Interscholastic Athletics: School Districts Provide Some Assistance to
Uninsured Student Athletes (Letter Report, 09/12/2000, GAO/HEHS-00-148).

Pursuant to a legislative requirement, GAO reviewed high school
interscholastic athletics, focusing on the: (1) number of uninsured high
school students in the United States and the extent to which the lack of
health insurance poses a barrier to participation in high school
athletic programs; and (2) strategies school districts have developed to
provide health insurance and health care to high school sports
participants.

GAO noted that: (1) in 1998, an estimated 3.4 million uninsured children
were of high school age; (2) among highly populated states, there were
wide differences in the percentage of uninsured children of high school
age; (3) GAO was unable to identify any national, state, or local
information on the extent to which these high school students were
prevented from participating in athletic programs because they lacked
basic health insurance; (4) the officials of the 51 athletic
associations GAO surveyed were unaware of any instance in which a high
school student was prohibited from playing high school sports because he
or she lacked health insurance; (5) however, according to these
officials, while 10 states and the District of Columbia require high
school students to have health insurance before joining a school's
athletic program, the other 39 states leave this decision to the
discretion of local school districts; (6) in 17 of the 18 large school
districts, district policy required student athletes to have health
insurance to participate in high school sports; (7) in addition, many of
these districts required student athletes to document insurance coverage
before participating in sports; (8) however, school officials in four of
these large districts reported that they did not have the resources to
monitor the accuracy of health insurance information before or during a
sport's season; (9) 16 of the 18 school districts provided free
catastrophic athletic accident insurance to all student athletes
regardless of their insurance status; (10) in most cases, the
catastrophic accident policy would cover all medical costs once a
family's expenses exceeded $25,000; (11) further, in all school
districts GAO reviewed, local schools have adopted strategies to provide
access to low-cost athletic accident insurance to student athletes; (12)
in eight school districts, free supplemental athletic accident insurance
was automatically provided to all student athletes; (13) in nine
districts, the families of student athletes were given the opportunity
to purchase low-cost athletic accident insurance; (14) school officials
in these districts reported that instances of uninsured student athletes
requiring athletic accident care were addressed through such activities
as accident trust funds established at the school district level and
through direct community involvement; and (15) private organizations
such as hospitals and clinics assisted local school districts by
offering free medical services to student athletes for sports-related
injuries and other services such as pre-participation physicals or
injury evaluation.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  HEHS-00-148
     TITLE:  Interscholastic Athletics: School Districts Provide Some
	     Assistance to Uninsured Student Athletes
      DATE:  09/12/2000
   SUBJECT:  Sports
	     School districts
	     Secondary schools
	     Health insurance
	     Surveys
	     Secondary school students
IDENTIFIER:  State Children's Health Insurance Program
	     Medicaid Program

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GAO/HEHS-00-148

Report to Senator Barbara Boxer

September 2000 INTERSCHOLASTIC ATHLETICS

School Districts Provide Some Assistance to Uninsured Student Athletes

GAO/ HEHS- 00- 148

Letter 3 Appendixes Appendix I: Scope and Methodology 16

Appendix II: Indianapolis Public Schools Athletic Insurance 19 Appendix III:
Fairfax County School District Supplemental Athletic

Accident Insurance 21 Appendix IV: Comments From the Department of Education
24 Appendix V: GAO Contacts and Staff Acknowledgments 25

Bibliography 26 Related GAO Products 27 Tables Table 1: Public High School
Districts Reviewed 16

Table 2: Agencies Contacted to Identify Available Data on Uninsured Student
Athletes 17

Figure Figure 1: Percentage of Uninsured Children Ages 14- 18 in Selected
States, 1999 8

Abbreviations

CPS Current Population Survey NCES National Center for Education Statistics
NFHS National Federation of State High School Associations SCHIP State
Children's Health Insurance Program SPORT Sport Physiology and Orthopaedic
Rehabilitation Treatment

Health, Education, and Human Services Division

Lett er

B- 283140 September 12, 2000 The Honorable Barbara Boxer United States
Senate

Dear Senator Boxer: Participation in extracurricular activities is
considered to be an important part of a child's education. Educational
research has demonstrated that students involved in school activities have
higher grade point averages and graduation rates and lower rates of
absenteeism and discipline referral. In addition, this body of research
suggests that extracurricular activities help students develop teamwork
skills, self- discipline, and self- confidence. Sports are thus an important
component of high school extracurricular programs. During the 1998-1999
school year, about 6. 5 million boys and girls participated in high school
athletic programs. Unfortunately, participation in sports carries risks;
some students are injured, and a small number are seriously hurt. Due to the
risk of injury and the potential cost of treatment, some youths may be
unable to participate in school- based athletic programs because they lack
health insurance. Moreover, some youths may participate in sports without
the benefit of health insurance.

