There’s been a lot of talk in recent years about who should pay for the medical bills when college athletes are injured while participating in their sport.

Stanley Doughty lost a contract with the Kansas City Chiefs because of an undiagnosed spinal injury he’d received while playing for the University of South Carolina, but there was no incentive for the school to pay for the surgery he needed — they simply didn’t have to.

NCAA member institutions are not required to provide long-term care for athletes who have exhausted their eligibility, graduated, or are no longer enrolled, as was the case for Doughty, who left the university 12 credits shy of graduating to play professionally.

Other student-athletes have lost their scholarships while they were still enrolled in college but unable to play because of injuries, like Patrick Courtney, who played football at North Carolina A & T State University. Courtney suffered from a hernia injury during training camp that required surgery. He was injured again when he rejoined his team on the field, and was forced to transfer when his scholarship was not renewed the following year.

Who Pays and What’s Covered

Though National Collegiate Athletic Association (NCAA) bylaws 3.2.4.8 (Certification of Insurance Coverage) and 3.2.4.8.1 (Amount of Coverage) require that student-athletes at member institutions have insurance for medical expenses related to athletic injuries, the schools are not required to cover what the insurance doesn’t, leaving it to parents, guardians, or the students themselves to take out policies and pay out-of-pocket costs. Only once treatment for an injury exceeds $90,000 does the NCAA cover the cost under their Catastrophic Injury Insurance Program.

Student-athletes who participate in NCAA championship events, however, are fully covered by NCAA insurance policies through the Participant Accident Program. According to NCAA Director of Travel and Insurance Juanita Sheely, “Any injury during an NCAA championship event is covered by NCAA insurance policies from the very first dollar of expense to the last."

Exceptional student-athletes — those who are likely to be early draft picks for the NFL, NHL, NBA, MLB, or WNBA — are permitted to purchase NCAA-sponsored disability insurance to protect against future loss of earnings as a professional athlete if they are approved by a program administrator. Loans are available to cover the cost of the insurance, which means that like the required basic coverage before the catastrophic insurance kicks in, student-athletes must foot the bill.

When it comes to coverage of student-athlete medical expenses, NCAA member institutions are allowed to determine their own policies and procedures, and are not required to pay for their student-athlete’s medical expenses, though some do. For example, University of Louisville’s Kevin Ware injured his leg during an NCAA tournament, and needed surgery and rehab to repair his leg. He was covered by both his family’s and the school’s insurance, and was not responsible for out-of-pocket expenses.

The University of Alabama also covers medical, dental, and rehabilitation expenses for student-athletes who receive sports-related injuries. When former player Tyrone Prothro fractured his tibia, an injury that was followed by a severe infection, the university paid for the 10 surgeries he needed.

Athletes who attend smaller schools, however, are often responsible for co-pays, deductibles, and other expenses, like at the University of Maine, where the students are responsible for up to $10,000 before school coverage kicks in.

For the past three years, the NCAA has permitted — but not required — Division I institutions to offer multiyear scholarships. But according to figures obtained by CBSSports.com, most schools continue to offer the majority of their scholarships as renewable one-year contracts, meaning that if athletes are injured or not healthy enough to play, they could lose their scholarships at the end of the year, and end up paying out of pocket for medical treatment.

How to Ease the Burden

Last year, the Big Ten Conference was the first to announce support for multiyear scholarships and improved medical insurance for student-athletes. When the organization finally does mandate enhanced benefits, it will potentially affect close to 9,500 student-athletes.

Effective this school year, the 7,000 sudent-athletes in the Pacific-12 Conference who receive scholarships will have four years of funding regardless of the sport a student plays, which can’t be reduced or canceled for any reason so long as the student remains in good academic standing and fulfills the terms of the scholarship. Additionally, members of the conference must pay for medical expenses incurred from athletic injuries for at least four years after a student leaves or graduates from an institution.

In 2012, California passed SB-1525, Postsecondary education: Student Athlete Bill of Rights, which holds that colleges and universities generating more than $10,000,000 in media revenue from sports must guarantee athletic scholarships and pay the deductibles for student-athletes who suffer sports-related injuries. Furthermore, schools must pay for the cost of ongoing medical treatment for at least two years after a student has graduated or left the university.

The California legislation is a step in the right direction, though perhaps coverage should be extended to four years post-attendance, as has been mandated by the Pac-12 Conference — the same number of years student-athletes are eligible for competition. Some student-athletes receive injuries that take longer than four years to heal, if they ever heal at all. In order to provide comprehensive support for student-athletes, at the conclusion of four years, if they are unable to function at full capacity because of a sports-related injury during their undergraduate career, former players should have the opportunity to enroll in an insurance program provided by the academic institution.

Find more information and advice about college for student-athletes, and use Noodle to find universities that match your needs.