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Claim Summary Report
Selected Report Criteria Client Name: Winthrop University Payor Type: <All> Policy Years: Last Five Years Campus: <All> Date Range: - Include Open Claims: Yes Include Denied Claims: No Include All Episodes: No Claims Through Date: 9/17/2026 12:41:04 PM P.O. Box 511 Matawan, NJ 07747 Phone: 800.445.3126 Fax: 732.583.9610 www.bobmccloskey.com
Leaders in Student & Sports Insurance Administration Since 1975
| Policy Year |
| Benefit Contract |
| Contract Type |
| Paid Claims |
| Claims Through Date |
| 2026-2027 |
| WRP00_080126-27 |
| SF-Self-Insured Retention/Agg Ded |
| $145.00 |
| 9/17/2026 |
| 2025-2026 |
| WRP00_080125-26 |
| SF-Self-Insured Retention/Agg Ded |
| $231,692.62 |
| 9/17/2026 |
| 2025-2026 |
| WRP00_080125-26 ADMIN DEC |
| SF-Admin Dec |
| $0.00 |
| 9/17/2026 |
| 2024-2025 |
| MCB 4850979_080124-25 |
| UNIV/COLLEGE |
| $121,339.25 |
| 9/17/2026 |
| 2024-2025 |
| WRP00_080124-25 ADMIN DEC |
| SF-Admin Dec |
| $1,778.94 |
| 9/17/2026 |
| 2024-2025 |
| WRP00_080124-25 EXHAUSTED |
| SF-Self-Insured Retention/Agg Ded |
| $220,000.00 |
| 9/17/2026 |
| 2023-2024 |
| MCB 4850979_080123-24 |
| UNIV/COLLEGE |
| $69,435.73 |
| 9/17/2026 |
| 2023-2024 |
| WRP00_080123-24 ADMIN DEC |
| SF-Admin Dec |
| $278.32 |
| 9/17/2026 |
| 2023-2024 |
| WRP00_080123-24 EXHAUSTED |
| SF-Self-Insured Retention/Agg Ded |
| $195,000.00 |
| 9/17/2026 |
| 2022-2023 |
| MCB 4850979_080122-23 |
| UNIV/COLLEGE |
| $59,589.74 |
| 9/17/2026 |
| 2022-2023 |
| WRP00_080122-23 ADMIN DEC |
| SF-Admin Dec |
| $7,256.51 |
| 9/17/2026 |
| 2022-2023 |
| WRP00_080122-23 EXHAUSTED |
| SF-Self-Insured Retention/Agg Ded |
| $195,000.00 |
| 9/17/2026 |
Benefit Contract ID: WRP00_080126-27 Effective Date: 8/1/2026
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 08/11/2026 |
| SOCCER |
| Men's |
| MOUTH |
| $145.00 |
| $145.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $145.00 |
| Total for Benefit Contract: WRP00_080126-27 |
| $145.00 |
| $145.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $145.00 |
Benefit Contract ID: WRP00_080125-26 Effective Date: 8/1/2025
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 08/16/2025 |
| SOCCER |
| Men's |
| SHOULDER |
| $545.00 |
| $330.00 |
| $215.00 |
| $0.00 |
| $305.00 |
| $0.00 |
| $25.00 |
| Name Withheld |
| 08/12/2025 |
| VOLLEYBALL |
| Women's |
| SHOULDER |
| $7,243.20 |
| $2,514.41 |
| $4,728.79 |
| $0.00 |
| $2,064.41 |
| $0.00 |
| $450.00 |
| Name Withheld |
| 02/14/2026 |
| SOFTBALL |
| Women's |
| HAND |
| $580.00 |
| $360.17 |
| $219.83 |
| $0.00 |
| $168.13 |
| $0.00 |
| $192.04 |
| Name Withheld |
| 02/18/2026 |
| SOCCER |
| Women's |
| SHOULDER |
| $7,791.45 |
| $2,513.44 |
| $5,278.01 |
| $0.00 |
| $0.00 |
| $0.00 |
| $2,513.44 |
| Name Withheld |
| 02/26/2026 |
| BASKETBALL |
| Men's |
| FOOT |
| $15,796.75 |
| $6,010.17 |
| $9,786.58 |
| $0.00 |
| $2,936.76 |
| $0.00 |
| $3,073.41 |
| Name Withheld |
| 09/05/2025 |
| TRACK & FIELD |
| Men's |
| FOOT |
| $515.00 |
| $377.25 |
| $137.75 |
| $0.00 |
| $352.25 |
| $0.00 |
| $25.00 |
| Name Withheld |
| 12/16/2025 |
| BASEBALL |
| Men's |
| KNEE |
| $1,855.00 |
| $658.85 |
| $1,196.15 |
| $0.00 |
| $431.25 |
| $0.00 |
| $227.60 |
| Name Withheld |
| 01/04/2026 |
| SOFTBALL |
| Women's |
| SHOULDER |
| $14,978.13 |
| $3,305.30 |
| $11,672.83 |
| $0.00 |
| $324.85 |
| $0.00 |
| $2,980.45 |
| Name Withheld |
| 09/14/2025 |
| SOFTBALL |
| Women's |
| ANKLE |
| $1,461.00 |
| $437.95 |
| $1,023.05 |
| $0.00 |
| $170.25 |
| $0.00 |
| $267.70 |
| Name Withheld |
| 08/27/2025 |
| SOCCER |
| Men's |
| GROIN |
| $613.00 |
| $467.97 |
| $145.03 |
| $0.00 |
| $432.97 |
| $0.00 |
| $35.00 |
| Name Withheld |
| 02/28/2026 |
| CROSS COUNTRY |
| Women's |
| LEG |
| $3,004.17 |
| $1,798.49 |
| $1,205.68 |
| $0.00 |
| $1,004.29 |
| $0.00 |
| $794.20 |
| Name Withheld |
| 08/04/2025 |
| SOCCER |
| Women's |
| HIP |
| $491.00 |
| $224.81 |
| $266.19 |
| $0.00 |
| $0.00 |
| $0.00 |
| $224.81 |
P.O. Box 511 Matawan, NJ 07747 Phone: 800.445.3126 Fax: 732.583.9610 www.bobmccloskey.com
Claims Through Date: 9/17/2026 12:41:04 PM Leaders in Student & Sports Insurance Administration Since 1975
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 01/20/2026 |
| SOFTBALL |
| Women's |
| MULTIPLE |
| $7,619.00 |
| $2,731.00 |
| $4,888.00 |
| $0.00 |
| $1,756.97 |
| $0.00 |
| $974.03 |
| Name Withheld |
| 08/09/2025 |
| SOCCER |
| Women's |
| FINGER |
| $473.00 |
| $243.11 |
| $229.89 |
| $0.00 |
| $0.00 |
| $0.00 |
| $243.11 |
| Name Withheld |
| 02/12/2026 |
| SOFTBALL |
| Women's |
| NOSE |
| $3,393.00 |
| $1,966.48 |
| $1,426.52 |
| $0.00 |
| $1,124.90 |
| $0.00 |
| $841.58 |
| Name Withheld |
| 01/02/2026 |
| BASKETBALL |
| Women's |
| FINGER |
| $3,034.72 |
| $1,287.89 |
| $1,746.83 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,287.89 |
| Name Withheld |
| 01/31/2026 |
| VOLLEYBALL |
| Women's |
| KNEE |
| $1,452.00 |
| $995.00 |
| $457.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $995.00 |
| Name Withheld |
| 09/13/2025 |
| SOCCER |
| Women's |
| HIP |
| $15,883.61 |
| $5,103.63 |
| $10,779.98 |
| $0.00 |
| $2,216.79 |
| $0.00 |
| $2,886.84 |
| Name Withheld |
| 10/04/2025 |
| BASEBALL |
| Men's |
| SHOULDER |
| $109,956.72 |
| $27,303.17 |
| $82,653.55 |
| $0.00 |
| $23,149.77 |
| $0.00 |
| $4,153.40 |
| Name Withheld |
| 10/17/2025 |
| SOCCER |
| Men's |
| KNEE |
| $62,648.51 |
| $27,674.26 |
| $34,974.25 |
| $0.00 |
| $0.00 |
| $0.00 |
| $27,674.26 |
| Name Withheld |
| 09/01/2025 |
| LACROSSE |
| Women's |
| FOOT |
| $9,367.00 |
| $2,854.22 |
| $6,512.78 |
| $0.00 |
| $1,695.80 |
| $0.00 |
| $1,158.42 |
| Name Withheld |
| 06/13/2026 |
| BASKETBALL |
| Women's |
| FOOT |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 08/03/2025 |
| SOCCER |
| Women's |
| KNEE |
| $5,090.00 |
| $1,928.35 |
| $3,161.65 |
| $0.00 |
| $362.99 |
| $0.00 |
| $1,565.36 |
| Name Withheld |
| 03/30/2026 |
| SOFTBALL |
| Women's |
| HIP |
| $17,640.21 |
| $6,726.99 |
| $10,913.22 |
| $0.00 |
| $0.00 |
| $0.00 |
| $6,726.99 |
| Name Withheld |
| 09/11/2025 |
| SOCCER |
| Women's |
| FOOT |
| $678.00 |
| $427.56 |
| $250.44 |
| $0.00 |
| $384.81 |
| $0.00 |
| $42.75 |
| Name Withheld |
| 08/23/2025 |
| SOCCER |
| Men's |
| KNEE |
| $29,048.54 |
| $9,132.27 |
| $19,916.27 |
| $0.00 |
| $5,507.32 |
| $0.00 |
| $3,624.95 |
| Name Withheld |
| 02/22/2026 |
| SOCCER |
| Women's |
| SHOULDER |
| $12,611.95 |
| $4,248.35 |
| $8,363.60 |
| $0.00 |
| $4,038.35 |
| $0.00 |
| $210.00 |
| Name Withheld |
| 09/19/2025 |
| TRACK & FIELD |
| Women's |
| SHOULDER |
| $9,328.83 |
| $2,692.76 |
| $6,636.07 |
| $0.00 |
| $0.00 |
| $0.00 |
| $2,692.76 |
| Name Withheld |
| 11/18/2025 |
| BASKETBALL |
| Men's |
| MOUTH |
| $3,219.20 |
| $1,908.40 |
| $940.80 |
| $370.00 |
| $0.00 |
| $0.00 |
| $1,908.40 |
| Name Withheld |
| 06/12/2026 |
| BASKETBALL |
| Women's |
| FOOT |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 01/11/2026 |
| LACROSSE |
| Women's |
| KNEE |
| $2,899.00 |
| $1,223.21 |
| $1,675.79 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,223.21 |
| Name Withheld |
| 12/03/2025 |
| BASEBALL |
| Women's |
| TEETH |
| $141.00 |
| $141.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $141.00 |
| Name Withheld |
| 10/04/2025 |
| SOCCER |
| Women's |
| ANKLE |
| $583.00 |
| $333.97 |
| $249.03 |
| $0.00 |
| $256.33 |
| $0.00 |
| $77.64 |
| Name Withheld |
| 11/01/2025 |
| BASKETBALL |
| Women's |
| MOUTH |
| $616.00 |
| $616.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $616.00 |
| Name Withheld |
| 03/31/2026 |
| LACROSSE |
| Women's |
| BACK |
| $1,341.09 |
| $443.08 |
| $898.01 |
| $0.00 |
| $0.00 |
| $0.00 |
| $443.08 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 11/29/2025 |
| BASKETBALL |
| Men's |
| FINGER |
| $1,095.94 |
| $568.20 |
| $527.74 |
| $0.00 |
| $0.00 |
| $0.00 |
| $568.20 |
| Name Withheld |
| 01/31/2026 |
| LACROSSE |
| Women's |
| THIGH |
| $295.00 |
| $229.99 |
| $65.01 |
| $0.00 |
| $179.99 |
| $0.00 |
| $50.00 |
| Name Withheld |
| 10/26/2025 |
| BASKETBALL |
| Women's |
| SHOULDER |
| $1,759.98 |
| $743.48 |
| $1,016.50 |
| $0.00 |
| $59.56 |
| $0.00 |
| $683.92 |
| Name Withheld |
| 03/01/2026 |
| SOFTBALL |
| Women's |
| HAND |
| $477.00 |
| $262.41 |
| $214.59 |
| $0.00 |
| $0.00 |
| $0.00 |
| $262.41 |
| Name Withheld |
| 09/14/2025 |
| SOCCER |
| Women's |
| KNEE |
| $483.00 |
| $270.34 |
| $212.66 |
| $0.00 |
| $270.34 |
| $0.00 |
| $0.00 |
| Name Withheld |
| 09/01/2025 |
| BASKETBALL |
| Women's |
| FOOT |
| $420.00 |
| $420.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $420.00 |
| Name Withheld |
| 10/14/2025 |
| BASKETBALL |
| Women's |
| LEG |
| $12,698.51 |
| $4,405.63 |
| $8,292.88 |
| $0.00 |
| $0.00 |
| $0.00 |
| $4,405.63 |
| Name Withheld |
| 08/24/2025 |
| SOCCER |
| Men's |
| ANKLE |
| $3,693.54 |
| $2,115.39 |
| $1,578.15 |
| $0.00 |
| $0.00 |
| $0.00 |
| $2,115.39 |
| Name Withheld |
| 02/10/2026 |
| BASKETBALL |
| Women's |
| RIB |
| $142.08 |
| $65.76 |
| $76.32 |
| $0.00 |
| $0.00 |
| $0.00 |
| $65.76 |
| Name Withheld |
| 03/30/2026 |
| TRACK & FIELD |
| Women's |
| FAINT/DIZZY/SH ORTNESS OF BREATH |
| $9,690.00 |
| $0.00 |
| $9,690.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| Name Withheld |
| 03/26/2026 |
| BASKETBALL |
| Men's |
| SHOULDER |
| $1,631.52 |
| $734.28 |
| $897.24 |
| $0.00 |
| $215.00 |
| $0.00 |
| $519.28 |
| Name Withheld |
| 06/15/2026 |
| BASKETBALL |
| Women's |
| FOOT |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 03/15/2026 |
| BASEBALL |
| Men's |
