600043002).

4. If you receive a request from your insurance company or the College's insurance company for additional information, please respond as quickly as possible, this will speed up the payment of the claim. 

5. To file claims under the secondary plan, please forward all itemized medical bills and, if applicable, the corresponding explanation of benefits from your insurance carrier(s) to the following address:

A-G Administrators, Inc
Attn: F&M Claims
PO Box 979
Valley Forge, PA 19482

Claims Adjuster:
Sydney Morse (smorse@agadm.com)
P: 484-302-0912
F: 610-933-4122

Fax: 610-933-4122
Email: claims@agadm.com 
The Customer Service Toll-Free number is 800-634-8628
Policy # ICIL00600043002

If you have any questions please feel free to contact my office.

Matthew S. Keller, MS, LAT, ATC
Director of Sports Medicine | matthew.keller@fandm.edu
717-358-3857