In your request, you expressed concern that some high school students may be
prevented from participating in their school's athletic programs because
they lacked health insurance, and you asked us to study this issue.
Specifically, you asked us to determine (1) the number of uninsured high
school students in the United States and the extent to which the lack of
health insurance poses a barrier to participation in high school athletic
programs and (2) the strategies school districts have developed to provide
health insurance and health care to high school sports participants.

To respond to your questions, we contacted federal and state officials and
experts on uninsured populations. To obtain a state- level perspective on
the issue of insurance and high school athletics, we conducted a national
survey of the 51 high school athletic associations (50 states and the
District of Columbia) and several site visits to state and local health and
athletic organizations. In addition, we reviewed 18 large school districts
through on- site visits and telephone interviews to obtain information on
how various school districts address this issue. App. I provides additional
details about our methodology.

Results in Brief In 1998, an estimated 3. 4 million uninsured children were
of high school age. Among highly populated states, there were wide
differences in the

percentage of uninsured children of high school age. The range included a
high of about 28 percent in Texas to about 6 percent in Massachusetts. We
were unable to identify any national, state, or local information on the
extent to which these high school students were prevented from participating
in athletic programs because they lacked basic health insurance. The
officials of the 51 athletic associations we surveyed were unaware of any
instance in which a high school student was prohibited from playing high
school sports because he or she lacked health insurance. However, according
to these officials, while 10 states and the District of Columbia require
high school students to have health insurance before joining a school's
athletic program, the other 39 states leave this decision to the discretion
of local school districts. In 17 of the 18 large school districts we
reviewed, district policy required student athletes to have health insurance
to participate in high school sports. In addition, many of these districts
required student athletes to document insurance coverage before
participating in sports. However, school officials in four of these large
districts reported that they did not have the resources to monitor the
accuracy of health insurance information before or during a sport's season.

Sixteen of the 18 school districts we reviewed provided free catastrophic
athletic accident insurance to all student athletes regardless of their
insurance status. In most cases, the catastrophic accident policy would
cover all medical costs once a family's expenses exceeded $25, 000. Two of
the 18 school districts are self- insured for catastrophic situations.
Further, in all school districts we reviewed, local schools have adopted
strategies to provide access to low- cost athletic accident insurance to
student athletes. In all but one of these districts, one of two strategies
was used to provide accident insurance to student athletes. First, in eight
school districts, free supplemental athletic accident insurance was
automatically provided to all student athletes. Second, in nine districts,
the families of student athletes were given the opportunity to purchase low-
cost athletic accident insurance. One district's policy is to cover all
medical costs of an athleticrelated injury. School officials in these
districts reported that instances of uninsured student athletes requiring
athletic accident care were addressed through such activities as accident
trust funds established at the school district level and through direct
community involvement. Also, private organizations such as hospitals and
clinics assisted local school districts by offering free medical services to
student athletes for sports- related injuries and other services such as
pre- participation physicals or injury evaluation.

Background For the school year 1998-1999, the National Federation of State
High School Associations (NFHS) reported that there were about 11.8 million

public high school students in the 50 states and the District of Columbia.
School- based sports programs include about 6.5 million participants in more
than 17,850 high schools across the nation. Of the total number of
participants, 3. 8 million were boys and 2.7 million were girls. As would be
expected, large states have high numbers of student athletes. Texas, for
example, had the greatest number of participants with 783, 751 high school
athletes, followed by California with 584,590 athletes. Among individual
sports, basketball is the most popular high school sport, with 16,763
programs for boys and 16, 439 programs for girls. In terms of individual
participants, football is the most popular boys' sport with 983,625
participants. Basketball is the most popular girls' sport, with 456, 873
students playing on high school teams.

