ELITE ATHLETE HEALTH INSURANCE PROGRAM (EAHI)
FREQUENTLY ASKED QUESTIONS


1. WHAT IS EAHI?

The United States Olympic Committee (USOC) Elite Athlete Health Insurance Program (EAHI) provides a level of base support by offering a program of health and major medical insurance for designated Elite Athletes to minimize out-of-pocket medical care expenses. EAHI is administered by Highmark Blue Cross Blue Shield (BCBS) and is a preferred provider organization (PPO) plan with a network of medical service providers contracted with BCBS. Costs associated with various medical benefits are included in the Summary of Benefits grid provided with this FAQ.

2. IS EAHI A PLAN THAT MEETS MINIMUM ESSENTIAL COVERAGE?

Under the Affordable Care Act, most U.S. residents must have health coverage that qualifies as minimum essential coverage to avoid tax penalties. EAHI is a qualifying health plan that meets minimum essential coverage.

3. HOW DO I QUALIFY FOR EAHI?

National Governing Bodies (NGBs) and U.S. Paralympics are awarded a number of EAHI slots by the USOC. Distribution of these EAHI slots is based on criteria established by the NGB and approved by the USOC. Questions regarding EAHI distribution criteria should be directed to the respective NGB or U.S. Paralympics Coordinator.

4. ARE THERE COSTS ASSOCIATED WITH EAHI?

The following table lists 2018 amounts paid by athletes and reported to the IRS once athletes enroll in EAHI:

2018 Benefit Value

Paid by Athlete

2018 Monthly
Taxable Amount

2018 Annual Taxable Amount

Athlete Only

$460

$0

$460

$5,520

Athlete + Child

$920

$110

$810

$9,720

Athlete + Spouse

$920

$132

$788

$9,456

Athlete + Family

$1,680

$144

$1,536

$18,432

The USOC is obligated to file IRS Form 1099-misc to report premiums paid on behalf of athletes on an annual basis, and the monthly taxable amount is considered added income.

5. WHAT ARE THE PROGRAM BENEFITS?

EAHI is administered by Highmark Blue Cross Blue Shield (BCBS) through a Preferred Provider Organization network (PPO). Please refer to the program benefits grid for a list of program benefits including the deductible, copayments, coinsurance, out-of-pocket maximums, sport injury coordination of benefits, etc.

6. HOW CAN I CHECK IF MY DOCTOR IS IN THE BCBS NETWORK?

For a list of BCBS participating providers, please go to www.bcbs.com and click on "Find a Doctor" (the first 3 letters of the member ID is "OAM").

7. WHAT IS THE $25,000 COORDINATION OF BENEFITS?

The $25,000 coordination of benefits is related to an acute injury incurred from an NGB or USOC sanctioned training or competition or an acute injury resulting from an unsanctioned training or competition where the athlete received or expected to receive compensation as a result of participation in the event. The $25,000 Coordination of Benefits does not apply to chronic sport injuries or acute injuries that are not sport related.

8. WHY IS THERE A $25,000 COORDINATION OF BENEFITS?

The USOC requires NGBs to carry a minimum of $25,000 sport accident policy to coordinate processing of acute sport injury claims on a secondary basis.

9. HOW DOES THE $25,000 COORDINATION OF BENEFITS WORK?

If an athlete's acute injury is sport-related, the athlete must file claims with EAHI (or any other personal policy) before filing it under the NGB sport accident policy. A NGB sport accident policy deductible, copay, or coinsurance may apply; contact the NGB for details.

10. HOW DOES AN ATHLETE ENROLL IN EAHI?

Once an athlete is offered EAHI and accepts the EAHI offer, an email with a link to the forms (EAHI Enrollment, EAHI Designee and W-9) is sent to the athlete's email address immediately. The athlete must complete and submit all forms for coverage to begin.

11. WHEN DOES COVERAGE BEGIN?

Once an athlete's completed forms are received, coverage will begin the 1st of the following month. For example, if the completed form is submitted on May 1st, coverage will begin that same day (May 1st); however, if the form is received on May 2nd - 31st, coverage will begin the 1st of the following month (June 1st).

12. CAN DEPENDENTS BE ADDED?

An athlete may add an eligible dependent to EAHI by including name, social security number, and birthdate on the Enrollment form. An eligible dependent is:

  • Spouse or Domestic Partner
  • Child(ren) or Step-Child(ren) aged 26 and under

The monthly premium paid by athlete is:

Child Only - $110

Spouse or Domestic Partner - $132

Family (2 or more) - $144

The following documents must be provided, along with athlete's Enrollment form:

  1. Proof of dependent status (i.e., Marriage Certificate, Domestic Partner Affidavit and forms of proof, and/or Birth Certificate)
  2. Bank Form - monthly premium payment is set up by automatic payment through a bank

If an athlete wishes to enroll a dependent(s), a request for the required forms must be submitted to eahi@usoc.org.

