USD 231 is pleased to offer student accident insurance coverage at no cost to all K-12 students. These programs will help remove the worry of all school-sponsored activities and athletic events by providing supplemental accident medical insurance for all students and athletic participants. This plan will also cover all students and athletic participants for sponsored/supervised group travel to and from school and school-sponsored events.
This coverage is excess (secondary) to primary health plans. All bills must be submitted to your primary insurance if an accident occurs. Any balances such as deductibles or copays will then be considered under the supplemental accident insurance.
Outlined below is important information regarding this coverage. It is intended as a brief description for reference only and is not the policy.
Only ACCIDENTS that occur in school-sponsored and supervised activities, INCLUDING participants in interscholastic sports, are covered.
DEFINITION OF ACCIDENT
An unexpected, sudden and definable event that is the direct cause of a bodily injury, independent of any illness, prior injury, or congenital predisposition.
Conditions that result from participating in an activity do not necessarily constitute accidents. For example, illnesses, diseases, degeneration, conditions caused by continued stress to a particular area of the body, and existing conditions aggravated by an accident are not covered.
This plan of insurance is EXCESS ONLY: It will not duplicate benefits paid or payable by any other insurance or plan including HMO's or PPO's.
The policy will not cover expenses payable under the insured's HMO (Health Maintenance Organization), or PPO (Preferred Provider Organization). If the insured chooses not to use an authorized medical vendor (under HMO or PPO), the policy will only cover expenses incurred that it would have honored had the insured used the proper medical vendor.
Medical treatment for a covered accident must begin within 60 days of that accident. Only expenses incurred within 104 weeks are considered. Benefits are determined on the basis of REASONABLE AND CUSTOMARY for the geographic location where services are performed.
Specific exclusions of the policy include, but are not limited to, sickness, or disease, in any form; non- prescription drugs; fighting; and orthotics not prescribed exclusively for rehabilitation (e.g., playing brace, mouth guard).
Any person who knowingly and with intent to injure, defraud or deceive any insurer files a statement of
claim containing any false, incomplete, or misleading information may be guilty of insurance fraud and subject to criminal and civil penalties.
Accidents must be reported to the school Nurse/Trainer within 20 days. The Nurse will provide you with a documented accident claim form, that you will complete. Medical bills must be submitted to First Agency within 90 days after date of treatment. Questions regarding claim procedures may be directed to First Agency at 5071 West H Avenue, Kalamazoo, Michigan 49009 or 269/381-6630 or Fax 269/381-3055.
HOW TO FILE YOUR ACCIDENT CLAIM FORM
Complete ALL blanks. If information is not applicable, indicate the reason it is not (e.g., deceased, unknown).
Attach all ITEMIZED bills to date (not balance due statements) for MEDICAL EXPENSES ONLY. Subsequent medical bills can be submitted within 90 days after date of treatment.
Include all worksheets, denials, and/or statements of benefits from your primary insurer. (Each charge must be processed by all other insurances/plans before they can be processed by First Agency.)
If you are employed and no coverage is provided by your employer, A LETTER OF VERIFICATION FROM YOUR EMPLOYER STATING THAT NO COVERAGE IS PROVIDED MUST BE SUBMITTED.
Mail claim form within 90 days of the accident to:
Guarantee Trust Life Ins. Co. administered by First Agency
5071 West H Avenue
Kalamazoo, MI 49009-8501
KANSAS ASSOCIATION OF SCHOOL BOARDS INSURANCE PROGRAM
For a local USD 231 contact regarding general questions on how to file a claim, contact Dana Hermon at (913) 856-2050.
For specific questions regarding covered medical benefits or the status of a claim, contact, The First Agency, a Gallagher Company, at (269) 381-6630.