Athletic injuries among high school athletes are common. A 1999 study
conducted for the National Athletic Trainers Association estimates that the
national student athlete population experiences more than 2 million injuries
of varying degree per year, around 500,000 doctor visits, and 30,000
hospitalizations. The study recorded injury data collected on 10 sports from
a national sample of high schools and found that football was associated
with the greatest number of injuries and involved the highest likelihood
that some type of injury would occur. Furthermore, of all injuries recorded
for all sports, 56 percent occurred during practice and 74 percent
restricted the student athlete from participating in a sports program for
fewer than 8 days. Another ongoing study conducted by the National Center
for Catastrophic Sports Injury Research examined serious and fatal injuries
suffered by high school sports participants from 1982 through 1998. During
this period, football players suffered 67 fatalities, 161 nonfatal injuries,
and 175 serious injuries. 1 With the exception of these studies, national
injury data are not routinely collected, maintained, or published.

1 The National Center for Catastrophic Sports Injury Research defines
nonfatal injuries as ones in which the athlete suffers “permanent
severe functional disability.” Serious injuries are defined as ones in
which the athlete suffers “no permanent functional disability but
severe injury.”

To help address the health insurance needs of low- income children, which
could include those participating in high school sports, the Congress
established the State Children's Health Insurance Program (SCHIP). 2 From
fiscal year 1998 to fiscal year 2008, this program will provide more than
$40 billion to states for the child health system under the federal/ state
Medicaid program or other state- established health insurance programs. The
Department of Health and Human Services distributes the funds to states
based on a formula that includes the state's number of low- income children,
the state's number of uninsured low- income children, and the state's health
care costs as compared with other states. States are afforded a significant
level of flexibility in defining the groups of children targeted for
coverage under the new program. Specifically, under SCHIP, states choose to
spend the new funds by (1) expanding Medicaid and building on the existing
program; (2) establishing a separate, stand- alone program; or (3) combining
these two approaches. The program targets funds at uninsured children in
families whose income is too high to qualify for Medicaid but is at or below
200 percent of the federal poverty level, that is, $32,900 for a family of
four. States also have discretion as to how to calculate income (gross, net,
or countable income). More significantly, states have flexibility in
establishing nonfinancial eligibility criteria. For example, SCHIP can use
criteria such as residency, geographic area, and access to other health
coverage. About 2 million children have been enrolled to date, but it
remains uncertain the extent to which additional children will enroll in
SCHIP.

2 In August 1997, as a part of the Balanced Budget Act of 1997, P. L. 105-
33, the State Children's Health Insurance Program (SCHIP) was established as
title XXI of the Social Security Act.

An Estimated 3 Million Of the 13 million children without basic health
insurance, more than 3

million are of high school age (14-18). 3 Substantial differences in the
Children of High

uninsured rate among children of high school age exist across states. For
School Age Are

example, the estimated uninsured rates among the states we either visited
Uninsured, But the

or contacted range from a high of 27. 9 percent in Texas to a low of 5.7
Extent to Which This Is

percent in Massachusetts (see fig. 1 for uninsured rates among large
states).

a Barrier to Sports Programs Is Unknown

3 We used the Current Population Survey (CPS) data to estimate the number of
high school students without insurance. The CPS is a monthly survey of about
50, 000 households conducted by the Bureau of the Census for the Bureau of
Labor Statistics. It is designed to produce reliable estimates at the
national level and, to a lesser extent, the regional level. Due to the
potentially small sample taken within small states, we focused our analysis
on selected large states.

Figure 1: Percentage of Uninsured Children Ages 14- -18 -- in Selected
States, 1999

Percentage

30 25 20 15 10

5 0

California Texas Massachusetts Florida Virginia Indiana Source: 1999 CPS
data.

The extent to which any of these children are prevented from participating
in high school sports is unknown. We found no systematic data collection
efforts or single data sources that document the number of high school
students prohibited from participating in school- based sports due to the
lack of insurance. In our survey of high school athletic associations,
officials were unaware of any instance in which a high school student was
prohibited from playing high school sports due to a lack of health
insurance.

Some states and school districts require high school student athletes to
have basic health insurance prior to and while participating in a sports
program. Our survey of high school athletic association officials found that
only 10 states and the District of Columbia have a statewide requirement
that student athletes have health insurance to participate in a sports
program. However, according to officials of high school athletic
associations, many school districts require health insurance for athletes.
Of the 18 school districts we reviewed, 17 required that their student
athletes have basic insurance to participate in high school sports. 4 Within
some of these districts, school officials we spoke to stated that athletic
staff at each school collect information about the status of each student
athlete's private insurance. For example, Fairfax County District Schools in
Virginia collect insurance information as part of establishing the
eligibility of student athletes, which generally includes a physical
examination and a signed parental consent form.

