MNU Secondary Athletic Insurance Policy Procedures

MidAmerica Nazarene University does provide secondary insurance should you become injured. This insurance has a $2000 deductible per injury. Should you become injured and submitting claims to them is necessary you must follow the following procedures:

1. Be sure you have signed a HIPPA (Health Insurance Portability and Accountability Act) form from the provider of service.
2. Be sure that a copy of your insurance information and a copy of your insurance card (if possible) has been given to the service provider.
3. List the following information as the secondary insurance:

   First Agency, Inc.
   5071 West H Avenue
   Kalamazoo, MI 49009-8501
   Attn: Lisa Kequom, Claims Adjustor
   Telephone number: 269-381-6630

4. You will be submitting all bills and EOB.s (Explanation of Benefits) to Lisa Kequom at the above listed address. She will serve as your primary contact person. All of this information is needed by First Agency to process your claim. If this information is not received by First Agency, the claim can not be processed.
5. You will need to see Chad Keller, the Head Athletic Trainer to complete both sides of a Parent/Guardian Student Information Sheet. This along with a Claim Sheet will be submitted by the university to First Agency.