| SHOULDER |
| $1,139.00 |
| $909.81 |
| $229.19 |
| $0.00 |
| $0.00 |
| $0.00 |
| $909.81 |
| Name Withheld |
| 02/10/2026 |
| LACROSSE |
| Women's |
| WRIST |
| $2,956.00 |
| $2,301.22 |
| $654.78 |
| $0.00 |
| $1,201.78 |
| $0.00 |
| $1,099.44 |
| Name Withheld |
| 11/17/2025 |
| CROSS COUNTRY |
| Women's |
| FOOT |
| $224.50 |
| $224.50 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $224.50 |
| Name Withheld |
| 04/13/2026 |
| CROSS COUNTRY |
| Women's |
| HIP |
| $1,139.00 |
| $240.99 |
| $898.01 |
| $0.00 |
| $0.00 |
| $0.00 |
| $240.99 |
| Name Withheld |
| 01/31/2026 |
| LACROSSE |
| Women's |
| THIGH |
| $2,370.00 |
| $1,613.57 |
| $756.43 |
| $0.00 |
| $283.57 |
| $0.00 |
| $1,330.00 |
| Name Withheld |
| 09/30/2025 |
| VOLLEYBALL |
| Women's |
| KNEE |
| $324.00 |
| $179.79 |
| $144.21 |
| $0.00 |
| $107.88 |
| $0.00 |
| $71.91 |
| Name Withheld |
| 01/23/2026 |
| TRACK & FIELD |
| Women's |
| LEG |
| $673.00 |
| $356.50 |
| $316.50 |
| $0.00 |
| $331.50 |
| $0.00 |
| $25.00 |
| Name Withheld |
| 09/22/2025 |
| BASKETBALL |
| Men's |
| MOUTH |
| $2,001.00 |
| $2,001.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $2,001.00 |
| Name Withheld |
| 02/14/2026 |
| TRACK & FIELD |
| Men's |
| FOOT |
| $2,757.06 |
| $1,028.84 |
| $1,728.22 |
| $39.80 |
| $0.00 |
| $0.00 |
| $1,028.84 |
| Name Withheld |
| 08/20/2025 |
| CROSS COUNTRY |
| Men's |
| HIP |
| $6,954.00 |
| $4,736.21 |
| $2,217.79 |
| $0.00 |
| $3,544.34 |
| $0.00 |
| $1,191.87 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 09/08/2025 |
| SOCCER |
| Men's |
| HAND |
| $958.00 |
| $502.72 |
| $455.28 |
| $0.00 |
| $0.00 |
| $0.00 |
| $502.72 |
| Name Withheld |
| 09/25/2025 |
| GOLF |
| Women's |
| KNEE |
| $12,333.46 |
| $4,080.65 |
| $8,252.81 |
| $0.00 |
| $0.00 |
| $0.00 |
| $4,080.65 |
| Name Withheld |
| 08/09/2025 |
| SOCCER |
| Men's |
| HAND |
| $3,209.60 |
| $1,539.29 |
| $1,670.31 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,539.29 |
| Name Withheld |
| 10/18/2025 |
| SOCCER |
| Women's |
| HIP |
| $1,365.04 |
| $460.89 |
| $904.15 |
| $0.00 |
| $0.00 |
| $0.00 |
| $460.89 |
| Name Withheld |
| 02/18/2026 |
| SOCCER |
| Women's |
| SHOULDER |
| $6,242.49 |
| $2,656.56 |
| $3,585.93 |
| $0.00 |
| $0.00 |
| $0.00 |
| $2,656.56 |
| Name Withheld |
| 11/07/2025 |
| TRACK & FIELD |
| Women's |
| FOOT |
| $784.67 |
| $394.01 |
| $390.66 |
| $0.00 |
| $0.00 |
| $0.00 |
| $394.01 |
| Name Withheld |
| 01/22/2026 |
| TRACK & FIELD |
| Women's |
| FOOT |
| $553.00 |
| $334.45 |
| $218.55 |
| $0.00 |
| $284.45 |
| $0.00 |
| $50.00 |
| Name Withheld |
| 10/24/2025 |
| SOCCER |
| Men's |
| SHOULDER |
| $64,621.32 |
| $30,436.28 |
| $34,185.04 |
| $0.00 |
| $0.00 |
| $0.00 |
| $30,436.28 |
| Name Withheld |
| 01/02/2026 |
| BASKETBALL |
| Women's |
| FINGER |
| $2,633.63 |
| $963.11 |
| $1,670.52 |
| $0.00 |
| $0.00 |
| $0.00 |
| $963.11 |
| Name Withheld |
| 02/20/2026 |
| SOCCER |
| Men's |
| KNEE |
| $415.00 |
| $283.04 |
| $131.96 |
| $0.00 |
| $0.00 |
| $0.00 |
| $283.04 |
| Name Withheld |
| 09/11/2025 |
| SOCCER |
| Women's |
| FINGER |
| $690.00 |
| $431.66 |
| $258.34 |
| $0.00 |
| $0.00 |
| $0.00 |
| $431.66 |
| Name Withheld |
| 09/08/2025 |
| SOFTBALL |
| Women's |
| HIP |
| $58,205.82 |
| $33,140.90 |
| $25,064.92 |
| $0.00 |
| $0.00 |
| $0.00 |
| $33,140.90 |
| Name Withheld |
| 08/26/2025 |
| SOFTBALL |
| Women's |
| HIP |
| $962.50 |
| $592.50 |
| $370.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $592.50 |
| Name Withheld |
| 11/17/2025 |
| SOCCER |
| Men's |
| WRIST |
| $12,077.40 |
| $6,222.76 |
| $5,854.64 |
| $0.00 |
| $1,457.86 |
| $0.00 |
| $4,764.90 |
| Name Withheld |
| 10/04/2025 |
| VOLLEYBALL |
| Women's |
| ELBOW |
| $3,109.00 |
| $1,064.17 |
| $2,044.83 |
| $0.00 |
| $767.82 |
| $0.00 |
| $296.35 |
| Name Withheld |
| 10/04/2025 |
| SOCCER |
| Men's |
| TOE |
| $1,255.46 |
| $641.64 |
| $613.82 |
| $0.00 |
| $0.00 |
| $0.00 |
| $641.64 |
| Name Withheld |
| 10/19/2025 |
| BASKETBALL |
| Men's |
| BACK |
| $465.00 |
| $206.45 |
| $258.55 |
| $0.00 |
| $0.00 |
| $0.00 |
| $206.45 |
| Name Withheld |
| 06/23/2026 |
| BASKETBALL |
| Women's |
| FOOT |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 01/12/2026 |
| GOLF |
| Women's |
| ANKLE |
| $1,501.00 |
| $1,200.80 |
| $300.20 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,200.80 |
| Name Withheld |
| 02/23/2026 |
| TRACK & FIELD |
| Women's |
| SHOULDER |
| $1,856.00 |
| $670.11 |
| $1,185.89 |
| $0.00 |
| $0.00 |
| $0.00 |
| $670.11 |
| Name Withheld |
| 08/09/2025 |
| SOCCER |
| Women's |
| KNEE |
| $2,288.00 |
| $906.71 |
| $1,381.29 |
| $0.00 |
| $747.90 |
| $0.00 |
| $158.81 |
| Name Withheld |
| 01/02/2026 |
| BASKETBALL |
| Women's |
| KNEE |
| $23,301.21 |
| $15,142.20 |
| $8,159.01 |
| $0.00 |
| $12,945.22 |
| $0.00 |
| $2,196.98 |
| Name Withheld |
| 09/23/2025 |
| BASEBALL |
| Men's |
| LEG |
| $503.24 |
| $238.31 |
| $264.93 |
| $0.00 |
| $0.00 |
| $0.00 |
| $238.31 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 09/30/2025 |
| LACROSSE |
| Women's |
| FOOT |
| $460.00 |
| $460.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $460.00 |
| Name Withheld |
| 01/10/2026 |
| BASKETBALL |
| Women's |
| KNEE |
| $1,138.86 |
| $643.43 |
| $495.43 |
| $0.00 |
| $0.00 |
| $0.00 |
| $643.43 |
| Name Withheld |
| 11/10/2025 |
| BASKETBALL |
| Men's |
| FOOT |
| $564.00 |
| $493.04 |
| $70.96 |
| $0.00 |
| $39.78 |
| $0.00 |
| $453.26 |
| Name Withheld |
| 10/07/2025 |
| LACROSSE |
| Women's |
| KNEE |
| $318.00 |
| $208.09 |
| $109.91 |
| $0.00 |
| $158.09 |
| $0.00 |
| $50.00 |
| Name Withheld |
| 08/13/2025 |
| SOCCER |
| Men's |
| HEAD |
| $2,571.00 |
| $1,241.46 |
| $1,329.54 |
| $0.00 |
| $909.07 |
| $0.00 |
| $332.39 |
| Name Withheld |
| 11/01/2025 |
| SOCCER |
| Men's |
| ANKLE |
| $59,277.28 |
| $51,937.60 |
| $7,339.68 |
| $0.00 |
| $42,528.96 |
| $0.00 |
| $9,408.64 |
| Name Withheld |
| 02/26/2026 |
| SOCCER |
| Women's |
| KNEE |
| $17,558.00 |
| $6,866.60 |
| $10,691.40 |
| $0.00 |
| $2,573.19 |
| $0.00 |
| $4,293.41 |
| Name Withheld |
| 07/31/2026 |
| BASKETBALL |
| Women's |
| EYE |
| $948.00 |
| $853.20 |
| $94.80 |
| $0.00 |
| $0.00 |
| $0.00 |
| $853.20 |
| Name Withheld |
| 03/02/2026 |
| BASKETBALL |
| Women's |
| RIB |
| $23,065.00 |
| $6,448.10 |
| $16,616.90 |
| $0.00 |
| $5,488.29 |
| $0.00 |
| $959.81 |
| Name Withheld |
| 09/13/2025 |
| VOLLEYBALL |
| Women's |
| FINGER |
| $636.28 |
| $307.18 |
| $329.10 |
| $0.00 |
| $0.00 |
| $0.00 |
| $307.18 |
| Name Withheld |
| 10/17/2025 |
| SOCCER |
| Men's |
| GROIN |
| $5,915.00 |
| $1,622.36 |
| $4,292.64 |
| $0.00 |
| $265.12 |
| $0.00 |
| $1,357.24 |
| Name Withheld |
| 11/21/2025 |
| BASKETBALL |
| Men's |
| ANKLE |
| $78,841.76 |
| $33,141.26 |
| $45,700.50 |
| $762.75 |
| $0.00 |
| $0.00 |
| $32,378.51 |
| Name Withheld |
| 12/08/2025 |
| TRACK & FIELD |
| Women's |
| LEG |
| $3,120.00 |
| $596.56 |
| $2,523.44 |
| $0.00 |
| $596.56 |
| $0.00 |
| $0.00 |
| Name Withheld |
| 02/27/2026 |
| TRACK & FIELD |
| Women's |
| KNEE |
| $2,744.47 |
| $1,070.61 |
| $1,673.86 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,070.61 |
| Name Withheld |
| 08/28/2025 |
| SOCCER |
| Men's |
| LEG |
| $3,892.01 |
| $1,443.99 |
| $2,448.02 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,443.99 |
| Name Withheld |
| 10/04/2025 |
| VOLLEYBALL |
| Women's |
| ABDOMEN |
| $1,809.00 |
| $1,333.21 |
| $475.79 |
| $0.00 |
| $933.26 |
| $0.00 |
| $399.95 |
| Name Withheld |
| 08/01/2025 |
| TRACK & FIELD |
| Men's |
| TOE |
| $318.00 |
| $182.16 |
| $135.84 |
| $0.00 |
| $0.00 |
| $0.00 |
| $182.16 |
| Name Withheld |
| 09/24/2025 |
| TRACK & FIELD |
| Women's |
| KNEE |
| $6,054.00 |
| $1,441.37 |
| $4,612.63 |
| $0.00 |
| $585.83 |
| $0.00 |
| $855.54 |
| Name Withheld |
| 09/11/2025 |
| SOCCER |
| Men's |
| THIGH |
| $3,534.00 |
| $1,885.22 |
| $1,648.78 |
| $0.00 |
| $817.15 |
| $0.00 |
| $1,068.07 |
Total for Benefit Contract: WRP00_080125-26
| $818,677.71 |
| $358,432.07 |
| $459,875.64 |
| $1,172.55 |
| $125,976.70 |
| $0.00 |
| $231,692.62 |
Benefit Contract ID: MCB 4850979_080124-25
Effective Date: 8/1/2024
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 10/16/2024 |
| SOCCER |
| Men's |
| HIP |
| $157,424.61 |
| $68,012.15 |
| $89,412.46 |
| $0.00 |
| $61,624.43 |
| $0.00 |
| $6,387.72 |
| Name Withheld |
| 08/19/2024 |
| BASKETBALL |
| Women's |
| OTHER |
| $553.00 |
| $159.05 |
| $393.95 |
| $0.00 |
| $123.05 |
| $0.00 |
| $36.00 |
| Name Withheld |
| 11/24/2024 |
| VOLLEYBALL |
| Women's |
| FINGER |
| $151.00 |
| $95.51 |
| $55.49 |
| $0.00 |
| $1.51 |
| $0.00 |
| $94.00 |
| Name Withheld |
| 08/01/2024 |
| VOLLEYBALL |
| Women's |
| LEG |
| $579.00 |
| $168.63 |
| $410.37 |
| $0.00 |
| $74.63 |
| $0.00 |
| $94.00 |
| Name Withheld |
| 08/26/2024 |
| BASEBALL |
| Men's |
| HIP |
| $13,358.58 |
| $6,386.55 |
| $6,972.03 |
| $0.00 |
| $5,109.24 |
| $0.00 |
| $1,277.31 |
| Name Withheld |
| 07/02/2025 |
| BASKETBALL |
| Women's |
| FOOT |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 07/08/2025 |
| VOLLEYBALL |
| Women's |
| SHOULDER |
| $7,953.40 |
| $2,628.38 |
| $5,325.02 |
| $0.00 |
| $633.04 |
| $0.00 |
| $1,995.34 |
| Name Withheld |
| 03/20/2025 |
| SOFTBALL |
| Women's |
| KNEE |
| $11,629.66 |
| $3,271.06 |
| $8,358.60 |
| $0.00 |
| $0.00 |
| $0.00 |
| $3,271.06 |
| Name Withheld |
| 06/17/2025 |
| BASKETBALL |
| Men's |
| GROIN |
| $2,176.00 |
| $441.34 |
| $1,734.66 |
| $0.00 |
| $0.00 |
| $0.00 |
| $441.34 |
| Name Withheld |
| 04/16/2025 |
| TRACK & FIELD |
| Women's |
| WRIST |
| $874.00 |
| $777.31 |
| $96.69 |
| $0.00 |