We found, however, that local schools often do not verify health insurance
information before students participate in sports, nor do they follow up on
this during the school year. High school officials in many of the 18
districts reviewed pointed out that this information is usually collected
only once during the school year and that schools are unable to verify the
accuracy of the data collected due to time and expense. Further, an expert
on uninsured populations noted that it is not unusual for students to lose
their insurance coverage at some point during the school year due to a
change in their parent's job status. For example, an athlete's parent may
lose his or her job at some point during the school year, resulting in lost
insurance benefits for the child. In addition, several school and health
care officials we spoke to suggested that it is not uncommon for students or
parents to misrepresent their current insurance status so that the student
can participate in a school's sports program.

4 Boston Public Schools have no requirement that student athletes have basic
health insurance to participate in school- based athletic programs. School
district officials reported that the district will routinely cover any costs
associated with an injury related to school athletics.

Some School Districts School districts and health care organizations in the
locations we visited

and Other have developed strategies to make athletic accident insurance
available to

student athletes and to provide access to athletic accident- related care.
Organizations Offer

Most school districts provided catastrophic athletic accident insurance to
Insurance and Care

all student athletes regardless of their insurance status and also offered
Options to All High

health insurance to student athletes free of charge or at low cost. School
district officials reported that both the school district and local
community

School Athletes organizations addressed instances of uninsured students who
required care

due to athletic accidents. In addition, in all 18 school districts we
reviewed, private organizationsï¿½including hospitals, medical centers, and
sports clinicsï¿½assisted local school districts by offering free medical
services to student athletes.

School Districts Offer Free Sixteen of the 18 school districts we reviewed
offered free catastrophic

or Low- Cost Accident coverage to high school athletes. The other two school
districts are selfinsured

Insurance for catastrophic situations. Catastrophic injury insurance is
meant

to cover the medical costs for serious injury, such as a fractured vertebra
or paralysis. In most of the school districts we contacted, this insurance
coverage commences when the athlete's medical bills reach $25,000. The
maximum amount of coverage ranges from $1 million to $5 million depending on
the district. School officials we spoke to stated that catastrophic injuries
within their districts are rare but that catastrophic insurance is
nonetheless important. For example, one school official from the El Paso
Independent School District in Texas said that one student had experienced
head trauma in a football game and had been hospitalized for 6 months. The
school districts we visited emphasized that the premiums they pay for
catastrophic insurance are relatively low. For example, the Austin
Independent School District in Texas pays approximately $13,000 to provide
catastrophic insurance coverage to all 10,000 students participating in
school sports.

In addition to catastrophic injury insurance, 17 of the 18 school districts
we reviewed either provide free supplemental athletic accident insurance to
student athletes or offer athletic accident insurance to student athletes
for a fee. Eight of the public school districts we contacted purchased
supplemental athletic accident insurance for their student athletes. These
plans are blanket policies purchased for a specific number of student
athletes at a set rate. For example, the San Antonio Independent Schools in
Texas pay approximately $260, 000 to cover about 17,000 sports

participants. Other examples of similar strategies are in effect across the
nation.

The El Paso Independent School District in Texas insures all high school
athletes at no charge to the student. The policy provides secondary
insurance coverage to most student athletes and acts as a primary plan for
student athletes who are injured during a sports activity and do not have
other insurance coverage. The District of Columbia insures high school
students participating in

sports at no charge to the student. Although the policy has a $100
deductible should the student athlete file a claim for needed care, very
seldom is the deductible fee charged for low- income students. The
Indianapolis School District in Indiana provides for and pays the

insurance premiums for high school students participating in sports. The
policy is intended to be a supplemental policy. However, if a student does
not have basic health insurance coverage, the school policy becomes the
primary insurance if the student is injured during athletics. App. II
presents an example of a supplemental athletic accident coverage plan that
is provided to student athletes' parents or guardians.

Nine school districts we reviewed offer students the opportunity to purchase
low- cost athletic accident insurance. In these districts, the student
athlete may purchase an athletic accident policy through the school. These
policies cover only accidents occurring during authorized events such as
games or formal practices. App. III, provided by Fairfax County School
District of Virginia, is an example of such a policy.

