Instructions for Athletic Paperwork for Howard Payne

University Student-Athletes

Please note that there are two sections of paperwork:

1. Paperwork that has to be filled out and sent into the athletic training staff.

These forms follow the online paperwork instructions. They can be mailed in,

faxed, scanned and emailed, or uploaded into the online program.

--You are greatly encouraged to make copies of these forms and bring

them to campus when you report for your sport.

--Items can be lost in the mail, poor fax quality or electronic files can be corrupted.

--Photos of the paperwork from cell phones will not be accepted.

However, if the quality is good, cell phone photos of the insurance card will be accepted.

You only need to print out and return pages 5-6 along with

a legible copy of your insurance card (front and back).

Do NOT send the paperwork to the coaches, Financial Aid/

Admissions office or to the University Nurse

2. Online Paperwork—the instructions begin on page 7, including the link to thewebsite and how to retrieve your password if you have forgotten it.

--The ID and password are not related to your HPU ID and password for

computer access.

--The ID and password is the same as you have used in years past.

--If you do not remember them, use the forgot password feature or contact Rachel Smith at rsmith@hputx.edu. --This paperwork is not the same as the online paperwork for Student Life/Nurse

There is a check list of all items needed to be sent into the athletic training staff. 1

Thank you for your decision to continue to participate in athletics at Howard Payne University for the2018 – 2019 academic year. There are electronic forms and print forms that need to be completed. All formsmust be com-pleted and returned by Thurdsday, July 26, 2018 to:

Howard Payne University

Rachel Smith – Athletics

1000 Fisk

Brownwood, TX 76801 Fax:

325-649-8908

rsmith@hputx.edu

All forms must be completed and verified before you can be cleared to participate in athletics (practice or games). Following this letter there are instructions on how to complete the online portion of the paperwork. Following the instructions is a check-list of what is required to be completed and then paperwork that needs to be printed out, completed and sent back into the address above.

Please pay close attention to Form D2 Insurance. HPU requires that all student athletes present proof of medical insurance coverage and maintain throughout the academic year appropriate medical coverage as out- lined on Form D2. Form D2 describes the methods and procedures for payment of expenses incurred due to athletic injury. A copy of Form D2 is provided on the athletic training website for reference. Please remember to send us a legible copy of both the front and back of your insurance card.

Only Incoming Freshmen and Transfer students need a physical examination no more than 6 months prior to reporting to Howard Payne University for participation in NCAA athletics. If you have not transferred to another college/univeristy since enrolling at HPU, you do not need a new physical. This does not include summer school taken at another school.

Our Team Physicians are Dr. Robert Hogue M.D. and Dr. Marlin Strefling MD. Dr. Hogue is a family practice physician and our Athletics’ Medical Director. Dr. Hogue has the final say on all medical questions. Dr. Strefling is our team Orthopedic Surgeon we will refer all orthopedic concerns to Dr, Strefling. Please check with your insur- ance carrier to have Dr. Hogue and Dr. Strefling in-network if at all possible.

Thank you again for choosing to continuing to attend Howard Payne University and participating inathletics. We are excited about the upcoming year and you being a part of athletics at Howard Payne University.

Rachel Smith MS, LAT, ATC

Director of Athletic Training Services

Howard Payne University

O) 325-649-8102F) 325-649-8908

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Checklist for Student Athlete Forms

Create/login to the ATS website

Complete/Edit/Verify ‘General’ tab

Complete/Edit/Verify ‘Insurance’ tab

Complete/Edit/Verify ‘Contacts’ tab

Complete each of the seven forms of the ‘Athlete Forms’

Authorization to Release Information

Concussion Policy

Medical Consent

Medical History

Medical Physician Release

Risk Waiver

Consent to Release Medical Information

Complete the paperwork to be sent in

D2 Medical Insurance Information

D1 Student-Athlete Information

Send in Forms and a legible copy of the front and back of your insurance card to:

Howard Payne University

Attn: Rachel Smith1000 Fisk St

Brownwood, TX 76801

Or email to: rsmith@hputx.edu Or

fax to: 325-649-8908

Do NOT send this paperwork, insurance cards, etc. to coaches, financial aid/admissions offices

or the University Nurse

You may upload the documents into ATS, the online software described in Section 2.

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Section 1:

Complete the following forms and

return only these forms and a

legible copy of the front and back

of your insurance card. Return to:

Howard Payne University

attn: Rachel Smith

1000 Fisk St

Brownwood, TX 76801

Fax: 325-649-8908

rsmith@hputx.edu

Do NOT send this paperwork, insurance cards, etc. to coaches, financial aid/admissions offices

or the University Nurse

You may fill in certain boxes on your computer and print out, sign and return the following forms. (D2, D1)

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Form D 2 Name 2018-19 Sport

Medical Insurance Information

Howard Payne University (HPU) requires all student-athletes (athletes) to present proof they have medicalinsurance coverage that is currently in place.

In order to play or practice intercollegiate sports at HPU, each athlete must have and maintainmedical insurance that does not exclude athletic activities and meets or exceeds the $20,000.00maximum benefit.

All medical bills for athletes must be submitted by the athlete or their parent/guardian to the athlete's insurance

company or it will be sent to the policyholder for submission to his or her company.

In cases where the athlete is covered under a PPO or HMO, the athlete must work within their

system for medical treatment. Required approvals must be obtained prior to treatment.

All medical bills for athletic injuries will first be submitted to the athlete’s insurance company for payment.

Deductibles, co-payments, co-insurance, etc. are the responsibility of the athlete or their parent/

guardian.

HPU carries a secondary accidental medical insurance plan for all athletes that covers injuries

sustained while participating in a sanctioned HPU athletic events and practices.