| $699.59 |
| $0.00 |
| $77.72 |
| Name Withheld |
| 07/07/2025 |
| BASKETBALL |
| Women's |
| HIP |
| $65.00 |
| $65.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $65.00 |
| Name Withheld |
| 07/01/2025 |
| BASKETBALL |
| Women's |
| FOOT |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 09/23/2024 |
| BASKETBALL |
| Women's |
| KNEE |
| $337.00 |
| $88.52 |
| $248.48 |
| $0.00 |
| $0.00 |
| $0.00 |
| $88.52 |
| Name Withheld |
| 02/24/2025 |
| VOLLEYBALL |
| Women's |
| WRIST |
| $390.00 |
| $232.02 |
| $157.98 |
| $0.00 |
| $139.22 |
| $0.00 |
| $92.80 |
| Name Withheld |
| 02/27/2025 |
| VOLLEYBALL |
| Women's |
| BACK |
| $1,404.25 |
| $427.25 |
| $977.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $427.25 |
| Name Withheld |
| 07/07/2025 |
| BASKETBALL |
| Women's |
| BACK |
| $280.00 |
| $280.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $280.00 |
| Name Withheld |
| 01/31/2025 |
| SOFTBALL |
| Women's |
| HAND |
| $360.00 |
| $114.36 |
| $245.64 |
| $0.00 |
| $0.00 |
| $0.00 |
| $114.36 |
| Name Withheld |
| 03/17/2025 |
| SOFTBALL |
| Women's |
| SHOULDER |
| $1,485.00 |
| $617.34 |
| $867.66 |
| $0.00 |
| $422.34 |
| $0.00 |
| $195.00 |
| Name Withheld |
| 02/03/2025 |
| VOLLEYBALL |
| Women's |
| KNEE |
| $1,104.00 |
| $966.75 |
| $137.25 |
| $0.00 |
| $52.75 |
| $0.00 |
| $914.00 |
| Name Withheld |
| 01/11/2025 |
| BASKETBALL |
| Women's |
| ANKLE |
| $1,460.00 |
| $398.92 |
| $1,061.08 |
| $0.00 |
| $311.03 |
| $0.00 |
| $87.89 |
| Name Withheld |
| 07/31/2025 |
| BASKETBALL |
| Women's |
| KNEE |
| $2,204.28 |
| $624.63 |
| $1,579.65 |
| $0.00 |
| $0.00 |
| $0.00 |
| $624.63 |
| Name Withheld |
| 09/18/2024 |
| SOCCER |
| Women's |
| KNEE |
| $5,352.65 |
| $1,637.25 |
| $3,715.40 |
| $0.00 |
| $1,542.25 |
| $0.00 |
| $95.00 |
| Name Withheld |
| 03/10/2025 |
| VOLLEYBALL |
| Women's |
| SHOULDER |
| $25,002.00 |
| $4,565.24 |
| $20,436.76 |
| $0.00 |
| $2,885.49 |
| $0.00 |
| $1,679.75 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 03/15/2025 |
| BASEBALL |
| Men's |
| SHOULDER |
| $8,815.00 |
| $4,439.85 |
| $4,375.15 |
| $0.00 |
| $2,839.85 |
| $0.00 |
| $1,600.00 |
| Name Withheld |
| 11/23/2024 |
| BASKETBALL |
| Men's |
| MOUTH |
| $1,170.00 |
| $1,170.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,170.00 |
| Name Withheld |
| 10/18/2024 |
| SOCCER |
| Men's |
| MOUTH |
| $6,816.00 |
| $6,816.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $6,816.00 |
| Name Withheld |
| 02/26/2025 |
| TRACK & FIELD |
| Women's |
| FOOT |
| $4,032.00 |
| $1,267.26 |
| $2,764.74 |
| $0.00 |
| $1,142.26 |
| $0.00 |
| $125.00 |
| Name Withheld |
| 01/04/2025 |
| BASKETBALL |
| Women's |
| KNEE |
| $187,090.24 |
| $64,872.00 |
| $122,218.24 |
| $0.00 |
| $0.00 |
| $0.00 |
| $64,872.00 |
| Name Withheld |
| 01/30/2025 |
| SOCCER |
| Women's |
| THIGH |
| $329,646.26 |
| $64,884.99 |
| $264,761.27 |
| $0.00 |
| $55,129.50 |
| $0.00 |
| $9,755.49 |
| Name Withheld |
| 07/28/2025 |
| BASKETBALL |
| Women's |
| BACK |
| $195.00 |
| $195.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $195.00 |
| Name Withheld |
| 03/28/2025 |
| SOCCER |
| Men's |
| THIGH |
| $413.00 |
| $413.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $413.00 |
| Name Withheld |
| 06/29/2025 |
| BASKETBALL |
| Women's |
| ANKLE |
| $440.00 |
| $407.88 |
| $32.12 |
| $0.00 |
| $367.10 |
| $0.00 |
| $40.78 |
| Name Withheld |
| 07/07/2025 |
| BASEBALL |
| Women's |
| KNEE |
| $517.79 |
| $247.19 |
| $270.60 |
| $0.00 |
| $0.00 |
| $0.00 |
| $247.19 |
| Name Withheld |
| 09/16/2024 |
| BASEBALL |
| Men's |
| SHOULDER |
| $6,121.20 |
| $1,501.03 |
| $4,620.17 |
| $0.00 |
| $944.92 |
| $0.00 |
| $556.11 |
| Name Withheld |
| 06/02/2025 |
| CROSS COUNTRY |
| Men's |
| FOOT |
| $33,399.23 |
| $7,959.44 |
| $25,439.79 |
| $0.00 |
| $5,538.25 |
| $0.00 |
| $2,421.19 |
| Name Withheld |
| 09/30/2024 |
| LACROSSE |
| Women's |
| BACK |
| $10,168.00 |
| $1,918.50 |
| $8,249.50 |
| $0.00 |
| $341.65 |
| $0.00 |
| $1,576.85 |
| Name Withheld |
| 05/06/2025 |
| LACROSSE |
| Women's |
| LEG |
| $151.00 |
| $104.12 |
| $46.88 |
| $0.00 |
| $69.12 |
| $0.00 |
| $35.00 |
| Name Withheld |
| 04/30/2025 |
| TRACK & FIELD |
| Men's |
| FOOT |
| $230.00 |
| $118.20 |
| $111.80 |
| $0.00 |
| $9.30 |
| $0.00 |
| $108.90 |
| Name Withheld |
| 04/01/2025 |
| LACROSSE |
| Women's |
| BACK |
| $6,454.00 |
| $1,260.00 |
| $5,194.00 |
| $0.00 |
| $587.00 |
| $0.00 |
| $673.00 |
| Name Withheld |
| 06/30/2025 |
| BASKETBALL |
| Women's |
| LEG |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 08/26/2024 |
| BASEBALL |
| Men's |
| RIB |
| $1,808.04 |
| $831.87 |
| $976.17 |
| $0.00 |
| $0.00 |
| $0.00 |
| $831.87 |
| Name Withheld |
| 10/01/2024 |
| BASKETBALL |
| Women's |
| LEG |
| $400.00 |
| $400.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $400.00 |
| Name Withheld |
| 05/14/2025 |
| TRACK & FIELD |
| Women's |
| SHOULDER |
| $24,747.90 |
| $6,323.34 |
| $18,424.56 |
| $0.00 |
| $1,947.81 |
| $0.00 |
| $4,375.53 |
| Name Withheld |
| 01/15/2025 |
| BASKETBALL |
| Men's |
| NOSE |
| $35,535.00 |
| $5,415.97 |
| $30,119.03 |
| $0.00 |
| $1,861.63 |
| $0.00 |
| $3,554.34 |
| Name Withheld |
| 04/12/2025 |
| BASEBALL |
| Men's |
| ELBOW |
| $1,299.00 |
| $239.90 |
| $1,059.10 |
| $0.00 |
| $0.00 |
| $0.00 |
| $239.90 |
| Name Withheld |
| 01/24/2025 |
| BASEBALL |
| Men's |
| SHOULDER |
| $3,254.00 |
| $795.33 |
| $2,645.67 |
| $0.00 |
| $332.48 |
| $0.00 |
| $462.85 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 10/10/2024 |
| BASKETBALL |
| Women's |
| BACK |
| $660.11 |
| $481.46 |
| $178.65 |
| $0.00 |
| $0.00 |
| $0.00 |
| $481.46 |
| Name Withheld |
| 07/01/2025 |
| BASKETBALL |
| Women's |
| TOE |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 07/18/2025 |
| SOCCER |
| Men's |
| THIGH |
| $454.30 |
| $289.10 |
| $165.20 |
| $0.00 |
| $0.00 |
| $0.00 |
| $289.10 |
Total for Benefit Contract: MCB 4850979_080124-25
| $899,720.50 |
| $266,068.69 |
| $633,838.81 |
| $0.00 |
| $144,729.44 |
| $0.00 |
| $121,339.25 |
Benefit Contract ID: WRP00_080124-25 ADMIN DEC
Effective Date: 8/1/2024
| Insured | Date of | Sport/Activity | Men's / |
| Body Part | | | |
| Charges | | | |
| Allowed | | | |
| Write-Off | | | |
| Ineligible | | | |
| Primary Ins. | | | |
| Deductible | | | |
| Amount | | | |
Accident Women's
| Charges |
| Amount |
| Amount |
| Paid |
Paid
| Name Withheld | 08/18/2024 | SOFTBALL | Women's |
| OTHER | | | |
| $6,833.95 | | | |
| $3,137.01 | | | |
| $3,696.94 | | | |
| $0.00 | | | |
| $1,358.07 | | | |
| $0.00 | | | |
| $1,778.94 | | | |
Total for Benefit Contract: WRP00_080124-25 ADMIN DEC
| $6,833.95 |
| $3,137.01 |
| $3,696.94 |
| $0.00 |
| $1,358.07 |
| $0.00 |
| $1,778.94 |
Benefit Contract ID: WRP00_080124-25 EXHAUSTED
Effective Date: 8/1/2024
| Insured |
| Date of |
| Sport/Activity |
| Men's / |
| Body Part |
| Charges |
| Allowed |
| Write-Off |
| Ineligible |
| Primary Ins. |
| Deductible |
| Amount |
Accident
Women's
| Charges |
| Amount |
| Amount |
| Paid |
Paid
| Name Withheld |
| 03/04/2025 |
| SOCCER |
| Women's |
| SHOULDER |
| $568.50 |
| $117.50 |
| $451.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $117.50 |
| Name Withheld |
| 08/18/2024 |
| SOFTBALL |
| Women's |
| FOOT |
| $396.00 |
| $396.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $396.00 |
| Name Withheld |
| 10/09/2024 |
| SOCCER |
| Men's |
| LEG |
| $7,739.00 |
| $4,262.70 |
| $3,476.30 |
| $0.00 |
| $2,597.98 |
| $0.00 |
| $1,664.72 |
| Name Withheld |
| 10/01/2024 |
| TRACK & FIELD |
| Women's |
| FOOT |
| $1,551.00 |
| $1,281.00 |
| $270.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,281.00 |
| Name Withheld |
| 10/11/2024 |
| LACROSSE |
| Women's |
| ELBOW |
| $2,238.00 |
| $1,155.20 |
| $1,082.80 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,155.20 |
| Name Withheld |
| 03/10/2025 |
| VOLLEYBALL |
| Women's |
| SHOULDER |
| $8,631.00 |
| $2,716.23 |
| $5,914.77 |
| $0.00 |
| $1,485.98 |
| $0.00 |
| $1,230.25 |
| Name Withheld |
| 08/26/2024 |
| BASEBALL |
| Men's |
| FOOT |
| $4,590.00 |
| $2,645.85 |
| $1,944.15 |
| $0.00 |
| $1,730.85 |
| $0.00 |
| $915.00 |
| Name Withheld |
| 07/31/2025 |
| BASKETBALL |
| Women's |
| KNEE |
| $318.00 |
| $207.46 |
| $110.54 |
| $0.00 |
| $145.22 |
| $0.00 |
| $62.24 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 07/01/2025 |
| BASKETBALL |
| Women's |
| FOOT |
| $440.00 |
| $0.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| Name Withheld |
| 02/26/2025 |
| BASKETBALL |
| Women's |
| EAR |
| $853.00 |
| $293.87 |
| $559.13 |
| $0.00 |
| $69.70 |
| $0.00 |
| $224.17 |
| Name Withheld |
| 10/04/2024 |
| BASEBALL |
| Men's |
| SHOULDER |
| $2,595.00 |
| $1,017.93 |
| $1,577.07 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,017.93 |
| Name Withheld |
| 07/01/2025 |
| BASKETBALL |
| Women's |
| FOOT |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 09/06/2024 |
| SOCCER |
| Men's |
| ELBOW |
| $3,591.00 |
| $2,519.30 |
| $1,071.70 |
| $0.00 |
| $1,700.00 |
| $0.00 |
| $819.30 |
| Name Withheld |
| 10/04/2024 |
| SOCCER |
| Men's |
| HEAD |
| $9,938.00 |
| $4,004.97 |
| $5,933.03 |
| $0.00 |
| $2,685.77 |
| $0.00 |
| $1,319.20 |
| Name Withheld |
| 12/03/2024 |
| TRACK & FIELD |
| Women's |
| BACK |
| $5,746.62 |
| $3,835.64 |
| $1,910.98 |
| $0.00 |
| $1,515.00 |
| $0.00 |
| $2,320.64 |
| Name Withheld |
| 11/05/2024 |
| BASEBALL |
| Men's |
| WRIST |
| $2,318.00 |
| $949.02 |
| $1,368.98 |
| $0.00 |
| $759.22 |
| $0.00 |
| $189.80 |
| Name Withheld |
| 09/25/2024 |
| BASKETBALL |
| Women's |
| ARM |
| $311.00 |