While most of the districts that offer these accident policies require them
only when the student athlete does not have insurance, some school districts
require that all student athletes- regardless of insurance status- purchase
a policy through the district. For example, the Hillsborough County Public
Schools in Florida require all student athletes to purchase a policy through
the district regardless of whether the athlete has private insurance. The
cost to the student is one- half of the total cost to the district. For
instance, if the cost to the district for football insurance is $90 to $95,
the student pays $45 to $48. One Hillsborough County school official cited
the fact that many families do not have a steady source of insurance. School
officials believe that having a policy for the mandatory purchase of
insurance is the best way to protect the school district from liability.
These officials also believe that the policy protects the athlete and his or
her family from the financial burden of paying for health care out of
pocket.

In addition, some school districts have implemented methods to provide
insurance to students of low- income families on a case- by- case basis. For
example, the Hillsborough County Public School District in Florida has an
annual “Football Jamboree.” The proceeds of this event go into a
trust fund designed to help poor families pay the cost of the district's
mandatory insurance. In cases of financial hardship, the principal of each
school can obtain funds from the trust to cover an athlete's insurance
costs.

Local School Districts and School officials acknowledge that in some
instances high school athletes

Community Groups participate in sports without the benefit of health
insurance. As we

Respond to Athletic indicated earlier, school officials cited a number of
factors that contribute

Accidents Among the to this situation, including the lack of resources to
verify students'

insurance status, a family member's loss of insurance coverage during the
Uninsured

sport season, or parents who misrepresent their insurance status at the
beginning of a season. Although student athletes who lose or have no
insurance would be covered by the district's free catastrophic accidental
insurance policy, their families would be at risk for medical expenses up to
the catastrophic threshold. However, school officials also reported that
instances of uninsured students requiring athletic accident care were
infrequent. The school districts we reviewed had various measures to meet
the health care needs of an injured athlete when the school district does
not know that the student is participating in sports without health
insurance.

According to school officials, the school and community actively respond to
athletic accidents among uninsured students to address health care needs and
minimize costs to the family. School district efforts included fundraising
drives, booster club contributions, and the provision of free care by health
care providers such as physicians and clinics. In some locations, school
districts rely on their health care partners to provide free medical service
to the injured student athlete. For example, districts such as the Los
Angeles Unified School District in California benefit from athletic trainers
provided by the University of Southern California Center for Athletic
Medicine Foundation and the West Coast Sports Medicine Foundation. The
athletic trainers, who are present at games and often during practices,
provide on- the- spot free care for many less serious injuries. School
officials also told us that, for more severe injuries, local hospitals and
community and school organizations such as booster clubs help ease the
financial burden on the athlete's family. These athletic accident plans and
medical services are limited to sports- related injuries incurred by
students with no basic health insurance.

Schools Partner With Health Many high school districts we reviewed have
developed partnerships with

Care Organizations to local health care organizations to provide a range of
health- related services

Provide Athletic Accident to student athletes. These organizations provide
student athletes with free

Services pre- participation physicals, injury evaluation services, access to

physicians, and rehabilitation services. More specifically, The West Coast
Sports Medicine Foundation, a nonprofit charitable

organization, provides approximately 12,000 high school students at 25 Los
Angeles area schools with the opportunity to participate in schoolbased
sports. The foundation provides student athletes with (1) free (no cost to
the athlete or family) athletic accident insurance coverage, (2) athletic
training to reduce and mitigate injuries, and (3) access to sports. The
Sport Physiology and Orthopaedic Rehabilitation Treatment

(SPORT) Clinic in Riverside, California, has contracted with area high
schools to provide a program for the care and prevention of athletic
injuries. Health care officials at the SPORT Clinic educate student athletes
to prevent or reduce athletic injuries, advise athletes on the care and
treatment of their injuries, and provide treatment of minor athletic
injuries. In addition, the clinic's facilities are available for use by high
school athletes. Medical consultation, treatment, and facilities are
available free of charge for each injury, for two weeks from the initial
visit. The Methodist Sports Medicine Center at the Methodist Hospital and
St.

Vincent's Medicine in Indianapolis have had informal agreements with the
Indianapolis Independent School District for more than15 years. These
medical providers furnish athletic trainers and doctors free of charge for
all games and tournaments. In addition, athletic trainers visit each high
school within the Indianapolis School District twice a week.

Finally, some districts use local health providers to conduct
preparticipation exams. The Healthsouth Doctor's Hospital of Coral Gables,
Florida, has an arrangement with Dade County Public Schools to provide
physicals free of charge to all high school athletes within the county.