13. DOES EAHI PROVIDE COVERAGE OUTSIDE THE U.S.?

Yes, EAHI provides coverage worldwide.

14. HOW DOES SOMEONE SPEAK ON BEHALF OF AN ATHLETE?

An athlete may complete and sign an "Authorization for Release of Information" form permitting another individual to act on his/her behalf on health insurance issues. An athlete may request this form by emailing the USOC's EAHI Administrator at eahi@usoc.org.

15. DOES EAHI HAVE A DENTAL PLAN?

EAHI does not include a dental plan; however, per the Affordable Care Act, limited dental services are provided under the medical plan for participants under the age of 19.

The USOC National Medical Network has a volunteer dental network that provides routine type dental care (i.e., cleaning & exam and cavity care) to athletes enrolled in EAHI (not available to dependents). Call the USOC's National Medical Network at 800-933-4473 ext 2, or email nmn@usoc.org with any questions or requests.

16. DOES EAHI HAVE A VISION PLAN?

EAHI does not include a vision plan; however, per the Affordable Care Act, limited vision services are provided under the medical plan for participants under the age of 19.

The USOC National Medical Network has a contact lens program that provides up to a one year supply of Johnson & Johnson or Bausch and Lomb contact lens free of charge to EAHI eligible athletes (not available to dependents). To participate in this program, an athlete must do the following:

  1. Obtain a current prescription (within the past 12 months) for a Johnson & Johnson or Bausch and Lomb contact lens.
  2. Email or mail: athlete's name/sport/date of birth/mailing address/current contact lens prescription to:

USOC National Medical Network
Attn: Contact Lens Program
1 Olympic Plaza
Colorado Springs, CO 80909
Phone: (800)-933-4473 ext 2
nmn@usoc.org

Athletes can receive contacts once every 12 months for as long as they remain eligible for EAHI.

17. WHAT IS THE NATIONAL MEDICAL NETWORK?

The USOC's National Medical Network (NMN) was created in 2012 and provides medical care through partnerships with top-tiered medical providers across the country at little or no cost to EAHI-eligible athletes. For more information on the NMN, please email nmn@usoc.org, call 800-933-4473 ext 2, or visit www.teamusa.org/nationalmedicalnetwork.

18. WHAT IS MEDICAL ASSISTANCE AND EVACUATION SERVICES?

Medical Assistance and Evacuation Services is travel assistance coverage is automatically provided to athletes enrolled in EAHI and available to athletes who travel more than 100 miles from their place of residence. Coverage includes, but not limited to:

  • Medical Assistance Services (i.e., locate nearest providers or hospitals, facilitate hospital payments, monitor case, and provide updates to family members upon approval)
  • Medical Evacuation and Repatriation Services (will arrange and pay for a medically supervised evacuation to the nearest medical facility or return to point of origin)
  • Travel Assistance (i.e., assists in the replacement of lost/stolen travel documents, translation services, and travel arrangements but does not cover the costs of any services provided)
  • Destination Services (Pre-travel information, travel & health information, real-time security intelligence)
  • Personal Security Services (i.e., assists with political or security evacuations but does not cover the costs of any services provided)

19. IS THERE LIFE INSURANCE COVERAGE?

The USOC provides a $10,000 life insurance policy through The Standard Insurance at no cost to athletes enrolled in EAHI. This policy is for athletes only and does not include dependents.

20. HOW DOES AN ATHLETE CANCEL COVERAGE?

An athlete may terminate EAHI coverage at any time. The request must be in writing and emailed to eahi@usoc.org. Please include the NGB contact when submitting a termination request. Once a written request is received, coverage will terminate at the end of the month.

21. HOW IS AN ATHLETE REMOVED FROM EAHI COVERAGE?

There are three ways to be removed from EAHI:

  1. Voluntary removal. An athlete may remove himself/herself from the EAHI Program at any time by providing the USOC's EAHI Administrator with a written request.
  2. Involuntary removal. When an athlete no longer meets the criteria to remain on EAHI, written notification will be mailed to the athlete's last known address on file at least 30-days prior to the date of termination confirming termination of coverage for athlete and dependents, if applicable. Termination is effective the first of the month following 30 days' written notification from the USOC.
  3. Doping Violation. An athlete reported to the USOC as having an anti-doping rule violation where the period of ineligibility is more than 3 months will be removed from EAHI. Termination is effective the first of the month following 30 days' written notification from the USOC.