| $196.32 |
| $114.68 |
| $0.00 |
| $171.32 |
| $0.00 |
| $25.00 |
| Name Withheld |
| 09/30/2024 |
| BASKETBALL |
| Women's |
| MOUTH |
| $231.00 |
| $231.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $231.00 |
| Name Withheld |
| 12/03/2024 |
| VOLLEYBALL |
| Women's |
| ELBOW |
| $21,814.80 |
| $10,764.40 |
| $11,050.40 |
| $0.00 |
| $6,096.90 |
| $0.00 |
| $4,667.50 |
| Name Withheld |
| 07/28/2025 |
| BASKETBALL |
| Women's |
| BACK |
| $876.25 |
| $551.25 |
| $325.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $551.25 |
| Name Withheld |
| 08/12/2024 |
| VOLLEYBALL |
| Women's |
| BACK |
| $19,767.00 |
| $4,364.11 |
| $15,402.89 |
| $0.00 |
| $845.52 |
| $0.00 |
| $3,518.59 |
| Name Withheld |
| 10/11/2024 |
| BASKETBALL |
| Women's |
| KNEE |
| $47,544.65 |
| $28,265.52 |
| $19,279.13 |
| $0.00 |
| $1,184.51 |
| $0.00 |
| $27,081.01 |
| Name Withheld |
| 09/16/2024 |
| BASEBALL |
| Men's |
| SHOULDER |
| $1,013.00 |
| $496.76 |
| $516.24 |
| $0.00 |
| $307.14 |
| $0.00 |
| $189.62 |
| Name Withheld |
| 10/10/2024 |
| CROSS COUNTRY |
| Men's |
| KNEE |
| $3,225.00 |
| $1,000.39 |
| $2,224.61 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,000.39 |
| Name Withheld |
| 09/20/2024 |
| LACROSSE |
| Women's |
| FOOT |
| $396.00 |
| $396.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $396.00 |
| Name Withheld |
| 08/18/2024 |
| TRACK & FIELD |
| Women's |
| HIP |
| $8,625.00 |
| $1,590.00 |
| $7,035.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,590.00 |
| Name Withheld |
| 03/29/2025 |
| SOCCER |
| Men's |
| KNEE |
| $398.00 |
| $398.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $398.00 |
| Name Withheld |
| 07/08/2025 |
| VOLLEYBALL |
| Women's |
| SHOULDER |
| $2,720.67 |
| $1,022.48 |
| $1,698.19 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,022.48 |
| Name Withheld |
| 08/23/2024 |
| VOLLEYBALL |
| Women's |
| BACK |
| $1,497.00 |
| $269.69 |
| $1,227.31 |
| $0.00 |
| $133.28 |
| $0.00 |
| $136.41 |
| Name Withheld |
| 04/12/2025 |
| BASEBALL |
| Men's |
| ELBOW |
| $765.00 |
| $323.18 |
| $441.82 |
| $0.00 |
| $35.51 |
| $0.00 |
| $287.67 |
| Name Withheld |
| 08/29/2024 |
| LACROSSE |
| Women's |
| LEG |
| $1,740.00 |
| $1,101.23 |
| $638.77 |
| $0.00 |
| $271.50 |
| $0.00 |
| $829.73 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 03/25/2025 |
| BASKETBALL |
| Women's |
| FOOT |
| $880.00 |
| $880.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $880.00 |
| Name Withheld |
| 08/29/2024 |
| BASEBALL |
| Men's |
| WRIST |
| $19,069.25 |
| $5,038.69 |
| $14,030.56 |
| $0.00 |
| $3,866.98 |
| $0.00 |
| $1,171.71 |
| Name Withheld |
| 03/01/2025 |
| BASEBALL |
| Men's |
| KNEE |
| $398.00 |
| $398.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $398.00 |
| Name Withheld |
| 03/13/2025 |
| SOCCER |
| Women's |
| KNEE |
| $5,031.00 |
| $2,252.56 |
| $2,778.44 |
| $0.00 |
| $1,532.56 |
| $0.00 |
| $720.00 |
| Name Withheld |
| 10/29/2024 |
| BASEBALL |
| Men's |
| ARM |
| $44,040.74 |
| $7,304.05 |
| $36,736.69 |
| $0.00 |
| $3,749.73 |
| $0.00 |
| $3,554.32 |
| Name Withheld |
| 02/19/2025 |
| SOFTBALL |
| Women's |
| RIB |
| $12,120.33 |
| $2,801.50 |
| $9,318.83 |
| $0.00 |
| $144.00 |
| $0.00 |
| $2,657.50 |
| Name Withheld |
| 02/11/2025 |
| TRACK & FIELD |
| Men's |
| WRIST |
| $422.00 |
| $343.78 |
| $78.22 |
| $0.00 |
| $303.78 |
| $0.00 |
| $40.00 |
| Name Withheld |
| 11/19/2024 |
| VOLLEYBALL |
| Women's |
| KNEE |
| $474.00 |
| $292.82 |
| $181.18 |
| $0.00 |
| $232.82 |
| $0.00 |
| $60.00 |
| Name Withheld |
| 01/27/2025 |
| TRACK & FIELD |
| Men's |
| LEG |
| $541.00 |
| $329.82 |
| $211.18 |
| $0.00 |
| $0.00 |
| $0.00 |
| $329.82 |
| Name Withheld |
| 03/15/2025 |
| BASEBALL |
| Men's |
| SHOULDER |
| $63,056.50 |
| $2,000.90 |
| $61,055.60 |
| $0.00 |
| $199.32 |
| $0.00 |
| $1,801.58 |
| Name Withheld |
| 03/11/2025 |
| BASEBALL |
| Men's |
| KNEE |
| $1,469.50 |
| $354.20 |
| $1,115.30 |
| $0.00 |
| $0.00 |
| $0.00 |
| $354.20 |
| Name Withheld |
| 10/01/2024 |
| SOCCER |
| Men's |
| KNEE |
| $8,062.76 |
| $2,787.73 |
| $5,275.03 |
| $0.00 |
| $0.00 |
| $0.00 |
| $2,787.73 |
| Name Withheld |
| 10/18/2024 |
| SOCCER |
| Men's |
| MOUTH |
| $8,631.00 |
| $6,051.52 |
| $2,579.48 |
| $0.00 |
| $162.00 |
| $0.00 |
| $5,889.52 |
| Name Withheld |
| 10/25/2024 |
| VOLLEYBALL |
| Women's |
| FINGER |
| $454.00 |
| $279.43 |
| $174.57 |
| $0.00 |
| $0.00 |
| $0.00 |
| $279.43 |
| Name Withheld |
| 08/07/2024 |
| SOCCER |
| Men's |
| GROIN |
| $413.00 |
| $413.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $413.00 |
| Name Withheld |
| 06/29/2025 |
| BASKETBALL |
| Women's |
| ANKLE |
| $396.00 |
| $396.00 |
| $0.00 |
| $0.00 |
| $41.40 |
| $0.00 |
| $354.60 |
| Name Withheld |
| 03/05/2025 |
| BASEBALL |
| Men's |
| THIGH |
| $2,128.00 |
| $880.81 |
| $1,247.19 |
| $0.00 |
| $0.00 |
| $0.00 |
| $880.81 |
| Name Withheld |
| 03/20/2025 |
| SOFTBALL |
| Women's |
| KNEE |
| $112,489.14 |
| $47,476.60 |
| $65,012.54 |
| $0.00 |
| $0.00 |
| $0.00 |
| $47,476.60 |
| Name Withheld |
| 01/24/2025 |
| BASEBALL |
| Men's |
| SHOULDER |
| $3,581.00 |
| $1,397.75 |
| $2,183.25 |
| $0.00 |
| $703.13 |
| $0.00 |
| $694.62 |
| Name Withheld |
| 10/16/2024 |
| LACROSSE |
| Women's |
| LEG |
| $1,820.00 |
| $1,456.00 |
| $364.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,456.00 |
| Name Withheld |
| 07/31/2025 |
| BASKETBALL |
| Women's |
| KNEE |
| $555.35 |
| $265.97 |
| $289.38 |
| $0.00 |
| $0.00 |
| $0.00 |
| $265.97 |
| Name Withheld |
| 09/18/2024 |
| SOCCER |
| Women's |
| KNEE |
| $3,243.00 |
| $723.67 |
| $2,519.33 |
| $0.00 |
| $473.67 |
| $0.00 |
| $250.00 |
| Name Withheld |
| 10/02/2024 |
| SOCCER |
| Women's |
| ANKLE |
| $311.00 |
| $199.52 |
| $111.48 |
| $0.00 |
| $0.00 |
| $0.00 |
| $199.52 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 07/17/2025 |
| BASKETBALL |
| Men's |
| RIB |
| $439.00 |
| $283.80 |
| $155.20 |
| $0.00 |
| $127.46 |
| $0.00 |
| $156.34 |
| Name Withheld |
| 08/19/2024 |
| BASKETBALL |
| Women's |
| OTHER |
| $44,020.79 |
| $6,744.12 |
| $37,301.67 |
| $0.00 |
| $2,550.79 |
| $0.00 |
| $4,168.33 |
| Name Withheld |
| 04/24/2025 |
| TRACK & FIELD |
| Women's |
| BACK |
| $2,912.00 |
| $842.12 |
| $2,069.88 |
| $0.00 |
| $613.69 |
| $0.00 |
| $228.43 |
| Name Withheld |
| 04/30/2025 |
| TRACK & FIELD |
| Men's |
| FOOT |
| $124.00 |
| $58.27 |
| $65.73 |
| $0.00 |
| $0.00 |
| $0.00 |
| $58.27 |
| Name Withheld |
| 09/06/2024 |
| SOFTBALL |
| Women's |
| FOOT |
| $413.00 |
| $180.52 |
| $232.48 |
| $0.00 |
| $0.00 |
| $0.00 |
| $180.52 |
| Name Withheld |
| 04/01/2025 |
| LACROSSE |
| Women's |
| BACK |
| $2,610.00 |
| $1,485.52 |
| $1,124.48 |
| $0.00 |
| $1,189.04 |
| $0.00 |
| $296.48 |
| Name Withheld |
| 11/24/2024 |
| VOLLEYBALL |
| Women's |
| FINGER |
| $840.00 |
| $511.89 |
| $328.11 |
| $0.00 |
| $89.61 |
| $0.00 |
| $422.28 |
| Name Withheld |
| 08/01/2024 |
| VOLLEYBALL |
| Women's |
| LEG |
| $396.00 |
| $396.00 |
| $0.00 |
| $0.00 |
| $302.00 |
| $0.00 |
| $94.00 |
| Name Withheld |
| 02/24/2025 |
| VOLLEYBALL |
| Women's |
| WRIST |
| $1,883.29 |
| $882.41 |
| $1,000.88 |
| $0.00 |
| $0.00 |
| $0.00 |
| $882.41 |
| Name Withheld |
| 11/21/2024 |
| VOLLEYBALL |
| Women's |
| SHOULDER |
| $5,576.52 |
| $1,646.16 |
| $3,930.36 |
| $0.00 |
| $271.73 |
| $0.00 |
| $1,374.43 |
| Name Withheld |
| 09/09/2024 |
| SOCCER |
| Women's |
| KNEE |
| $2,040.38 |
| $937.04 |
| $1,103.34 |
| $0.00 |
| $665.67 |
| $0.00 |
| $271.37 |
| Name Withheld |
| 08/26/2024 |
| BASEBALL |
| Men's |
| RIB |
| $4,228.95 |
| $888.49 |
| $3,340.46 |
| $0.00 |
| $0.00 |
| $0.00 |
| $888.49 |
| Name Withheld |
| 01/04/2025 |
| BASKETBALL |
| Women's |
| KNEE |
| $211,856.97 |
| $39,570.64 |
| $172,286.33 |
| $0.00 |
| $0.00 |
| $0.00 |
| $39,570.64 |
| Name Withheld |
| 01/01/2025 |
| BASKETBALL |
| Women's |
| FOOT |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 12/10/2024 |
| BASKETBALL |
| Women's |
| KNEE |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 01/30/2025 |
| SOCCER |
| Women's |
| THIGH |
| $9,756.68 |
| $4,309.15 |
| $5,447.53 |
| $0.00 |
| $0.00 |
| $0.00 |
| $4,309.15 |
| Name Withheld |
| 10/01/2024 |
| BASKETBALL |
| Women's |
| LEG |
| $5,671.47 |
| $2,457.58 |
| $3,213.89 |
| $0.00 |
| $0.00 |
| $0.00 |
| $2,457.58 |
| Name Withheld |
| 07/01/2025 |
| BASKETBALL |
| Women's |
| EYE |
| $194.00 |
| $194.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $194.00 |
| Name Withheld |
| 07/07/2025 |
| BASEBALL |
| Women's |
| KNEE |
| $1,362.16 |
| $483.26 |
| $878.90 |
| $0.00 |
| $0.00 |
| $0.00 |
| $483.26 |
| Name Withheld |
| 02/25/2025 |
| SOCCER |
| Men's |
| NOSE |
| $11,958.00 |
| $4,794.35 |
| $7,163.65 |
| $0.00 |
| $2,885.07 |
| $0.00 |
| $1,909.28 |
| Name Withheld |
| 10/27/2024 |
| CROSS COUNTRY |
| Women's |
| LEG |
| $1,908.00 |
| $801.08 |
| $1,106.92 |
| $0.00 |
| $0.00 |
| $0.00 |
| $801.08 |
| Name Withheld |
| 08/27/2024 |
| TRACK & FIELD |
| Women's |
| KNEE |
| $2,025.00 |
| $729.02 |
| $1,295.98 |
| $0.00 |
| $53.61 |
| $0.00 |
| $675.41 |
| Name Withheld |
| 01/11/2025 |
| BASKETBALL |
| Women's |
| ANKLE |
| $7,482.00 |
| $2,147.40 |
| $5,334.60 |
| $0.00 |
| $1,722.54 |
| $0.00 |
| $424.86 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 07/01/2025 |
| BASKETBALL |
| Women's |
| ANKLE |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 04/25/2025 |
| TRACK & FIELD |
| Women's |
| HAND |
| $736.92 |
| $361.25 |
| $375.67 |
| $0.00 |
| $0.00 |
| $0.00 |
| $361.25 |
| Name Withheld |
| 01/21/2025 |
| TRACK & FIELD |
| Women's |
| LEG |
| $3,540.00 |