Agency Comments and We provided the Department of Education with the
opportunity to

Our Evaluation comment on a draft of this report. Education concurred with
our findings

(see app. IV).

We will send copies of this report to The Honorable Richard W. Riley,
Secretary of Education, and to school officials in the states we visited. We
will also make copies available to others on request.

If you have any questions regarding this report, please contact me at (202)
512- 7215. Key contacts and staff acknowledgments for this report are listed
in app. V.

Sincerely yours, Marnie S. Shaul Associate Director, Education, Workforce,

and Income Security Issues

Appendi Appendi xes xI

Scope and Methodology We designed our study to collect data on whether high
school students are prevented from participating in sports because they lack
health insurance. We also sought to determine the number of uninsured high
school students in the United States, the extent to which the lack of health
insurance posed a barrier to participation in high school athletic programs,
and the strategies health care organizations and school districts have
developed to assist student athletes with health insurance or health care.
We interviewed education, health, and athletic officials at the national,
state, and local levels and contacted 18 large public school districts. We
visited 8 public school districts and conducted telephone interviews with
officials at 10 public school districts.

We also administered a survey to high school athletic association officials
in all 50 states and the District of Columbia to help determine whether
students participate in sports without the benefit of health insurance. For
our statistical analysis of uninsured children and school districts, we used
the 1999 Current Population Survey (CPS) and the National Center for
Education Statistics' (NCES) database, respectively. We performed our work
between July 1999 and July 2000 in accordance with generally accepted
government auditing standards.

School District Reviews We visited 8 school districts and telephoned
officials at another 10 school districts that used a variety of methods to
provide assistance to student

athletes. All districts were among the largest in the nation. Within each
school district we interviewed athletic directors, business and insurance
managers, athletic health care service coordinators, and other relevant
staff involved with student athletes (see table 1).

Table 1: Public High School Districts Reviewed State School Districts

CA Los Angeles Unified School District San Francisco Unified School District
DC District of Columbia Public Schools FL Dade County Public Schools

Hillsborough County Public Schools Orange County Schools Palm Beach County
School District

(Continued From Previous Page)

State School Districts

Pinellas County School District Polk County School District IN Indianapolis
Public School District MA Boston Public Schools TX Austin Independent School
District

Dallas Independent School District El Paso Independent School District
Houston Independent School District Northside Independent School District
San Antonio Independent School District VA Fairfax County Public Schools

Athletic Association Survey We designed and mailed a data collection
instrument to representatives of the interscholastic athletic associations
of the 50 states and the District of Columbia. The survey focused on five
areas: insurance requirements for student athletes, insurance plans
available to student athletes, premiums and types of coverage offered to the
student athletes, instances of students participating in sports without
health insurance, and innovative methods to provide student athletes with
health insurance. We received 49 completed questionnaires.

National, State, and Local We interviewed education and health officials at
the national, state, and

Education and Health local levels to identify federal, state, and local
health insurance

Agencies requirements for student athletes. We also collected information on

whether any of these agencies had data on uninsured student athletes (see
table 2).

Table 2: Agencies Contacted to Identify Available Data on Uninsured Student
Athletes

Agency contacted Data No data Anecdotal

U. S. Department of Education X U. S. Department of Education, State of
Massachusetts X U. S. Department of Health and Human Services X

(Continued From Previous Page)

Agency contacted Data No data Anecdotal

Children's Defense Fund X Center on Budget and Policy Priorities X National
Parent Teachers Association X Council of Chief School Officers X Robert Wood
Johnson Foundation X President's Council on Physical Fitness X National
Alliance for Health and Physical Education X National Center for Health
Statistics X National Assembly on School- Based Health Care X X USC Center
for Athletic Medicine X X Health Care for All (Coaches Campaign, Mass.) X X
National Federation of State High School Associations X Coaches Campaign,
Penn. X National Federation Officials Association X West Coast Sports
Medicine Foundation X X Healthsouth Doctor's Hospital, Coral Gables, Fla. X
The SPORT Clinic X X California Athletic Trainers Association X X National
Federation Coaches Association X National Youth Sports Safety Foundation,
Inc. X California Interscholastic Foundation X Massachusetts Interscholastic
Athletic Association

X (MIAA) National Association of Insurance Commissioners X

National Athletic Trainers Association (NATA) X National Interscholastic
Athletic Administrators

X Association Texas University Interscholastic League X

Texas Department of Health X Texas Healthy Kids Corporation X American
Association of School Administrators X Bureau of Labor Statistics (Current
Population Survey) a X a Data have limitations.

