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Wenatchee Valley College

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Sports Med Forms

Sports Medicine

    The Wenatchee Valley College Sports Medicine Department provides sports medicine services to the student-athlete of WVC. These services include prevention, evaluation, treatment, and rehabilitation of athletic injuries. We provide a patient-centered approach accounting for both physical and mental health while considering the patient’s needs, goals, and beliefs.

Forms

  • New student Packet
  • Returner Packet
  • Instructions for Baseline CVS
    • Each team will have a check-in with the Sports Medicine Staff prior to the start of their first practice. During this time, please bring your completed packet, a copy of your insurance card (or the card itself), and any questions or concerns you may have. The Certified Athletic Trainer will quickly review your medical history and ask any pertinent questions, take a picture of your insurance card (or collect the copy), and verify you have completed the concussion baseline test.
  • Open Gym/Tryout waiver
  • Instructions for post injury CVS
  • Secondary insurance information
    • Secondary insurance form
    • Who’s Covered
      • The plan covers all intercollegiate student athletes, student managers, student trainers, student coaches, student cheerleaders, dance & drill teams and mascots (as listed in the Sports Census) for bodily injury sustained during an athletic event or other activity which is authorized by, organized by, or directly supervised by an official representative of the Policyholder, including practices, games, off-season body conditioning and related covered travel. In addition, prospective athletes, and their chaperones (up to two) are covered for activities during or directly related to an official visit for which the athlete was invited by the Policyholder. Claims will be paid EXCESS of all other insurance for expenses incurred within the benefit period.
    • What’s Covered
      • Injuries that occur during play or practice and traveling as a member of a supervised group. After the deductible and other coverages, the plan will pay 100% of usual, customary, and reasonable charges incurred within 2 years of an injury. Some benefits are limited to a specific maximum. Examples of covered expenses are: ·
      • Treatment by a legally qualified physician
      • Care or services from a hospital or ambulatory surgical center
      • Services from a registered graduate nurse (RN or LPN) not related to the insured by blood or marriage
      • Professional ambulance service
      • Orthopedic appliances
      • Treatment by a physical therapist
      • Treatment by a Physician’s Assistant (PA)
  • Medical Deductible $500.00
    • Must be met through the student-athlete’s primary insurance coverage
    • Or through out of pocket expenses
  • Maximum Medical Benefit –
    • Excess Coverage Only $25,000 Per Injury for eligible insureds / $10,000 Per Injury for chaperones
  •  Accidental Death & Dismemberment Benefit
    • $10,000 – Loss of Life (if within 365 days of injury)
    • $10,000 – Loss of Two or More Members (if within 365 days of injury)
    • $ 5,000 – Loss of One Member (if within 365 days of injury)
  • This is a general summary of the insurance. All standard provisions, limitations and exclusions of proposed insurance benefits are outlined in a specimen policy that is available on request. If there is any conflict between the proposal and the policy, policy provision will prevail.