| $1,768.86 |
| $1,771.14 |
| $0.00 |
| $1,728.86 |
| $0.00 |
| $40.00 |
| Name Withheld |
| 09/05/2024 |
| SOCCER |
| Women's |
| KNEE |
| $5,222.00 |
| $1,751.64 |
| $3,470.36 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,751.64 |
| Name Withheld |
| 11/12/2024 |
| LACROSSE |
| Women's |
| BACK |
| $1,766.80 |
| $226.40 |
| $1,540.40 |
| $0.00 |
| $0.00 |
| $0.00 |
| $226.40 |
| Name Withheld |
| 03/27/2025 |
| BASKETBALL |
| Men's |
| FOOT |
| $396.00 |
| $396.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $396.00 |
| Name Withheld |
| 07/01/2025 |
| BASKETBALL |
| Women's |
| KNEE |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 04/16/2025 |
| TRACK & FIELD |
| Women's |
| WRIST |
| $565.00 |
| $107.70 |
| $457.30 |
| $0.00 |
| $96.93 |
| $0.00 |
| $10.77 |
| Name Withheld |
| 09/23/2024 |
| BASKETBALL |
| Women's |
| KNEE |
| $15,401.08 |
| $4,386.56 |
| $11,014.52 |
| $0.00 |
| $90.50 |
| $0.00 |
| $4,296.06 |
| Name Withheld |
| 01/28/2025 |
| LACROSSE |
| Women's |
| BACK |
| $9,659.00 |
| $3,876.31 |
| $5,782.69 |
| $0.00 |
| $2,740.61 |
| $0.00 |
| $1,135.70 |
| Name Withheld |
| 01/07/2025 |
| BASKETBALL |
| Men's |
| FACE |
| $1,055.00 |
| $828.86 |
| $226.14 |
| $0.00 |
| $153.59 |
| $0.00 |
| $675.27 |
| Name Withheld |
| 11/23/2024 |
| BASKETBALL |
| Men's |
| MOUTH |
| $366.00 |
| $366.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $366.00 |
| Name Withheld |
| 01/30/2025 |
| SOCCER |
| Women's |
| THIGH |
| $542.00 |
| $106.00 |
| $436.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $106.00 |
| Name Withheld |
| 01/15/2025 |
| TRACK & FIELD |
| Men's |
| FOOT |
| $7,270.00 |
| $1,874.78 |
| $3,770.22 |
| $2,032.00 |
| $1,368.67 |
| $0.00 |
| $506.11 |
| Name Withheld |
| 08/26/2024 |
| BASEBALL |
| Men's |
| HIP |
| $21,059.00 |
| $12,382.93 |
| $8,676.07 |
| $0.00 |
| $9,856.96 |
| $0.00 |
| $2,525.97 |
| Name Withheld |
| 01/23/2025 |
| VOLLEYBALL |
| Women's |
| WRIST |
| $841.00 |
| $521.77 |
| $319.23 |
| $0.00 |
| $136.83 |
| $0.00 |
| $384.94 |
| Name Withheld |
| 09/25/2024 |
| SOCCER |
| Women's |
| ANKLE |
| $311.00 |
| $196.32 |
| $114.68 |
| $0.00 |
| $151.32 |
| $0.00 |
| $45.00 |
| Name Withheld |
| 05/02/2024 |
| SOCCER |
| Women's |
| THIGH |
| $2,003.50 |
| $678.33 |
| $1,325.17 |
| $0.00 |
| $202.83 |
| $0.00 |
| $475.50 |
| Name Withheld |
| 01/20/2025 |
| TRACK & FIELD |
| Women's |
| FOOT |
| $833.25 |
| $606.88 |
| $226.37 |
| $0.00 |
| $525.63 |
| $0.00 |
| $81.25 |
| Name Withheld |
| 08/14/2024 |
| VOLLEYBALL |
| Women's |
| SHOULDER |
| $20,496.00 |
| $9,030.63 |
| $11,465.37 |
| $0.00 |
| $7,643.21 |
| $0.00 |
| $1,387.42 |
| Name Withheld |
| 02/27/2025 |
| VOLLEYBALL |
| Women's |
| BACK |
| $7,876.50 |
| $2,583.90 |
| $5,292.60 |
| $0.00 |
| $0.00 |
| $0.00 |
| $2,583.90 |
| Name Withheld |
| 10/28/2024 |
| BASKETBALL |
| Women's |
| HIP |
| $474.00 |
| $474.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $474.00 |
| Name Withheld |
| 08/21/2024 |
| VOLLEYBALL |
| Women's |
| KNEE |
| $1,775.00 |
| $1,197.23 |
| $577.77 |
| $0.00 |
| $1,077.53 |
| $0.00 |
| $119.70 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 08/15/2024 |
| CROSS COUNTRY |
| Women's |
| CHEST/TORSO |
| $2,154.00 |
| $488.90 |
| $1,665.10 |
| $0.00 |
| $0.00 |
| $0.00 |
| $488.90 |
| Name Withheld |
| 07/02/2025 |
| BASKETBALL |
| Women's |
| FOOT |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| Name Withheld |
| 07/07/2025 |
| BASKETBALL |
| Women's |
| BACK |
| $490.00 |
| $490.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $490.00 |
| Name Withheld |
| 01/31/2025 |
| SOFTBALL |
| Women's |
| HAND |
| $510.00 |
| $295.37 |
| $214.63 |
| $0.00 |
| $0.00 |
| $0.00 |
| $295.37 |
| Name Withheld |
| 03/17/2025 |
| SOFTBALL |
| Women's |
| SHOULDER |
| $9,976.00 |
| $2,692.68 |
| $7,283.32 |
| $0.00 |
| $278.86 |
| $0.00 |
| $2,413.82 |
| Name Withheld |
| 05/14/2025 |
| TRACK & FIELD |
| Women's |
| SHOULDER |
| $4,361.00 |
| $1,147.73 |
| $3,213.27 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,147.73 |
| Name Withheld |
| 01/15/2025 |
| BASKETBALL |
| Men's |
| NOSE |
| $732.00 |
| $453.97 |
| $278.03 |
| $0.00 |
| $0.00 |
| $0.00 |
| $453.97 |
| Name Withheld |
| 09/30/2024 |
| LACROSSE |
| Women's |
| BACK |
| $1,155.00 |
| $815.88 |
| $339.12 |
| $0.00 |
| $508.73 |
| $0.00 |
| $307.15 |
| Name Withheld |
| 10/20/2024 |
| SOCCER |
| Men's |
| THIGH |
| $784.68 |
| $349.98 |
| $434.70 |
| $0.00 |
| $0.00 |
| $0.00 |
| $349.98 |
| Name Withheld |
| 12/09/2024 |
| LACROSSE |
| Women's |
| LEG |
| $1,673.00 |
| $1,078.36 |
| $594.64 |
| $0.00 |
| $238.42 |
| $0.00 |
| $839.94 |
| Name Withheld |
| 03/12/2025 |
| SOCCER |
| Women's |
| KNEE |
| $622.81 |
| $355.56 |
| $267.25 |
| $0.00 |
| $0.00 |
| $0.00 |
| $355.56 |
| Name Withheld |
| 09/02/2024 |
| CROSS COUNTRY |
| Women's |
| FOOT |
| $8,190.35 |
| $2,451.80 |
| $5,738.55 |
| $0.00 |
| $399.58 |
| $0.00 |
| $2,052.22 |
| Name Withheld |
| 07/30/2025 |
| SOCCER |
| Women's |
| FOOT |
| $324.00 |
| $179.79 |
| $144.21 |
| $0.00 |
| $164.79 |
| $0.00 |
| $15.00 |
| Name Withheld |
| 08/26/2024 |
| BASKETBALL |
| Women's |
| HIP |
| $65.00 |
| $55.00 |
| $10.00 |
| $0.00 |
| $25.00 |
| $0.00 |
| $30.00 |
| Name Withheld |
| 06/17/2025 |
| BASKETBALL |
| Men's |
| GROIN |
| $7,162.00 |
| $2,195.59 |
| $4,966.41 |
| $0.00 |
| $0.00 |
| $0.00 |
| $2,195.59 |
| Name Withheld |
| 11/04/2024 |
| TRACK & FIELD |
| Men's |
| ELBOW |
| $9,661.00 |
| $1,808.76 |
| $7,852.24 |
| $0.00 |
| $1,231.01 |
| $0.00 |
| $577.75 |
| Name Withheld |
| 08/15/2024 |
| SOCCER |
| Men's |
| RIB |
| $439.00 |
| $439.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $439.00 |
Total for Benefit Contract: WRP00_080124-25 EXHAUSTED
| $922,851.16 |
| $292,260.86 |
| $628,550.30 |
| $2,032.00 |
| $72,235.86 |
| $0.00 |
| $220,000.00 |
Benefit Contract ID: MCB 4850979_080123-24
Effective Date: 8/1/2023
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 08/20/2023 |
| TRACK & FIELD |
| Men's |
| BACK |
| $677.75 |
| $677.75 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $677.75 |
| Name Withheld |
| 09/23/2023 |
| SOCCER |
| Women's |
| KNEE |
| $3,940.00 |
| $1,360.00 |
| $2,580.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,360.00 |
| Name Withheld |
| 04/22/2024 |
| LACROSSE |
| Women's |
| KNEE |
| $16,463.36 |
| $7,445.92 |
| $9,017.44 |
| $0.00 |
| $0.00 |
| $0.00 |
| $7,445.92 |
| Name Withheld |
| 01/26/2024 |
| GOLF |
| Women's |
| FOOT |
| $35,231.82 |
| $14,821.12 |
| $20,410.70 |
| $0.00 |
| $0.00 |
| $0.00 |
| $14,821.12 |
| Name Withheld |
| 09/15/2023 |
| VOLLEYBALL |
| Women's |
| BACK |
| $6,248.00 |
| $4,102.38 |
| $2,145.62 |
| $0.00 |
| $3,327.04 |
| $0.00 |
| $775.34 |
| Name Withheld |
| 02/25/2024 |
| BASEBALL |
| Men's |
| ELBOW |
| $433.00 |
| $433.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $433.00 |
| Name Withheld |
| 04/10/2024 |
| TRACK & FIELD |
| Women's |
| BACK |
| $8,773.59 |
| $3,455.87 |
| $5,317.72 |
| $0.00 |
| $1,828.33 |
| $0.00 |
| $1,627.54 |
| Name Withheld |
| 01/19/2024 |
| TRACK & FIELD |
| Women's |
| ANKLE |
| $662.00 |
| $479.17 |
| $182.83 |
| $0.00 |
| $144.62 |
| $0.00 |
| $334.55 |
| Name Withheld |
| 05/02/2024 |
| SOCCER |
| Women's |
| THIGH |
| $127,448.93 |
| $33,961.69 |
| $93,337.24 |
| $0.00 |
| $26,841.68 |
| $0.00 |
| $7,120.01 |
| Name Withheld |
| 10/25/2023 |
| LACROSSE |
| Women's |
| KNEE |
| $723.00 |
| $515.36 |
| $207.64 |
| $0.00 |
| $475.36 |
| $0.00 |
| $40.00 |
| Name Withheld |
| 07/22/2024 |
| FOOTBALL |
| Women's |
| FOOT |
| $853.05 |
| $376.36 |
| $476.69 |
| $0.00 |
| $0.00 |
| $0.00 |
| $376.36 |
| Name Withheld |
| 07/15/2024 |
| VOLLEYBALL |
| Women's |
| LEG |
| $473.00 |
| $286.32 |
| $186.68 |
| $0.00 |
| $257.69 |
| $0.00 |
| $28.63 |
| Name Withheld |
| 10/04/2023 |
| SOCCER |
| Women's |
| KNEE |
| $6,675.87 |
| $2,222.49 |
| $4,453.38 |
| $0.00 |
| $1,490.17 |
| $0.00 |
| $732.32 |
| Name Withheld |
| 04/01/2024 |
| TRACK & FIELD |
| Women's |
| HIP |
| $9,019.00 |
| $1,621.00 |
| $7,398.00 |
| $0.00 |
| $61.00 |
| $0.00 |
| $1,560.00 |
| Name Withheld |
| 02/28/2024 |
| TRACK & FIELD |
| Women's |
| FOOT |
| $2,296.00 |
| $599.48 |
| $1,696.52 |
| $0.00 |
| $0.00 |
| $0.00 |
| $599.48 |
| Name Withheld |
| 07/12/2024 |
| BASKETBALL |
| Women's |
| HIP |
| $25,475.00 |
| $7,740.22 |
| $17,734.78 |
| $0.00 |
| $3,753.85 |
| $0.00 |
| $3,986.37 |
| Name Withheld |
| 09/14/2023 |
| SOCCER |
| Women's |
| KNEE |
| $33,182.50 |
| $11,420.64 |
| $21,761.86 |
| $0.00 |
| $7,759.85 |
| $0.00 |
| $3,660.79 |
| Name Withheld |
| 04/08/2024 |
| TRACK & FIELD |
| Women's |
| LEG |
| $302.32 |
| $167.43 |
| $134.89 |
| $0.00 |
| $0.00 |
| $0.00 |
| $167.43 |
| Name Withheld |
| 07/08/2024 |
| BASKETBALL |
| Men's |
| BACK |
| $165.00 |
| $165.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $165.00 |
| Name Withheld |
| 09/19/2023 |
| LACROSSE |
| Women's |
| HIP |
| $3,384.00 |
| $820.94 |
| $2,563.06 |
| $0.00 |
| $437.06 |
| $0.00 |
| $383.88 |
| Name Withheld |
| 05/01/2024 |
| BASEBALL |
| Men's |
| FINGER |
| $413.00 |
| $274.85 |
| $138.15 |
| $0.00 |
| $239.85 |
| $0.00 |
| $35.00 |
| Name Withheld |
| 02/01/2024 |
| GOLF |
| Women's |
| SHOULDER |
| $18,246.25 |
| $3,396.25 |
| $14,850.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $3,396.25 |
| Name Withheld |
| 07/25/2024 |
| BASKETBALL |
| Men's |
| FOOT |
| $468.00 |
| $294.94 |
| $173.06 |
| $0.00 |
| $194.94 |
| $0.00 |
| $100.00 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 02/18/2024 |
| LACROSSE |
| Men's |
| KNEE |