Indianapolis Public Schools Athletic

Appendi xII

Insurance The Indianapolis Public Schools pay for health insurance that
covers high school students for injuries suffered in sports. The policy is
intended to be a supplemental athletic accident policy; however, if a
student does not have other insurance coverage, the school policy becomes
the primary insurance. Also, if a student is covered by Medicaid or SCHIP,
the district's supplemental policy becomes the primary coverage.

Only accidents that occur while the student is involved in an athletic event
or practice are covered. This policy defines an accident as an unexpected,
sudden, and definable event that is the direct cause of a bodily injury,
independent of any illness, prior injury, or congenital predisposition.
Coverage is only for care not covered by any family or employer group
coverage or plan. This policy has no deductible.

The following page gives an example of a letter that the Indianapolis Public
Schools send to parents and guardians explaining the insurance coverage
provided to student athletes.

Fairfax County School District Supplemental

Appendi xI II

Athletic Accident Insurance Ten of the school districts we reviewed offer
students the opportunity to purchase low- cost supplemental accident
insurance. The specifics of the policies offered vary from district to
district. Generally, such a policy would cover only accidents that occur
during school- sponsored and -supervised sporting events, practices, or
transportation in a school- furnished vehicle to such an event. The policies
act as primary coverage for student athletes without insurance and as
secondary coverage for those with insurance. Additional coverage, such as
24- hour accident coverage, may be obtained for an additional charge. The
following pages are an illustration of the supplemental accident insurance
policy offered to student athletes of the Fairfax County School District.

Comments From the Department of

Appendi xI V Education

Appendi xV

GAO Contacts and Staff Acknowledgments GAO Contacts David D. Bellis, (202)
512- 7278 Christine M. Shine, (617) 565- 7547 Staff

In addition to the individuals named above, Christopher Galvin and Kevin
Acknowledgments

Murphy made key contributions to this report.

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Insurance and Characteristics of the Uninsured: Analysis of the March 1999
Current Population Survey. Washington, D. C.: December 1999.

Herz, Elicia, and Baumrucker, Evelyne. State Children's Health Insurance
Program: A Brief Overview. Washington, D. C.: Congressional Research
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C.: University of North Carolina, 1999.

Powell, John W., and Barber- Foss, Kim D. “Injury Patterns in Selected
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-. Health Insurance Coverage of Children. Washington, D. C.: Congressional
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-. Health Insurance: Uninsured Children by State, 1996-1998. Washington, D.
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-. Health Insurance: Uninsured by State, 1998. Washington, D. C.:
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July 1999. NCES 1999-318.

Related GAO Products Medicaid and SCHIP: Comparisons of Outreach, Enrollment
Practices, and Benefits( GAO/ HEHS- 00- 86, Apr. 14, 2000).

Medicaid in Schools: Improper Payments Demand Improvements in HCFA
Oversight( GAO/ HEHS/ OSI- 00- 69, Apr. 5, 2000).

Intercollegiate Athletics: Comparison of Selected Characteristics of Men's
and Women's Programs( GAO/ HEHS- 99- 3R, June 18, 1999).

Children's Health Insurance Program: State Implementation Approaches Are
Evolving( GAO/ HEHS- 99- 65, May 14, 1999).

Intercollegiate Athletics: Status of Efforts to Promote Gender Equity (GAO/
HEHS- 97- 10, Oct. 25, 1996).

Health Insurance for Children: Private Insurance Coverage Continues to
Deteriorate( GAO/ HEHS- 96- 129, June 17, 1996).

Health Insurance for Children: State and Private Programs Create New
Strategies to Insure Children( GAO/ HEHS- 96- 35, Jan. 18, 1996).

(104978) Lett er

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GAO United States General Accounting Office

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Contents

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Appendix I

Appendix I Scope and Methodology

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Appendix I Scope and Methodology

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Appendix II

Appendix II Indianapolis Public Schools Athletic Insurance

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Appendix III

Appendix III Fairfax County School District Supplemental Athletic Accident
Insurance

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Appendix III Fairfax County School District Supplemental Athletic Accident
Insurance

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Appendix IV

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Appendix V

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