Student Athlete Forms
All Student Athletes who are 18 years of age, or older, MUST complete these forms online. Student Athletes under 18 years of age should contact Dana Roche (email@example.com) in Athletics before completing the Medical Consent, Authorization for Release and Preparticipation Physical Evaluation forms below.
- Medical Consent (due July 30th)
- Authorization for Release (due July 30th)
- Preparticipation Physical Evaluation (due July 30th)
- Insurance Enrollment/Waiver Form (due June 30th)
**Please contact Dana Roche (firstname.lastname@example.org) in Athletics with questions about the Medical Consent, Authorization for Release or Preparticipation Physical Evaluation.
New Student Athletes (Incoming Freshmen and Transfer Students) MUST complete the Confidential Health Record form. The sickle cell trait and meningitis waivers are only required if you did not receive the sickle cell testing or meningitis vaccine. Please mail these forms to the Wellness Center by July 30th. Please contact the Wellness Center (email@example.com) with questions about these important health forms.
- Confidential Health Record (pay special attention to “Item H”)
- Sickle Cell Trait Information/Waiver
- Meningitis Waiver
Sickle Cell Trait Information
The NCAA requires that all student athletes have knowledge of their sickle cell trait status, and provide proof of this knowledge to Ursinus College. Proof can be documented by; 1) having your primary care physician complete “Item H” on the Ursinus College Confidential Health Record, 2) providing laboratory results of testing, OR 3) completing the Ursinus College Sickle Cell Trait Form for NCAA Intercollegiate Athletics, found using the link provided above.
Student Health Insurance Information
The annual cost for the student health plan through United Healthcare for the 2019-2020 year is $1624.00. The annual coverage is in effect from August 7, 2019 through August 6, 2020. **NOTE** Any student entering as a full-time student in the Spring 2020 term can purchase the student health plan for Spring 2020 semester and Summer 2020 at a cost of $971.00, coverage effective January 1, 2020- August 6, 2020.
**NOTE** Any student entering as a full-time student in the Spring 2020 term must complete the health insurance waiver/enrollment online form above. Proof of insurance must be provided no later than January 31, 2020 or a charge of $971.00 for the student health plan will be applied to your student account.
For more information on the Student Health Plan Option provided by United Healthcare, please see the 2019-2020 insurance information flyer and brochure below.
If you have additional questions about what the student health plan covers, please contact First Risk Advisors Customer Service at 800-505-4160 or email firstname.lastname@example.org. You can also visit http://www.firststudent.com/
Losing Your Health Coverage?
If you did not enroll during our open enrollment period and have since lost coverage under your original plan, you may qualify for a Qualifying Life Event. A qualifying life event is an event that triggers an open enrollment window for an individual to purchase the Student Health Plan outside of the scheduled open enrollment period upon providing proof of involuntary loss of coverage and payment, within 30 days of losing coverage. (example: marriage, divorce, loss of job, etc)
The enrollment form, check or money order and the letter of creditable coverage, must be received within 30 days of losing coverage. After 30 days, the student or dependents will no longer be eligible to enroll in the plan, until fall of the following school year. Please click here for cost and enrollment information as a Qualifying Life Event.