Former Player Life Improvement Plan
Section 2Joint Replacements
The Joint Replacement benefit shall be continued under the FPLIP. Different levels of benefits are provided to eligible former players depending on whether they are covered by medical insurance.
Former players covered by medical insurance will be entitled to the lesser of $5,250 ($10,500 in the case of a bilateral procedure) or the former player’s co-insurance for health care items and services related to the joint replacement surgery, provided the expense was incurred within one year of the former player’s surgery and would be eligible for payment under the NFL Player Insurance Plan.
If a former player is not covered by insurance and qualifies to receive charitable care from the NFL Player Care Foundation under the charitable care standards established and interpreted by the NFL Player Care Foundation’s board of directors (to the extent the NFL Player Care Foundation continues to provide such charitable care to former NFL players), the former player will be treated at a participating healthcare facility qualified to perform the joint replacement. The FPLIP will pay 20% of a pre-negotiated rate. In addition, if such former player experiences complications from joint replacement surgery, the FPLIP will pay 100% of the reasonable and customary amount charged for the treatment of the complications up to a maximum of $250,000, provided the expense is incurred within one year of surgery.
Limitations. No benefits will be paid for revisions of prior procedures that replaced a joint. Bilateral procedures will not be available for former players who qualify for payment pursuant to Subsection 1(b) of this Article.