| $2,216.50 |
| $738.12 |
| $1,478.38 |
| $0.00 |
| $550.62 |
| $0.00 |
| $187.50 |
| Name Withheld |
| 07/12/2024 |
| BASKETBALL |
| Women's |
| FOOT |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 10/02/2023 |
| BASEBALL |
| Men's |
| HAND |
| $3,443.88 |
| $1,800.29 |
| $1,643.59 |
| $0.00 |
| $866.09 |
| $0.00 |
| $934.20 |
| Name Withheld |
| 07/08/2024 |
| BASKETBALL |
| Women's |
| FOOT |
| $450.00 |
| $450.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $450.00 |
| Name Withheld |
| 03/20/2024 |
| BASKETBALL |
| Men's |
| HIP |
| $30,433.54 |
| $15,295.21 |
| $15,138.33 |
| $0.00 |
| $0.00 |
| $0.00 |
| $15,295.21 |
| Name Withheld |
| 01/09/2024 |
| SOFTBALL |
| Men's |
| SHOULDER |
| $7,768.00 |
| $2,673.97 |
| $5,094.03 |
| $0.00 |
| $1,065.87 |
| $0.00 |
| $1,608.10 |
| Name Withheld |
| 01/16/2024 |
| TRACK & FIELD |
| Women's |
| BACK |
| $225.00 |
| $200.00 |
| $25.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $200.00 |
| Name Withheld |
| 03/01/2024 |
| VOLLEYBALL |
| Women's |
| FOOT |
| $468.98 |
| $468.98 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $468.98 |
| Name Withheld |
| 09/12/2023 |
| LACROSSE |
| Women's |
| KNEE |
| $435.00 |
| $178.35 |
| $256.65 |
| $0.00 |
| $153.35 |
| $0.00 |
| $25.00 |
Total for Benefit Contract: MCB 4850979_080123-24
| $347,435.34 |
| $118,883.10 |
| $228,402.24 |
| $0.00 |
| $49,447.37 |
| $0.00 |
| $69,435.73 |
Benefit Contract ID: WRP00_080123-24 ADMIN DEC
Effective Date: 8/1/2023
| Insured | Date of | Sport/Activity | Men's / |
| Body Part | | | |
| Charges | | | |
| Allowed | | | |
| Write-Off | | | |
| Ineligible | | | |
| Primary Ins. | | | |
| Deductible | | | |
| Amount | | | |
Accident Women's
| Charges |
| Amount |
| Amount |
| Paid |
Paid
| Name Withheld | 07/08/2024 | BASKETBALL | Women's |
| OTHER | | | |
| $1,945.00 | | | |
| $1,292.71 | | | |
| $652.29 | | | |
| $0.00 | | | |
| $1,252.71 | | | |
| $0.00 | | | |
| $40.00 | | | |
| Name Withheld | 03/16/2024 | TRACK & FIELD | Men's |
| OTHER | | | |
| $5,017.30 | | | |
| $238.32 | | | |
| $4,778.98 | | | |
| $0.00 | | | |
| $0.00 | | | |
| $0.00 | | | |
| $238.32 | | | |
Total for Benefit Contract: WRP00_080123-24 ADMIN DEC
| $6,962.30 |
| $1,531.03 |
| $5,431.27 |
| $0.00 |
| $1,252.71 |
| $0.00 |
| $278.32 |
Benefit Contract ID: WRP00_080123-24 EXHAUSTED
Effective Date: 8/1/2023
| Insured | Date of | Sport/Activity | Men's / |
| Body Part | | | |
| Charges | | | |
| Allowed | | | |
| Write-Off | | | |
| Ineligible | | | |
| Primary Ins. | | | |
| Deductible | | | |
| Amount | | | |
Accident Women's
| Charges |
| Amount |
| Amount |
| Paid |
Paid
| Name Withheld | 08/22/2023 | BASKETBALL | Men's |
| LEG | | | |
| $5,822.00 | | | |
| $4,657.60 | | | |
| $1,164.40 | | | |
| $0.00 | | | |
| $0.00 | | | |
| $0.00 | | | |
| $4,657.60 | | | |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 06/07/2024 |
| BASKETBALL |
| Men's |
| FOOT |
| $440.00 |
| $396.00 |
| $44.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $396.00 |
| Name Withheld |
| 10/24/2023 |
| GOLF |
| Women's |
| SHOULDER |
| $1,016.00 |
| $542.57 |
| $473.43 |
| $0.00 |
| $443.35 |
| $0.00 |
| $99.22 |
| Name Withheld |
| 02/03/2024 |
| SOFTBALL |
| Women's |
| HAND |
| $57.00 |
| $57.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $57.00 |
| Name Withheld |
| 10/06/2023 |
| BASEBALL |
| Men's |
| BACK |
| $1,973.00 |
| $1,190.62 |
| $782.38 |
| $0.00 |
| $251.73 |
| $0.00 |
| $938.89 |
| Name Withheld |
| 10/04/2023 |
| SOCCER |
| Women's |
| KNEE |
| $63,967.21 |
| $10,729.59 |
| $53,207.44 |
| $0.00 |
| $7,207.29 |
| $0.00 |
| $3,522.30 |
| Name Withheld |
| 02/07/2024 |
| BASKETBALL |
| Men's |
| MOUTH |
| $115.00 |
| $115.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $115.00 |
| Name Withheld |
| 10/02/2023 |
| BASEBALL |
| Men's |
| HAND |
| $7,395.00 |
| $3,791.13 |
| $3,603.87 |
| $0.00 |
| $2,044.36 |
| $0.00 |
| $1,746.77 |
| Name Withheld |
| 08/17/2023 |
| SOCCER |
| Men's |
| FOOT |
| $358.00 |
| $286.40 |
| $71.60 |
| $0.00 |
| $0.00 |
| $0.00 |
| $286.40 |
| Name Withheld |
| 10/06/2023 |
| BASEBALL |
| Men's |
| ELBOW |
| $43,481.86 |
| $9,154.76 |
| $34,327.10 |
| $0.00 |
| $20.96 |
| $0.00 |
| $9,133.80 |
| Name Withheld |
| 02/01/2024 |
| GOLF |
| Women's |
| SHOULDER |
| $15,223.75 |
| $8,782.04 |
| $6,441.71 |
| $0.00 |
| $1,229.20 |
| $0.00 |
| $7,552.84 |
| Name Withheld |
| 07/12/2024 |
| BASKETBALL |
| Women's |
| FOOT |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 01/18/2024 |
| BASKETBALL |
| Men's |
| FOOT |
| $234.00 |
| $144.74 |
| $89.26 |
| $0.00 |
| $124.74 |
| $0.00 |
| $20.00 |
| Name Withheld |
| 08/31/2023 |
| SOFTBALL |
| Women's |
| ANKLE |
| $275.00 |
| $147.02 |
| $127.98 |
| $0.00 |
| $53.02 |
| $0.00 |
| $94.00 |
| Name Withheld |
| 04/10/2024 |
| TRACK & FIELD |
| Women's |
| BACK |
| $413.00 |
| $321.16 |
| $91.84 |
| $0.00 |
| $271.16 |
| $0.00 |
| $50.00 |
| Name Withheld |
| 08/09/2023 |
| SOCCER |
| Men's |
| KNEE |
| $492.00 |
| $393.60 |
| $98.40 |
| $0.00 |
| $0.00 |
| $0.00 |
| $393.60 |
| Name Withheld |
| 01/19/2024 |
| TRACK & FIELD |
| Women's |
| ANKLE |
| $358.00 |
| $190.83 |
| $167.17 |
| $0.00 |
| $0.00 |
| $0.00 |
| $190.83 |
| Name Withheld |
| 05/02/2024 |
| SOCCER |
| Women's |
| THIGH |
| $10,322.00 |
| $1,713.90 |
| $8,608.10 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,713.90 |
| Name Withheld |
| 07/22/2024 |
| FOOTBALL |
| Women's |
| FOOT |
| $108.70 |
| $52.41 |
| $56.29 |
| $0.00 |
| $32.41 |
| $0.00 |
| $20.00 |
| Name Withheld |
| 07/15/2024 |
| VOLLEYBALL |
| Women's |
| LEG |
| $1,436.00 |
| $979.36 |
| $456.64 |
| $0.00 |
| $881.43 |
| $0.00 |
| $97.93 |
| Name Withheld |
| 10/12/2023 |
| BASEBALL |
| Men's |
| ELBOW |
| $1,226.11 |
| $1,118.94 |
| $107.17 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,118.94 |
| Name Withheld |
| 08/01/2023 |
| BASKETBALL |
| Women's |
| OTHER |
| $746.01 |
| $576.39 |
| $169.62 |
| $0.00 |
| $0.00 |
| $0.00 |
| $576.39 |
| Name Withheld |
| 09/16/2023 |
| VOLLEYBALL |
| Women's |
| KNEE |
| $21,068.36 |
| $10,957.44 |
| $10,110.92 |
| $0.00 |
| $7,007.23 |
| $0.00 |
| $3,950.21 |
| Name Withheld |
| 09/20/2023 |
| TRACK & FIELD |
| Women's |
| KNEE |
| $4,133.00 |
| $1,497.29 |
| $2,635.71 |
| $0.00 |
| $606.57 |
| $0.00 |
| $1,042.11 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 10/01/2023 |
| SOFTBALL |
| Women's |
| ELBOW |
| $2,095.00 |
| $697.38 |
| $1,397.62 |
| $0.00 |
| $520.08 |
| $0.00 |
| $177.30 |
| Name Withheld |
| 10/13/2023 |
| BASKETBALL |
| Men's |
| FOOT |
| $3,656.00 |
| $2,547.47 |
| $1,108.53 |
| $0.00 |
| $2,037.97 |
| $0.00 |
| $509.50 |
| Name Withheld |
| 11/06/2023 |
| BASKETBALL |
| Men's |
| TOE |
| $275.00 |
| $174.08 |
| $100.92 |
| $0.00 |
| $114.08 |
| $0.00 |
| $60.00 |
| Name Withheld |
| 12/17/2023 |
| BASKETBALL |
| Men's |
| FOOT |
| $1,672.00 |
| $1,264.88 |
| $407.12 |
| $0.00 |
| $861.48 |
| $0.00 |
| $403.40 |
| Name Withheld |
| 03/19/2024 |
| SOFTBALL |
| Women's |
| KNEE |
| $2,237.00 |
| $813.63 |
| $1,423.37 |
| $0.00 |
| $0.00 |
| $0.00 |
| $813.63 |
| Name Withheld |
| 09/11/2023 |
| TRACK & FIELD |
| Women's |
| SHOULDER |
| $480.00 |
| $277.91 |
| $202.09 |
| $0.00 |
| $175.39 |
| $0.00 |
| $102.52 |
| Name Withheld |
| 02/24/2024 |
| BASEBALL |
| Men's |
| HAND |
| $706.65 |
| $501.65 |
| $205.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $501.65 |
| Name Withheld |
| 10/16/2023 |
| SOCCER |
| Men's |
| BACK |
| $1,712.00 |
| $933.94 |
| $778.06 |
| $0.00 |
| $846.30 |
| $0.00 |
| $87.64 |
| Name Withheld |
| 09/18/2023 |
| SOCCER |
| Women's |
| KNEE |
| $7,028.00 |
| $1,476.34 |
| $5,551.66 |
| $0.00 |
| $1,326.34 |
| $0.00 |
| $150.00 |
| Name Withheld |
| 11/09/2023 |
| LACROSSE |
| Men's |
| KNEE |
| $1,436.00 |
| $1,108.77 |
| $327.23 |
| $0.00 |
| $29.57 |
| $0.00 |
| $1,079.20 |
| Name Withheld |
| 08/21/2023 |
| CROSS COUNTRY |
| Women's |
| LEG |
| $4,060.95 |
| $3,338.35 |
| $722.60 |
| $0.00 |
| $0.00 |
| $0.00 |
| $3,338.35 |
| Name Withheld |
| 02/03/2024 |
| BASEBALL |
| Men's |
| WRIST |
| $718.00 |
| $464.68 |
| $253.32 |
| $0.00 |
| $404.68 |
| $0.00 |
| $60.00 |
| Name Withheld |
| 09/07/2023 |
| LACROSSE |
| Women's |
| KNEE |
| $1,199.00 |
| $751.77 |
| $447.23 |
| $0.00 |
| $726.77 |
| $0.00 |
| $25.00 |
| Name Withheld |
| 10/11/2023 |
| VOLLEYBALL |
| Women's |
| FOOT |
| $778.00 |
| $444.41 |
| $333.59 |
| $0.00 |
| $354.41 |
| $0.00 |
| $90.00 |
| Name Withheld |
| 01/13/2024 |
| BASEBALL |
| Men's |
| KNEE |
| $377.00 |
| $301.60 |
| $75.40 |
| $0.00 |
| $0.00 |
| $0.00 |
| $301.60 |
| Name Withheld |
| 09/23/2023 |
| LACROSSE |
| Men's |
| FACE |
| $200.00 |
| $130.00 |
| $70.00 |
| $0.00 |
| $130.00 |
| $0.00 |
| $0.00 |
| Name Withheld |
| 10/07/2023 |
| BASKETBALL |
| Men's |
| FOOT |
| $358.00 |
| $190.06 |
| $167.94 |
| $0.00 |
| $170.06 |
| $0.00 |
| $20.00 |
| Name Withheld |
| 07/25/2024 |
| BASKETBALL |
| Men's |
| FOOT |
| $2,471.00 |
| $290.31 |
| $2,180.69 |
| $0.00 |
| $215.31 |
| $0.00 |
| $75.00 |
| Name Withheld |
| 01/09/2024 |
| SOFTBALL |
| Women's |
| WRIST |
| $9,031.25 |
| $2,752.69 |
| $6,278.56 |
| $0.00 |
| $977.92 |
| $0.00 |
| $1,774.77 |
| Name Withheld |
| 10/13/2023 |
| BASKETBALL |
| Women's |
| TOE |
| $993.58 |
| $391.31 |
| $602.27 |
| $0.00 |
| $229.11 |
| $0.00 |
| $162.20 |
| Name Withheld |
| 10/25/2023 |
| LACROSSE |
| Women's |
| KNEE |
| $5,834.00 |
| $3,587.77 |
| $2,246.23 |
| $0.00 |
| $3,022.62 |
| $0.00 |
| $565.15 |
| Name Withheld |
| 10/11/2023 |
| VOLLEYBALL |
| Women's |
| FINGER |
| $2,484.00 |
| $1,987.20 |