22. CAN AN ATHLETE CONTINUE ON EAHI?

An athlete who is enrolled in EAHI but no longer qualifies to remain in the program, will receive notification in the mail from the USOC's EAHI Administrator of removal from the program with the option of purchasing up to 12 months of temporary coverage on the USOC's Continuance Plan. Information will be mailed upon termination, and the athlete will have up to 60 days from the date of termination to enroll in the program. Currently, the monthly premium rates are as follows:

Athlete Only - $469.20

Athlete + 1 Dependent - $938.40

Athlete + Family - $1,713.60



Program Benefits
HIGHMARK BLUE CROSS BLUE SHIELD
PREFERRED PROVIDER ORGANIZATION


USOC Elite Athlete Health Insurance Program


Benefits

Network

Out-of-Network

General Provisions

Benefit Period

2018 Calendar Year

Deductible (per benefit period)

Individual

Family

 

None

None

 

$1,000

$2,000

Sport Injury Coordination of Benefits

$25,000 per injury

Plan Payment Level - Based on the plan allowance charge (PRC)

90% until out-of-pocket limit is met; then 100%;

70% after deductible until out-of-pocket limit is met; then 100%

Out-of-Pocket Limits

Individual

Family

 

$1,500

$3,000

 

$3,000

$9,000

Office Visits1

Primary Care Physician Office Visits2

90% after $15 copayment

70% after deductible

Specialist Office Visits

90% after $15 copayment

70% after deductible

Retail Clinic

90% after $15 copayment

70% after deductible

Urgent Care

90% after $15 copayment

70% after deductible

Telemedicine

100% after $10 copayment

Not Covered

Preventive Care Services

Adult

Routine physical exams

100%

Not Covered

Adult Immunizations

100%

Not Covered

Routine gynecological exams

100%

Not Covered

PAP Test

100%

Not Covered

Mammograms

Annual routine (after age 40)

Medically Necessary

 

100%

90%

 

Not Covered

70% after deductible

Pediatric

Routine physical exams

100%

Not Covered

Pediatric immunizations

100%

Not Covered

Pediatric dental services (one basic screening and fluoride treatment per year)

100%

Not Covered

Pediatric vision exam (one per year)

100%

Not Covered

Emergency Room Services

Emergency Room Services

80% after $100 copayment (waived if admitted as an inpatient)

80% after $100 copayment (waived if admitted as an inpatient); deductible does not apply

Hospital Services

Hospital Services - Inpatient Copayment

$250 per admission

$250 per admission

Hospital Services - Inpatient

90% after inpatient copayment

70% after deductible and inpatient copayment

Hospital Services - Inpatient Rehabilitation
(occupational therapy, speech therapy, respiratory therapy)

90% after inpatient copayment

70% after deductible and inpatient copayment

Combined Limit: 45 days per benefit period

Hospital Services - Inpatient Rehabilitation (physical therapy)

90% after inpatient copayment

70% after deductible and inpatient copayment

Hospital Services - Outpatient3

90%

70% after deductible

Hospital Services - Outpatient Surgery

90% after $250 copayment

70% after $250 copayment and deductible

Physical Medicine, Rehabilitation and Habilitative Services

Physical Therapy (Professional, includes but is not limited to all forms of spinal manipulations, chiropractic, neuromuscular and acupuncture care)

100% after $15 copayment per date of service, per provider

70% after deductible

40 visits per calendar year for Physical Therapy
40 visits per calendar year for Chiropractic care
15 visits per calendar year for Acupuncture care

Sport-Related Injuries4

Contact your respective NGB/Paralympic EAHI Coordinator to report injury

Contact your respective NGB/Paralympic EAHI Coordinator to report injury

Occupational Therapy

90% after $15 copayment

70% after deductible

Limit: 20 visits per benefit period.

Speech Therapy

90% after $15 copayment

70% after deductible

Limit: 20 visits per benefit period.