This policy has a $20,000 deductible per incident per athlete that must be paid by the athlete or

their parent/guardian or the primary insurance.

The athlete or their parent/guardian must have medical insurance that will cover the first $20,000 of the athlete's

medical expenses related to an athletic injury.

HPU will submit claims that exceed $20,000 to our insurance company once a claim form is com-

pleted with the athlete’s signature.

It is the responsibility of the athlete or their parent/guardian to provide the explanation of benefits

and bills for expenses exceeding $20,000 to the head athletic trainer at HPU or our insurance

company.

Please remember to advise us at once about any change in your medical insurance coverage.

An athlete is not allowed to practice or play without current medical insurance coverage.

If an athlete's medical insurance coverage lapses and an injury occurs, the athlete or their parent/

guardian will be responsible for at least the first $20,000 of medical expenses.

Policy Holder’s Signature: Date:

Student Athlete’s Signature: Date:

Return form to: Howard Payne University, attn Rachel Smith, 1000 Fisk St, Brownwood TX 76801,

rsmith@hputx.edu Fax: 325-649-8908

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Form D 1 Name

2018-19 Sport

STUDENT ATHLETE INFORMATION Last name: First Name: M.I.:

Permanent Address: City/State/ Zip: Eligibility: Fr. SO. JR. SR.

Social Security Number*: Date of Birth: Gender:

Home phone: ( ) Cell phone: ( )

Local Address:(if known) City/State/Zip

Emergency Contact #1

Name: Relationship: Home: ( ) Cell : ( )

Emergency Contact #2

Name: Relationship: Home: ( ) Cell : ( )

PRIMARY INSURANCE INFORMATION

Policy Holder Name: First: MI: Last:

Relationship to Athlete: Employer:

Work Address: City, State, Zip

Date of Birth: Social Security Number*:

Insurance Company: Type of Insurance (PPO, HMO, etc.):

Group Number: Policy Number:

Insurance Company Phone:

Returning student-athletes: Is this the same insurance from last year? YES NO

If there is other insurance, please provide the same information as above on an additional form.

YOU MUST INCLUDE A LEGIBLE COPY OF BOTH THE FRONT & BACK OF YOUR INSURANCE CARD!

PLEASE READ CAREFULLY AND COMPLETELY

I/We have read the attached letter and have been informed of the medical insurance program and policies of Howard Payne University. I/We further agree to carry medical and hospital insurance for my child (or dependent) during the time in which he/she is participating in the HPU athletic program.

I/We agree that all information provided in this document is accurate and complete to the best of my/our knowledge. I/We understand that any incorrect or undisclosed information can result in duplicate payments creating a substantial overpayment. The responsibility of such overpayment will be the obligation of the undersigned to reimburse in full, upon request, all amounts deemed refundable.

Student Athlete:

Guardian/Father:

Date:

Date:

Guardian/Mother: Date:

* Social Security Numbers are only used to make doctor appointments or file insurance claims.

Return form to: Howard Payne University, attn Rachel Smith, 1000 Fisk St, Brownwood TX 76801,

rsmith@hputx.edu Fax: 325-649-89086

Section 2: Instructions for Completing Athletic

Medical Paperwork Please make sure you read the instructions on the following pages

Go to hputx2.atsusers.com (no www., etc.) (if you have trouble opening the link, cut and paste it to your browser)

INTERNET EXPLORER IS NOT THE PREFERRED BROWSER FOR THIS APPLICATION. PLEASE

USE FIREFOX, CHROME OR SAFARI TO COMPLETE THE FORMS

You can now use your tablet or smart phone

to fill out the forms and sign them with your

finger or a stylus.

hputx2.atsusers.com

Enter your ID and Password

If you have forgotten your ID or Password,

you can use these links to recover them using

your saved email address.

Use the email that you used last year.

The database is ATSHPUTX.

If you have problems after that, email

Rachel Smith at rsmith@hputx.edu

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Fill out Athlete Information. All boxes that

are yellow are required

Update any information that is incorrect.

Please update your eligibility year.

Press ‘Save” or ‘Verify” buttons once completed. Please don’t forget to update

eligibility year.

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Complete/update as much of the information as possible. You are required to have primary health

insurance to participate in athletics.

If your insurance company is not on the drop down list,

you can add a new insurance company by clicking this

You can ‘double click’ on the current insurance

information to make any changes.

Once completed make sure you click the ‘save’ button.

If no changes are needed press the ‘verify’ button.

If you upload a copy of your current insurance card, you do not have to

send a copy into the athletic training staff.

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Fill out a contact with a good phone number. This is used in case of an emergency that

we have to contact someone about an injury/illness.

Try to have at least two contacts.

After you have completed the contact information,

hit save button.

You may also hit the ‘Verify’ button if the contacts

have not changed.

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You may skip the Immunizations/Paperwork tab.

Press the Forms tab.

Click the drop down menu.

Select the first form and press ‘new’ button.

You will repeat this step until all seven forms are completed.

You have to complete the seven forms

every new school year.

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After reading the form, sign with the mouse (or finger on

smartphone or tablet), type your name and hit sign.

AFTER you click sign, press save. Do not forget to save or you

will have to redo the form!!

You do NOT need to print out these seven forms. They

are saved in the program.

After you have completed each form and hit save, use the drop down menu to go

to the next form, click on the form and hit new. There are seven forms online that

you must complete.

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Optional

The eFiles tab allows you to upload additional paperwork. You may upload the forms that need to

be sent in here, if you wish.

You do NOT have to print out the forms from the ‘Forms’ tab. They are saved in the program.

This is the most secure way of sending in the printed documents, besides physically bringing them

the athletic training staff.

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