| $496.80 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,987.20 |
| Name Withheld |
| 01/04/2024 |
| BASKETBALL |
| Women's |
| TOE |
| $744.34 |
| $196.75 |
| $547.59 |
| $0.00 |
| $116.75 |
| $0.00 |
| $80.00 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 02/18/2024 |
| LACROSSE |
| Men's |
| KNEE |
| $12,679.00 |
| $4,391.21 |
| $8,287.79 |
| $0.00 |
| $3,741.21 |
| $0.00 |
| $650.00 |
| Name Withheld |
| 09/27/2023 |
| SOCCER |
| Women's |
| KNEE |
| $29,971.03 |
| $11,878.69 |
| $18,092.34 |
| $0.00 |
| $5,439.80 |
| $0.00 |
| $6,438.89 |
| Name Withheld |
| 09/06/2023 |
| BASKETBALL |
| Women's |
| LEG |
| $12,889.00 |
| $3,513.44 |
| $9,375.56 |
| $0.00 |
| $190.17 |
| $0.00 |
| $3,323.27 |
| Name Withheld |
| 08/12/2023 |
| VOLLEYBALL |
| Women's |
| SHOULDER |
| $34,844.34 |
| $9,802.07 |
| $25,042.27 |
| $0.00 |
| $7,109.27 |
| $0.00 |
| $2,692.80 |
| Name Withheld |
| 07/12/2024 |
| BASKETBALL |
| Women's |
| FOOT |
| $450.00 |
| $450.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $450.00 |
| Name Withheld |
| 08/28/2023 |
| GOLF |
| Women's |
| ARM |
| $2,590.00 |
| $2,071.92 |
| $518.08 |
| $0.00 |
| $0.00 |
| $0.00 |
| $2,071.92 |
| Name Withheld |
| 10/23/2023 |
| CROSS COUNTRY |
| Men's |
| KNEE |
| $5,262.00 |
| $1,908.61 |
| $3,353.39 |
| $0.00 |
| $202.80 |
| $0.00 |
| $1,545.81 |
| Name Withheld |
| 10/24/2023 |
| LACROSSE |
| Women's |
| LEG |
| $3,367.00 |
| $686.31 |
| $2,680.69 |
| $0.00 |
| $0.00 |
| $0.00 |
| $686.31 |
| Name Withheld |
| 09/12/2023 |
| LACROSSE |
| Women's |
| KNEE |
| $31,363.00 |
| $8,387.64 |
| $22,975.36 |
| $0.00 |
| $1,172.24 |
| $0.00 |
| $7,215.40 |
| Name Withheld |
| 01/26/2024 |
| GOLF |
| Women's |
| FOOT |
| $43,334.54 |
| $11,565.67 |
| $26,429.63 |
| $0.00 |
| $0.00 |
| $0.00 |
| $11,565.67 |
| Name Withheld |
| 09/07/2023 |
| BASEBALL |
| Women's |
| ELBOW |
| $1,439.00 |
| $942.26 |
| $496.74 |
| $0.00 |
| $753.81 |
| $0.00 |
| $188.45 |
| Name Withheld |
| 03/20/2024 |
| BASKETBALL |
| Men's |
| HIP |
| $13,686.75 |
| $7,446.35 |
| $6,240.40 |
| $0.00 |
| $0.00 |
| $0.00 |
| $7,446.35 |
| Name Withheld |
| 11/02/2023 |
| BASEBALL |
| Men's |
| KNEE |
| $2,696.58 |
| $1,273.29 |
| $1,423.29 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,273.29 |
| Name Withheld |
| 10/21/2023 |
| BASEBALL |
| Men's |
| ELBOW |
| $144.00 |
| $119.58 |
| $24.42 |
| $0.00 |
| $95.66 |
| $0.00 |
| $23.92 |
| Name Withheld |
| 07/22/2024 |
| BASKETBALL |
| Men's |
| FOOT |
| $440.00 |
| $396.00 |
| $44.00 |
| $0.00 |
| $41.40 |
| $0.00 |
| $354.60 |
| Name Withheld |
| 01/09/2024 |
| SOFTBALL |
| Men's |
| SHOULDER |
| $15,461.00 |
| $3,456.07 |
| $12,004.93 |
| $0.00 |
| $446.93 |
| $0.00 |
| $3,009.14 |
| Name Withheld |
| 02/25/2024 |
| BASEBALL |
| Men's |
| ELBOW |
| $1,581.00 |
| $1,351.81 |
| $229.19 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,351.81 |
| Name Withheld |
| 02/28/2024 |
| TRACK & FIELD |
| Women's |
| FOOT |
| $358.00 |
| $207.80 |
| $150.20 |
| $0.00 |
| $0.00 |
| $0.00 |
| $207.80 |
| Name Withheld |
| 01/20/2024 |
| BASKETBALL |
| Men's |
| KNEE |
| $1,691.00 |
| $1,352.80 |
| $338.20 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,352.80 |
| Name Withheld |
| 11/30/2023 |
| TRACK & FIELD |
| Women's |
| FOOT |
| $3,394.00 |
| $1,042.04 |
| $2,351.96 |
| $0.00 |
| $857.74 |
| $0.00 |
| $184.30 |
| Name Withheld |
| 01/18/2024 |
| BASKETBALL |
| Men's |
| BACK |
| $2,610.00 |
| $1,340.26 |
| $1,269.74 |
| $0.00 |
| $129.21 |
| $0.00 |
| $1,211.05 |
| Name Withheld |
| 07/12/2024 |
| BASKETBALL |
| Women's |
| BACK |
| $755.00 |
| $269.50 |
| $485.50 |
| $0.00 |
| $0.00 |
| $0.00 |
| $269.50 |
| Name Withheld |
| 09/14/2023 |
| SOCCER |
| Women's |
| KNEE |
| $2,805.34 |
| $1,984.42 |
| $820.92 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,984.42 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 09/24/2023 |
| CROSS COUNTRY |
| Men's |
| LEG |
| $1,070.00 |
| $415.17 |
| $654.83 |
| $0.00 |
| $296.13 |
| $0.00 |
| $119.04 |
| Name Withheld |
| 12/04/2023 |
| TRACK & FIELD |
| Men's |
| BACK |
| $2,074.00 |
| $626.25 |
| $1,447.75 |
| $0.00 |
| $356.01 |
| $0.00 |
| $270.24 |
| Name Withheld |
| 08/20/2023 |
| TRACK & FIELD |
| Men's |
| BACK |
| $11,082.89 |
| $3,808.34 |
| $7,274.55 |
| $0.00 |
| $0.00 |
| $0.00 |
| $3,808.34 |
| Name Withheld |
| 09/23/2023 |
| SOCCER |
| Women's |
| KNEE |
| $9,256.02 |
| $3,866.96 |
| $5,389.06 |
| $0.00 |
| $0.00 |
| $0.00 |
| $3,866.96 |
| Name Withheld |
| 10/23/2023 |
| TRACK & FIELD |
| Men's |
| ANKLE |
| $550.00 |
| $440.00 |
| $110.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 10/12/2023 |
| BASKETBALL |
| Women's |
| BACK |
| $538.00 |
| $269.00 |
| $269.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $269.00 |
| Name Withheld |
| 09/21/2023 |
| SOFTBALL |
| Women's |
| MOUTH |
| $5,964.00 |
| $1,433.26 |
| $1,598.00 |
| $4,086.00 |
| $1,016.19 |
| $0.00 |
| $417.07 |
| Name Withheld |
| 10/05/2023 |
| TRACK & FIELD |
| Women's |
| THIGH |
| $459.00 |
| $411.60 |
| $47.40 |
| $0.00 |
| $0.00 |
| $0.00 |
| $411.60 |
| Name Withheld |
| 11/04/2023 |
| BASEBALL |
| Men's |
| EAR |
| $6,204.90 |
| $3,237.47 |
| $2,967.43 |
| $0.00 |
| $2,892.47 |
| $0.00 |
| $345.00 |
| Name Withheld |
| 10/11/2023 |
| TRACK & FIELD |
| Women's |
| KNEE |
| $165.00 |
| $106.12 |
| $58.88 |
| $0.00 |
| $81.12 |
| $0.00 |
| $25.00 |
| Name Withheld |
| 11/20/2023 |
| BASKETBALL |
| Men's |
| FINGER |
| $237.00 |
| $158.44 |
| $78.56 |
| $0.00 |
| $128.44 |
| $0.00 |
| $30.00 |
| Name Withheld |
| 02/04/2024 |
| BASEBALL |
| Men's |
| SHOULDER |
| $73,566.38 |
| $52,127.69 |
| $21,438.69 |
| $0.00 |
| $44,389.46 |
| $0.00 |
| $7,738.23 |
| Name Withheld |
| 08/24/2023 |
| SOCCER |
| Women's |
| KNEE |
| $22,328.00 |
| $6,832.40 |
| $15,495.60 |
| $0.00 |
| $5,979.48 |
| $0.00 |
| $852.92 |
| Name Withheld |
| 01/19/2024 |
| TRACK & FIELD |
| Women's |
| FOOT |
| $39,841.77 |
| $8,460.10 |
| $31,381.67 |
| $0.00 |
| $6,354.40 |
| $0.00 |
| $2,105.70 |
| Name Withheld |
| 04/14/2024 |
| BASEBALL |
| Men's |
| FACE |
| $10,456.79 |
| $3,373.63 |
| $7,083.16 |
| $0.00 |
| $0.00 |
| $0.00 |
| $3,373.63 |
| Name Withheld |
| 08/14/2023 |
| SOCCER |
| Women's |
| KNEE |
| $1,538.00 |
| $1,230.40 |
| $307.60 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,230.40 |
| Name Withheld |
| 02/21/2024 |
| SOCCER |
| Women's |
| SHOULDER |
| $453.00 |
| $305.82 |
| $147.18 |
| $0.00 |
| $0.00 |
| $0.00 |
| $305.82 |
| Name Withheld |
| 09/08/2023 |
| GOLF |
| Men's |
| BACK |
| $3,414.00 |
| $2,688.20 |
| $725.80 |
| $0.00 |
| $0.00 |
| $0.00 |
| $2,688.20 |
| Name Withheld |
| 09/20/2023 |
| SOCCER |
| Men's |
| HIP |
| $31,757.97 |
| $12,683.48 |
| $19,060.49 |
| $0.00 |
| $7,980.90 |
| $0.00 |
| $4,702.58 |
| Name Withheld |
| 03/28/2024 |
| VOLLEYBALL |
| Women's |
| ANKLE |
| $1,501.00 |
| $932.52 |
| $568.48 |
| $0.00 |
| $156.48 |
| $0.00 |
| $776.04 |
| Name Withheld |
| 09/15/2023 |
| VOLLEYBALL |
| Women's |
| BACK |
| $18,155.95 |
| $12,508.90 |
| $5,647.05 |
| $0.00 |
| $11,103.93 |
| $0.00 |
| $1,404.97 |
| Name Withheld |
| 04/27/2024 |
| TRACK & FIELD |
| Women's |
| LEG |
| $320.00 |
| $123.21 |
| $196.79 |
| $0.00 |
| $0.00 |
| $0.00 |
| $123.21 |
| Name Withheld |
| 01/12/2024 |
| GOLF |
| Men's |
| BACK |
| $3,398.00 |
| $2,718.40 |
| $679.60 |
| $0.00 |
| $0.00 |
| $0.00 |
| $2,718.40 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 09/24/2023 |
| SOCCER |
| Men's |
| HEAD |
| $16,219.67 |
| $10,817.69 |
| $5,401.98 |
| $0.00 |
| $8,504.32 |
| $0.00 |
| $2,313.37 |
| Name Withheld |
| 07/12/2024 |
| BASKETBALL |
| Women's |
| HIP |
| $34,855.70 |
| $7,739.06 |
| $27,116.64 |
| $0.00 |
| $2,639.05 |
| $0.00 |
| $5,100.01 |
| Name Withheld |
| 08/11/2023 |
| SOCCER |
| Women's |
| KNEE |
| $118,520.96 |
| $29,341.94 |
| $89,179.02 |
| $0.00 |
| $22,677.83 |
| $0.00 |
| $6,664.11 |
| Name Withheld |
| 01/16/2024 |
| TRACK & FIELD |
| Women's |
| BACK |
| $1,845.00 |
| $1,308.50 |
| $536.50 |
| $0.00 |
| $1,233.50 |
| $0.00 |
| $75.00 |
| Name Withheld |
| 03/01/2024 |
| VOLLEYBALL |
| Women's |
| FOOT |
| $8,462.56 |
| $5,320.34 |
| $3,142.22 |
| $0.00 |
| $0.00 |
| $0.00 |
| $5,320.34 |
| Name Withheld |
| 11/29/2023 |
| BASKETBALL |
| Women's |
| RIB |
| $346.69 |
| $175.92 |
| $170.77 |
| $0.00 |
| $0.00 |
| $0.00 |
| $175.92 |
| Name Withheld |
| 12/06/2023 |
| TRACK & FIELD |
| Men's |
| KNEE |
| $3,213.52 |
| $1,259.43 |
| $1,954.09 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,259.43 |
| Name Withheld |
| 10/17/2023 |
| SOCCER |
| Women's |
| KNEE |
| $12,275.00 |
| $2,583.34 |
| $9,691.66 |
| $0.00 |
| $983.34 |
| $0.00 |
| $1,600.00 |
| Name Withheld |
| 01/03/2024 |
| LACROSSE |
| Women's |
| SHOULDER |
| $13,368.00 |
| $8,419.16 |
| $4,948.84 |
| $0.00 |
| $4,453.25 |
| $0.00 |
| $3,965.91 |
| Name Withheld |
| 11/29/2023 |
| BASKETBALL |
| Women's |
| KNEE |
| $856.00 |
| $605.37 |
| $250.63 |
| $0.00 |
| $143.37 |
| $0.00 |
| $462.00 |
| Name Withheld |
| 10/20/2023 |
| VOLLEYBALL |
| Women's |
| KNEE |
| $19,909.74 |
| $13,635.17 |
| $6,274.57 |
| $0.00 |
| $0.00 |
| $0.00 |
| $13,635.17 |
| Name Withheld |
| 06/10/2024 |
| BASKETBALL |
| RIB |
| $252.00 |
| $160.89 |
| $91.11 |
| $0.00 |
| $128.72 |
| $0.00 |
| $32.17 |
| Name Withheld |
| 08/25/2023 |
| VOLLEYBALL |
| Women's |
| KNEE |
| $779.00 |
| $711.20 |
| $67.80 |
| $0.00 |
| $0.00 |
| $0.00 |
| $711.20 |
| Name Withheld |
| 08/16/2023 |
| TRACK & FIELD |
| Men's |
| KNEE |
| $3,258.50 |
| $1,397.30 |
| $1,861.20 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,397.30 |
