Insurance Information UNK Athletics

Sign In Screen Website is address will be the address you provided to your coach For returning athletes, your password is the same. For new athletes, you will need to create a password.

Home Screen This is the home page On the side of the screen you’ll see a set of Tabs Let’s Start with the general tab

General Information Screen Fill out your First Name, Last Name, Class (Freshman, Sophomore, etc), Gender, Birth Date, and your Sport

Address Information Tab Fill out your Primary Address (this will be your School/Local address) and your Secondary Address (this will be your home/permanent address) School/Local Address Home Address

Emergency Contact Information Tab Fill out a Primary Emergency Contact (This is your Parents/Guardians Information)

Insurance Information Tab Fill out all areas for your Primary Insurance Information (You do not have to complete the Secondary Insurance Information)

Medical Information Screen Fill out any alerts (such as Allergies)….. Fill out recent immunizations date (Under the Immunizations Tab), And make sure to fill out any medication you are taking, the dosage of that medication, and how many times a day you take that medication. Add any medication that is not in the drop down list (Under the Drugs Taken Section) After you are done with this screen, hit SAVE at the top to save everything before you go onto the questionnaire.

Medical History Questionnaire This is the medical history questionnaire, MAKE SURE YOU HIT THE SAVE BUTTON OR ELSE ALL INFORMATION WILL BE LOST

Forms Print off the forms that apply to you, then complete and return to UNK Athletic Office: Physical (Incoming Freshman and Transfers Only) Female Medical History Questionnaire Athletic Insurance Questions/Authorization to Obtain Medical Information (All Athletes; minors will need parent’s signature) Important Insurance Information Signature Page (All Athletes; any athlete under their parent’s primary insurance will need a parent’s signature)

Form 1: Female Athlete Medical Questionnaire

Form 2: Physical Form Only FRESHMEN and TRANSFERS need to complete this form! Returning students you do not have to complete this.

Form 3: Insurance Information Form Call the customer service number on the back of the Insurance card and ask them the questions at the top. Circle yes or no. Sign and date and please put your sport as well

Form 4: Policy and Procedures Form It comes with 2 extra pages explaining the Policies and Procedures of what you need to do to get your bill covered and exactly what we do cover. (If you are under parents insurance they need to sign as well)

What else we need $130 insurance fee and $35 athletic participation fee = Total made payable to UNK Athletics $165(Cash, Check, or Credit) Copy of the front AND back of your insurance card DEADLINE IS: July 27 th – a late fee could be assessed Mailing address: University of Nebraska at Kearney Attn: Insurance Department HSC th Avenue Kearney, NE REMINDER: Forms you need to turn in Female Medical History Questionnaire (Females only) Physical (Transfers and Freshman) Athletic Primary Insurance Questions-Authorization to obtain information Form (yes or no questions) Important Insurance Information signature page (Parents signature needed if you are under their insurance) Fax Number: (308) You may also turn in forms in person to HSC room 105 (in the Athletic Office)

Questions?? Contact Michelle Smidt (308) Jake Sawatzky (308) Rachael Page (308) Michelle Broderson (308)