Cardiac Rehabilitation, Chemotherapy, Infusion Therapy, Radiation Therapy, Respiratory Therapy, and Dialysis Treatment

90%

70% after deductible

Diagnostic Services

Diagnostic Services (including routine and pre-admission testing)
(Lab, x-ray, allergy testing and other diagnostic medical tests)

90%

70% after deductible

Behavioral Health Services

Mental Health Care Services - Inpatient

90% after inpatient copayment

70% after deductible

Mental Health Care Services - Outpatient

90% after $15 copayment

70% after deductible

Substance Abuse Services - Inpatient Detoxification

90% after inpatient copayment

70% after deductible

Substance Abuse Services - Inpatient Residential Treatment and Rehabilitation Services

90% after inpatient copayment

70% after deductible

Substance Abuse Services - Outpatient

90% after $15 copayment

70% after deductible

Other Services

Allergy Extracts and Injections

90%

70% after deductible

Assisted Fertilization Treatment

Not Covered

Autism Spectrum Disorder

90%

70% after deductible

Ambulance - emergency

90%

70% after deductible

Ambulance - non-emergency

90%

70% after deductible

Dental Services Related to Accidental Injury

90%

70% after deductible

Diabetes Treatment

90%

70% after deductible

Durable Medical Equipment, Orthotics, Prosthetics5
(Pre-certification required for DME over $3,000)

90%

Not Covered

Enteral Formulae

90%

70% after deductible

Home Infusion Therapy

90%

70% after deductible

Home Health Care

90% after $15 copayment

Not Covered

Hospice Care Services

90%

70% after deductible

Infertility Counseling, Testing and Treatment

90%

70% after deductible

Maternity (professional services)

90%

70% after deductible

Pediatric Extended Care Services

90%

70% after deductible

Private Duty Nursing

90%

90% after deductible

Skilled Nursing Facility Care

90% after inpatient copayment

70% after deductible and inpatient copayment

Inpatient copayment waived if admitted directly to SNF from Facility

Medical/Surgical Expenses (except office visits)

90%

70% after deductible

Sterilization (for men)

90%

Not Covered

Transplant Services

90%

Not Covered

Transportation and Lodging Limit: $10,000 per covered transplant, limited to $100 per day.

Precertification Requirements

Yes6

Premier Prescription Drug Program
Mandatory Generic7
(Defined by Premier Pharmacy Network - Not Physician Network)

Recommended Rx
Retail up to 34-day supply
$7 copayment generic
$15 copayment brand formulary
$30 copayment brand non-formulary
Mandatory generic (hard)

Maintenance Drugs through Mail Order up to 90-day supply
$14 copayment generic
$30 copayment brand formulary
$60 copayment brand non-formulary
Mandatory generic (hard)

Note: Certain benefits may be subject to day, visit, and/or hour limits. In connection with such benefits, all services you receive during a benefit period will reduce the remaining number of days, visits, and/or hours available under that benefit, regardless of whether you have satisfied your deductible.

1 You may be responsible for a facility fee, clinic charge or similar fee or charge (in addition to any professional fees) if your office visit or service is provided at a location that qualifies as a hospital department or a satellite building of a hospital.

2 A physician whose practice is limited to family practice, general practice, internal medicine or pediatrics.

3 Other cost sharing provisions and/or limits may apply to specific benefits, i.e., physical medicine, therapies, diagnostic services, mental health/substance abuse visits.

4 A sport-related injury is defined as bodily damage occurring during training or competition sanctioned, sponsored or otherwise conducted under the auspices of your National Governing Body (NGB); bodily damage occurring at an event sanctioned, sponsored or otherwise conducted under the auspices of the United States Olympic Committee or at an Olympic Training Center; or any bodily damage occurring during any training, competition, exhibition or other event in your sport, outside the sanction, sponsorship or auspices of your NGB or the United States Olympic Committee that you expect to receive or receive remuneration as a result of your participation. If you incur a sport-related injury, you must report your injury to your NGB or U. S. Paralympics Coordinator immediately. Failure to do so may lead to a delay in processing provider claims.

5 If precertification does not occur and it is later determined that all or part of the benefit was not medically necessary or appropriate, patient will be responsible for payment of any costs not covered.

6 Highmark must be contacted prior to issuance of DME over $3,000, a planned inpatient admission or within 48 hours of an emergency inpatient admission. Some facility providers will contact Highmark and obtain precertification of the inpatient admission on your behalf. Be sure to verify that your provider is contacting Highmark for precertification. If your provider does not, you are responsible for contacting Highmark. Also be sure to confirm Highmark's determination of medical necessity and appropriateness. If this does not occur and it is later determined that all or part of the inpatient stay was not medically necessary or appropriate, the patient will be responsible for payment of any costs not covered.

7 Under the mandatory generic provision, the member is responsible for the payment differential when a generic drug is available and the doctor or patient specifies a brand name drug. The member payment is the price difference between the brand drug and the generic drug in addition to the brand drug copayment.