| Name Withheld |
| 11/06/2023 |
| TRACK & FIELD |
| Men's |
| HEAT EXHAUSTION |
| $2,142.00 |
| $1,457.06 |
| $684.94 |
| $0.00 |
| $1,241.69 |
| $0.00 |
| $215.37 |
| Name Withheld |
| 04/22/2024 |
| LACROSSE |
| Women's |
| KNEE |
| $1,584.03 |
| $1,409.17 |
| $174.86 |
| $0.00 |
| $259.14 |
| $0.00 |
| $1,150.03 |
| Name Withheld |
| 01/17/2024 |
| BASKETBALL |
| Women's |
| HAND |
| $6,292.00 |
| $1,923.87 |
| $4,368.13 |
| $0.00 |
| $1,631.48 |
| $0.00 |
| $292.39 |
| Name Withheld |
| 09/19/2023 |
| LACROSSE |
| Women's |
| HIP |
| $57,799.00 |
| $20,589.36 |
| $37,209.64 |
| $0.00 |
| $16,643.24 |
| $0.00 |
| $3,946.12 |
| Name Withheld |
| 03/12/2024 |
| BASEBALL |
| Men's |
| SHOULDER |
| $1,672.00 |
| $1,283.00 |
| $389.00 |
| $0.00 |
| $650.00 |
| $0.00 |
| $633.00 |
| Name Withheld |
| 02/22/2024 |
| SOCCER |
| Men's |
| LEG |
| $357.00 |
| $285.60 |
| $71.40 |
| $0.00 |
| $0.00 |
| $0.00 |
| $285.60 |
| Name Withheld |
| 10/12/2023 |
| BASKETBALL |
| Women's |
| FOOT |
| $1,794.00 |
| $1,435.20 |
| $358.80 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,435.20 |
| Name Withheld |
| 08/11/2023 |
| SOCCER |
| Women's |
| HIP |
| $1,842.00 |
| $1,043.40 |
| $798.60 |
| $0.00 |
| $810.73 |
| $0.00 |
| $232.67 |
Total for Benefit Contract: WRP00_080123-24 EXHAUSTED
| $1,007,435.3 |
| $390,355.81 |
| $608,763.42 |
| $4,086.00 |
| $195,347.20 |
| $0.00 |
| $195,000.00 |
Benefit Contract ID: MCB 4850979_080122-23
Effective Date: 8/1/2022
| Insured |
| Date of |
| Sport/Activity |
| Men's / |
| Body Part |
| Charges |
| Allowed |
| Write-Off |
| Ineligible |
| Primary Ins. |
| Deductible |
| Amount |
Accident
Women's
| Charges |
| Amount |
| Amount |
| Paid |
Paid
| Name Withheld |
| 02/15/2023 |
| LACROSSE |
| Women's |
| KNEE |
| $7,242.00 |
| $3,574.26 |
| $3,667.74 |
| $0.00 |
| $0.00 |
| $0.00 |
| $3,574.26 |
| Name Withheld |
| 10/13/2022 |
| BASKETBALL |
| Men's |
| ANKLE |
| $446.91 |
| $446.91 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $446.91 |
| Name Withheld |
| 01/11/2023 |
| BASEBALL |
| Men's |
| HAND |
| $4,730.00 |
| $1,330.00 |
| $3,400.00 |
| $0.00 |
| $340.00 |
| $0.00 |
| $990.00 |
| Name Withheld |
| 02/24/2023 |
| TRACK & FIELD |
| Women's |
| FOOT |
| $2,424.07 |
| $772.17 |
| $1,651.90 |
| $0.00 |
| $446.48 |
| $0.00 |
| $325.69 |
| Name Withheld |
| 08/13/2022 |
| VOLLEYBALL |
| Women's |
| KNEE |
| $270.00 |
| $0.00 |
| $270.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| Name Withheld |
| 01/11/2023 |
| SOCCER |
| Men's |
| BACK |
| $36,549.04 |
| $4,499.18 |
| $32,049.86 |
| $0.00 |
| $2,796.39 |
| $0.00 |
| $1,702.79 |
| Name Withheld |
| 08/23/2022 |
| BASKETBALL |
| Women's |
| KNEE |
| $9,711.50 |
| $1,974.50 |
| $7,737.00 |
| $0.00 |
| $1,153.00 |
| $0.00 |
| $821.50 |
| Name Withheld |
| 05/12/2023 |
| BASEBALL |
| Men's |
| ELBOW |
| $3,159.00 |
| $1,561.46 |
| $1,597.54 |
| $0.00 |
| $1,061.58 |
| $0.00 |
| $499.88 |
| Name Withheld |
| 02/04/2023 |
| TRACK & FIELD |
| Women's |
| KNEE |
| $260.00 |
| $123.60 |
| $136.40 |
| $0.00 |
| $103.60 |
| $0.00 |
| $20.00 |
| Name Withheld |
| 03/20/2023 |
| TRACK & FIELD |
| Women's |
| HIP |
| $1,220.00 |
| $380.96 |
| $839.04 |
| $0.00 |
| $342.88 |
| $0.00 |
| $38.08 |
| Name Withheld |
| 02/05/2023 |
| BASEBALL |
| Men's |
| ELBOW |
| $2,984.00 |
| $1,392.51 |
| $1,591.49 |
| $0.00 |
| $609.51 |
| $0.00 |
| $783.00 |
| Name Withheld |
| 04/29/2023 |
| TRACK & FIELD |
| Men's |
| LEG |
| $2,014.40 |
| $696.37 |
| $1,318.03 |
| $0.00 |
| $187.48 |
| $0.00 |
| $508.89 |
| Name Withheld |
| 07/19/2023 |
| BASKETBALL |
| Women's |
| ANKLE |
| $440.00 |
| $440.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $440.00 |
| Name Withheld |
| 03/27/2023 |
| SOCCER |
| Women's |
| KNEE |
| $35,645.98 |
| $8,652.23 |
| $26,993.75 |
| $0.00 |
| $65.88 |
| $0.00 |
| $8,586.35 |
| Name Withheld |
| 07/13/2023 |
| BASKETBALL |
| Women's |
| SHOULDER |
| $601.00 |
| $480.80 |
| $120.20 |
| $0.00 |
| $0.00 |
| $0.00 |
| $480.80 |
| Name Withheld |
| 02/24/2023 |
| TRACK & FIELD |
| Men's |
| FOOT |
| $707.00 |
| $565.60 |
| $141.40 |
| $0.00 |
| $0.00 |
| $0.00 |
| $565.60 |
| Name Withheld |
| 09/12/2022 |
| GOLF |
| Women's |
| NECK |
| $17,087.00 |
| $3,282.82 |
| $13,804.18 |
| $0.00 |
| $116.50 |
| $0.00 |
| $3,166.32 |
| Name Withheld |
| 10/16/2022 |
| BASKETBALL |
| Men's |
| TOE |
| $590.00 |
| $590.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $590.00 |
| Name Withheld |
| 10/25/2022 |
| VOLLEYBALL |
| Women's |
| ANKLE |
| $72,982.35 |
| $66,529.38 |
| $6,452.97 |
| $0.00 |
| $63,669.56 |
| $0.00 |
| $2,859.82 |
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 03/01/2023 |
| BASKETBALL |
| Women's |
| FOOT |
| $5,015.25 |
| $3,491.85 |
| $1,523.40 |
| $0.00 |
| $0.00 |
| $0.00 |
| $3,491.85 |
| Name Withheld |
| 10/22/2022 |
| SOCCER |
| Women's |
| KNEE |
| $300.00 |
| $88.00 |
| $212.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $88.00 |
| Name Withheld |
| 01/06/2023 |
| BASKETBALL |
| Women's |
| NOSE |
| $24,177.10 |
| $4,063.22 |
| $20,113.88 |
| $0.00 |
| $483.09 |
| $0.00 |
| $3,580.13 |
| Name Withheld |
| 05/06/2023 |
| BASEBALL |
| Men's |
| SHOULDER |
| $2,542.00 |
| $595.00 |
| $1,947.00 |
| $0.00 |
| $175.00 |
| $0.00 |
| $420.00 |
| Name Withheld |
| 01/12/2023 |
| LACROSSE |
| Women's |
| KNEE |
| $206,715.93 |
| $86,241.11 |
| $120,474.82 |
| $0.00 |
| $69,734.86 |
| $0.00 |
| $16,506.25 |
| Name Withheld |
| 01/09/2023 |
| LACROSSE |
| Women's |
| ELBOW |
| $35,910.93 |
| $8,039.48 |
| $27,871.45 |
| $0.00 |
| $1,486.31 |
| $0.00 |
| $6,553.17 |
| Name Withheld |
| 10/03/2022 |
| BASEBALL |
| Men's |
| BACK |
| $414.00 |
| $167.16 |
| $246.84 |
| $0.00 |
| $92.16 |
| $0.00 |
| $75.00 |
| Name Withheld |
| 04/20/2023 |
| SOFTBALL |
| Men's |
| KNEE |
| $5,699.00 |
| $4,441.95 |
| $1,257.05 |
| $0.00 |
| $2,928.65 |
| $0.00 |
| $1,513.30 |
| Name Withheld |
| 07/11/2023 |
| BASKETBALL |
| Women's |
| LEG |
| $2,377.00 |
| $1,066.34 |
| $1,310.66 |
| $0.00 |
| $836.34 |
| $0.00 |
| $230.00 |
| Name Withheld |
| 10/07/2022 |
| LACROSSE |
| Women's |
| KNEE |
| $66,748.60 |
| $4,963.08 |
| $61,785.52 |
| $0.00 |
| $4,580.93 |
| $0.00 |
| $382.15 |
| Name Withheld |
| 03/13/2023 |
| SOCCER |
| Women's |
| BACK |
| $6,642.00 |
| $3,622.90 |
| $3,019.10 |
| $0.00 |
| $3,272.90 |
| $0.00 |
| $350.00 |
Total for Benefit Contract: MCB 4850979_080122-23
| $555,606.06 |
| $214,072.84 |
| $341,533.22 |
| $0.00 |
| $154,483.10 |
| $0.00 |
| $59,589.74 |
Benefit Contract ID: WRP00_080122-23 ADMIN DEC
Effective Date: 8/1/2022
| Insured | Date of | Sport/Activity | Men's / |
| Body Part | | | |
| Charges | | | |
| Allowed | | | |
| Write-Off | | | |
| Ineligible | | | |
| Primary Ins. | | | |
| Deductible | | | |
| Amount | | | |
Accident Women's
| Charges |
| Amount |
| Amount |
| Paid |
Paid
| Name Withheld | 03/27/2023 | SOCCER | Women's |
| KNEE | | | |
| $22,518.00 | | | |
| $7,256.51 | | | |
| $10,018.00 | | | |
| $0.00 | | | |
| $0.00 | | | |
| $0.00 | | | |
| $7,256.51 | | | |
Total for Benefit Contract: WRP00_080122-23 ADMIN DEC
| $22,518.00 |
| $7,256.51 |
| $10,018.00 |
| $0.00 |
| $0.00 |
| $0.00 |
| $7,256.51 |
Benefit Contract ID: WRP00_080122-23 EXHAUSTED
Effective Date: 8/1/2022
| Insured |
| Date of Accident |
| Sport/Activity |
| Men's / Women's |
| Body Part |
| Charges |
| Allowed Charges |
| Write-Off Amount |
| Ineligible Amount |
| Primary Ins. |
Paid
Paid
| Name Withheld |
| 02/15/2023 |
| LACROSSE |
| Women's |
| KNEE |
| $38,309.97 |
| $11,390.21 |
| $26,919.76 |
| $0.00 |
| $7,633.08 |
| $0.00 |
| $3,757.13 |
| Name Withheld |
| 10/13/2022 |
| BASKETBALL |
| Men's |
| ANKLE |
| $77,544.35 |
| $34,247.07 |
| $42,850.37 |
| $0.00 |
| $0.00 |
| $0.00 |
| $34,247.07 |
| Name Withheld |
| 01/11/2023 |
| BASEBALL |
| Men's |
| HAND |
| $556.00 |
| $306.12 |
| $249.88 |
| $0.00 |
| $155.72 |
| $0.00 |
| $150.40 |
| Name Withheld |
| 10/06/2022 |
| BASKETBALL |
| Men's |
| ANKLE |
| $1,673.00 |
| $1,093.71 |
| $579.29 |
| $0.00 |
| $710.81 |
| $0.00 |
| $382.90 |
| Name Withheld |
| 05/20/2023 |
| BASEBALL |
| Men's |
| ELBOW |
| $2,577.00 |
| $1,610.42 |
| $966.58 |
| $0.00 |
| $1,179.92 |
| $0.00 |
| $430.50 |
| Name Withheld |
| 08/24/2022 |
| BASKETBALL |
| Men's |
| TOE |
| $234.00 |
| $187.20 |
| $46.80 |
| $0.00 |
| $0.00 |
| $0.00 |
| $187.20 |
| Name Withheld |
| 12/16/2022 |
| BASKETBALL |
| Men's |
| FOOT |
| $1,199.00 |
| $959.20 |
| $239.80 |
| $0.00 |
| $0.00 |
| $0.00 |
| $959.20 |
| Name Withheld |
| 08/01/2022 |
| BASKETBALL |
| Women's |
| FOOT |
| $56,715.33 |
| $20,895.26 |
| $35,820.07 |
| $0.00 |
| $0.00 |
| $0.00 |
| $20,895.26 |
| Name Withheld |
| 10/03/2022 |
| BASKETBALL |
| Men's |
| KNEE |
| $492.00 |
| $266.80 |
| $225.20 |
| $0.00 |
| $236.80 |
| $0.00 |
| $30.00 |
| Name Withheld |
| 11/07/2022 |
| BASEBALL |
| Men's |
| FOOT |
| $358.00 |
| $195.56 |
| $162.44 |
| $0.00 |
| $156.46 |
| $0.00 |
| $39.10 |
| Name Withheld |
| 01/13/2023 |
| BASKETBALL |
| Men's |
| ANKLE |
| $2,052.00 |
| $1,641.60 |
| $410.40 |
| $0.00 |
| $0.00 |
| $0.00 |
| $1,641.60 |
| Name Withheld |
| 10/16/2022 |
| BASKETBALL |
| Men's |
| TOE |
| $13,131.69 |
| $10,041.72 |
| $3,089.97 |
| $0.00 |
| $0.00 |
| $0.00 |
| $10,041.72 |
| Name Withheld |
| 10/24/2022 |
| BASKETBALL |
| Men's |
| FOOT |
| $151.00 |
| $95.51 |
| $55.49 |
| $0.00 |
| $45.51 |
| $0.00 |
| $50.00 |
| Name Withheld |
| 03/25/2023 |
| BASEBALL |
| Men's |
| ANKLE |
| $3,777.00 |
| $947.48 |
| $2,829.52 |
This is the start of the file's text. The full file is on GovTribe.