Sports Medicine Forms
Intercollegiate Athletic Insurance
Augustana College does not currently offer an Affordable Care Act (ACA) compliant student health insurance plan for student-athletes. If you need to shop for coverage: Augustana's preferred options for domestic student-athletes is Pivot Health (https://www.pivothealth.com/product/short-term-health-insurance) and for international students is Gallagher ISS (https://iss.gallagherstudent.com/). We HIGHLY recommend your plan has the following minimums: Overall Plan Maximum of $500,000 per injury, Coinsurance is 80% In-Network/70% Out-of-Network, and Intercollegiate Sports coverage of $10,000
Maximum per injury.
We recommend all international student athletes make sure their insurance works for athletic injuries. Most do not cover athletic injuries without additional coverage. PLEASE REVIEW YOUR COVERAGE.
The College provides SECONDARY COVERAGE, at no additional cost, for students participating in intercollegiate athletics.
Intercollegiate sport injuries resulting in expenses over $2,500 during the 2023/24 plan year are covered, within the plan limits, under a master athletic insurance contract sponsored by Augustana College. The deductible is $2,500 per injury for the 2023/24 plan year.
In order for the secondary coverage to take effect the injury must have occurred during participation of an NCAA intercollegiate activity. Any other injuries will not be covered (intramurals, extracurricular, non Augustana summer leagues, etc.) NCAA athletic injuries must be reported to an Augustana College Athletic Trainer or personal physician within 60 days of injury to be considered eligible for payment under the secondary coverage plan.
NCAA Sexual Violence Document
Augustana College and the NCAA are committed to sexual violence prevention. In accordance with NCAA requirements, Augustana College requires all students who seek to participate in intercollegiate athletics to disclose whether they have been disciplined through a Title IX or sexual misconduct hearing, or criminally convicted of sexual violence.
Additional forms
Athletic Travel Release
Social Conduct Agreement
Medical Authorization
Waiver and Release of Claims
Registrar Grade Release Form
