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Getting to Know the CBA - Episode 16: Article 23 - Insurance Coverages

Stevie Roxelle - @stevieroxelle - Biscuit Fox

After last week's relatively short episode on the Competition Committee, we've got another article that only goes over a few pages. This time, we'll take a look at the insurance coverages extended to the players by agreement of the NHL and NHLPA.

You can find the entire CBA here (PDF)

Article 23: Insurance Coverages

We'll cover this one section-by-section. Try to stay awake.

23.1 - Establishment of Trust, Board of Trustees

The insurance coverages provided in this article are paid from a (tax-exempt) trust funded by the NHL and NHLPA which is administered jointly by both groups. The Board of Trustees has the authority to create any number of committees to cover day-to-day administration or other needs that may arise. They may also hire/use a third party administrator and/or legal counsel they may need. They're required to offer the coverages specifically laid out in the CBA as long as those coverages are commercially available and reasonably-priced. The NHLPA can suggest changes to benefits and the NHL cannot reasonably withhold consent for those changes.

23.2 - Group Life/Accidental Death Coverages

Each player is covered for $1M under a group life insurance policy, starting the first day he's on a roster and ending the following Nov. 1st. Additionally, each player will be covered by an accidental death policy worth his salary for that year (not to exceed $15M). If the player's salary goes up, so does the coverage in the next year. If his salary goes down, then the coverage drops to the lower amount as of Nov. 1st.

Additionally, player's spouses are also automatically covered with a $250,000 life policy with an additional $100K accidental death & dismemberment policy, following the same November 1st expiry/renewal date as goes for the players. NHLPA employees may also get coverage under the group policy as well.

23.3 - Career Ending/Serious Disability Policy

These two types of coverages both overlap and intervene one another, so they're listed under the same section. If a player suffers both a disability listed and it ends his career (which is very likely), then only the larger of the benefits is paid to him. Taking receipt of this benefit releases everybody involved from follow-on claims for recompense (although not to other insurance claims). The Injury or illness must result from his performing his duties to the team "solely and independently of any other cause". Pre-existing conditions don't count.

Here are the payments for career-ending injuries. It's important to note that career-ending means a player can't play hockey for more than 12 months and isn't expected to ever play again. He doesn't have to be disabled from doing other forms of work, but his ability to play at an NHL level has ended. If you look at Exhibits 9-12, which include all of the claim and release forms for these coverages, you'll see that a player who returns to play professional hockey after receiving this benefit has to repay the money.

Player's Age Benefit Amount (US Dollars)
Under 31 $1,000,000
31 $840,000
32 $680,000
33 $520,000
34 $360,000
35+ $200,000

For players 33 or younger, the benefit is reduced to $500,000 if one hasn't played more than 41 NHL games by that point in his career.

Here's the list of disabilities and the payments for getting those. Have fun reading this one!

Disability Type Benefit Amount (US Dollars)
Loss of Brain Functions $5,000,000
Paralysis $5,000,000
Organ Failure $3,000,000
Terminal Illness $3,000,000
Loss of a Limb $2,500,000
Loss of Two Limbs $4,000,000
Loss of Sight (both eyes) $4,000,000
Loss of Sight (one eye) $2,000,000
Loss of Hearing or Speech $750,000
Loss of Hearing and Speech $1,000,000
Loss of One Hand or Foot $750,000
Loss of Any Two Hands or Feet $1,000,000

For clarity, the word "Loss" means the player can't use it, not that it's necessarily amputated.

23.4 - The SPC

This section is a reminder that a player keeps getting his full NHL salary as long as he has a contract. He wouldn't take the career ending or serious disability until after his SPC expired.

23.5 - Group Health Benefits

The Clubs and NHLPA maintain a group health benefit plan. That plan isn't completely laid out in this document, but all players are given a copy of how the group health plan works and, as such, whatever that plan says should be considered a part of the CBA. It's also not the intent of this section of the CBA to prevent participation in the plan by by those who wish to pay into it at their own expense or to prevent players from purchasing additional benefits for themselves at their own expense. Just like with the life coverages, the NHLPA may cover its employees under the plan as long as the NHLPA pays for it.

23.6 - Persistent Eligibility, Plan Options

When a player reaches 160 games played (or a goalie hits 160 games dressed), he's eligible to pay his own way into the plan forever, even if he's no longer playing. This benefit extends to the player's spouse even after his death. If he continues his career in the minor leagues, where he's not covered by this plan, but is covered by the minor-league club, then he can still jump back to the NHL plan at his own expense, as long as he's kept continuous health coverage during this time.

This is slightly out of place here, but this section also puts the responsibility on the Board of Trustees to review the plan yearly and offer a selection of coverage choices.

23.7 - Benefits in the Plan Description

There is a list of benefits which will be included in the plan, including Lasik surgery, speech therapy, routine eye exams/vaccinations, and a range of other treatments. I'm not going to list them all, but if you'd like to peruse them, they're on page 152. Remember that these are coverages for things outside of what the team automatically treats for players (injuries suffered while playing). These are also coverages for loved ones. On top of the list, 23.7(b) lays out that reasonable and customary charges for medically necessary products and services are covered and that the plan extends to cover Canadien residents outside of their home provinces.

23.8 - Off-Season Coverage

As long as players weren't on emergency recall or playoff standby at the end of the season (or if they were on the roaster for half the season anyway), the plan covers them through the summer as well.

23.9 - Coverages for Non-Covered Players

Players in Training/Conditioning Camp who aren't automatically covered by the plan will be reimbursed for for emergency medical/dental treatments which are made necessary by something that happens at camp, or while traveling to or from such camp. He's also automatically covered for a $50,000 career ending injury (not illness) and accidental death & dismemberment.

23.10 - Medical Records Release, Exit Physicals

A player gets to hold his own medical records (to the extend they're physically stored) at the time of his annual exit physical. This physical documents all the injuries which may require future medical or dental treatments. The club retains responsibility to pay for such procedures/treatments in the future, no matter how far out they're needed as long as the need for them is hockey-related.

23.11 - The Central Bureaucracy

The NHL has the responsibility to designate a central contact person for the NHLPA to discuss and process claims for hockey-related injuries, except in cases where the player's club is already providing the treatment. These claims should be reviewed and process in as timely a manner as possible.

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Up next, Article 24 dealing with international hockey.