NFL Joint Replacement Program
The NFL Joint Replacement Program provides medical and financial resources to retired players who are uninsured or lack the financing to have joint replacement surgery.
The Plan provides the Basic Benefit to any Eligible Player. If you are covered by insurance, the Basic Benefit is the lesser of (i) $5,250 or (ii) your co-insurance for health care items or services directly related to your surgery, such as your co-pays, provided the expense was incurred within one year of your surgery. If your surgery was performed before October 1, 2009, the $5,250 benefit was $5,000.
If a player is not covered by insurance and does not have the means to pay for this surgery, he may qualify for financial assistance from the NFL Player Care Foundation. In that case, he will not bear any of the costs associated with the surgery as long as the surgery is at one of several specially designated facilities. In addition, most normal complications arising from surgery are covered in full, up to a maximum of $250,000.
For more information regarding the Joint Replacement Benefit Program or to receive an application, please contact 1-800-NFL-GOAL or 1-800-635-4625.
Who is eligible for the Program?
To be eligible for the Basic Benefit, you must be a Retired Player and an independent, Board Certified Orthopedic Surgeon or Rheumatologist must certify, on a form provided by the Plan, that surgery to replace your knee, hip or shoulder is medically necessary. You must then send the certification, along with a completed application, to the Benefits Administrator to obtain confirmation that you are an Eligible Player. Effective November 1, 2010, if you apply for Joint Replacement Benefits after your surgery, the Benefits Administrator must receive the certification and completed application no later than 365 days after the date of the surgery.
What are the Benefits?
If players are covered by insurance, the Program will pay or reimburse the lesser of (i) $5,250 or (ii) the co-insurance for health care items or services directly related to their surgery. Players are also entitled to special treatment on a VIP basis if they elect to have their surgery at one of the healthcare facilities designated by the NFL Former Player Life Improvement Plan.
How do players apply?
Players must complete an application and a HIPAA authorization form. Also, they must have a Board Certified Orthopedist or Rheumatologist complete the form to certify that joint replacement surgery is medically necessary. Application materials are available by calling the NFL Player Benefits Department at 1-800-NFL-GOAL or 1-800-635-4625.
Where should Players have their surgery?
If players have insurance coverage or other financial resources, they may have their surgery anywhere they choose. However, the NFL Former Player Life Improvement Plan will grant access to a network of facilities throughout the country that are designated centers of excellence for joint replacements. If they choose one of these facilities, they will be treated as a VIP simply because they are retired NFL players. If a player qualifies for financial assistance from the NFL Player Care Foundation, surgery must be at one of the facilities designated by the NFL Former Player Life Improvement Plan. These facilities are located throughout the United States and players may choose where they will have their surgery.
Can Benefits be paid directly to a Provider?
Unless surgery is funded through the NFL Player Care Foundation, Benefits will only be paid to the Player.
Are Plan Benefits subject to an offset?
Generally, yes. For example, the joint replacement benefits are secondary to any other plan or arrangement available to cover expenses related to surgery.
Links
Good Samaritan Hospital/Arthritis Institute
1225 Wilshire Boulevard
Los Angeles, CA 90017
www.goodsam.org
Northwestern Memorial Hospital
251 East Huron
Chicago, IL 60611
www.nmh.org
Texas Orthopedic Hospital/Fondren Orthopedic Group
7401 South Main Street
Houston, TX 77030
www.texasorthopedic.com
