Schools are not required by law to purchase insurance or pay for student's medical expenses associated with school related accidental injuries.  However, as a public service,, the  School District has negotiated with an insurance company to offer parents the option of purchasing a low cost accident insurance plan.  The plan is made available to financially assist families without insurance. The policy also provides supplemental coverage to help parents pay for some the expenses not collectible from family insurance deductibles and copays.

SCOPE OF COVERAGE: The Full Time accident plan provides medical benefits for injuries that occur:                                               IN SCHOOL, SCHOOL SPORTS (except tackle football), AWAY FROM SCHOOL, AT HOME, WEEKENDS AND DURING VACATION PERIODS INCLUDING THE SUMMER MONTHS.  [Refer to additional information below regarding policy benefits, terms and limitations. 

FULL TIME ACCIDENT INSURANCE COST:  A one-time payment of $40.00 provides Full Time coverage                                                                                          

SUPPLEMENTAL COVERAGE PROVISION:  If a student is not covered by other insurance or source of coverage, the school policy will pay eligible medical expenses up to the specified dollar limits as summarized below.  If a student is eligible to receive medical benefits from other insurance, an HMO, PPO, pre-paid medical services plan or other source of coverage, the school policy may provide supplement coverage to help parents pay for some of  the unpaid bills due to deductibles or co pays.  However, parents are ultimately responsible for paying their children's medical expenses that are not covered by other sources of coverage and the sports accident insurance policy purchased by the school district. If a student is covered by another source of coverage, parents must first file and obtain benefits from their primary coverage source before being eligible to receive benefits from the school sports policy.

                                                                 SUMMARY OF POLICY BENEFITS AND LIMITATIONS

Doctors, hospitals and other medical service providers are free to set their own fee schedules. Fees can vary substantially. The school policy does not guarantee 100% reimbursement for all medical expenses incurred by injured students. To be eligible to receive benefits from the school policy, an injured student must require and receive medical treatment by a licensed physician within 30 days after the date of a covered accident. If treatment is received within 30 days from the date of injury, the school policy will pay for necessary medical services, hospital, physician's or dental care incurred within one year from the date of the school injury up to the following specified dollar limits:

Maximum Medical Benefit: Up to $25,000 per cover accident subject to the following limits

Deductible: No Deductible

Physician Visits/Consultations: Pays up to $60 for the initial visit; up to $35 for each follow-up day visits

Surgeon's Fees and Fracture Care Benefit:  Benefit paid based on a limited fee schedule (CRVS X 100) depending on the type of surgery  performed; may not pay 100% of charges

Anesthesiology Fees: Pays up to 25% of the allowable surgeon’s benefit

In-Patient Hospital Expenses: Pays up to $500 per overnight stay for semi-private room & board; Pays up to $1,000 per day for Intensive Care room & board; Pays up to $2,500 for recovery and operating room charges; Pays up to  $250 per day of overnight confinement for all hospital miscellaneous expenses  such as lab, radiology, therapy, rehab, supplies, drugs, equipment, monitoring, medical devices, etc.). No benefits for convenience items such as gift shop, visitors meals, Cable TV, etc.

Out-Patient Hospital or Surgi-Center Facility Charges: Pays up to $2,500 for all billed charges when major surgery requiring general anesthesia is performed

Emergency Room Treatment: Pays up to $500 for all ER billed services; For non-emergency services benefit is limited to $60

Out-Patient visits for Physical Therapy/Manipulations/Adjustments: Pays up to $250 @ $35 per visit

Orthopedic Appliances/Casting Materials/Braces/Crutches: Pays up to $100 for all services combined

Out-Patient Prescription Drugs: Pays up to $50

Dental Treatment (including X-Rays and supplies): Pays up to  $250 for treatment per injured “whole, sound and natural” tooth  for all dental care; (orthodontic services and treatment of previously damaged or decayed teeth not covered)

Ground or Air Ambulance Service: Pays up to $1,000 for initial trip to the closest medical treatment facility

Motor Vehicle Related Injury Benefit: Based on above-described policy benefits not to exceed $500

POLICY EXCLUSIONS: The policy will not pay for medical treatment due to the following: Participation in any school sports, club sports, sports camps, clinics or classes;  Illness or any disease process; fighting or participating in a riot; aggravation of or re-occurrence of conditions that didn't originally happen during a covered football injury; mental conditions; orthodontic treatment; any condition not due solely to an identifiable accident occurring while this policy was in force.  Medical treatment by a licensed doctor must be rendered within 30 days from the covered accident date to be eligible for policy benefits.  No benefits are payable for any expenses not listed in the summary of policy benefits listed above. This is only a summary description of coverage. Other policy terms and limitations may apply.  All payments will be determined by the actual policy language.

HOW TO FILE A CLAIM: Obtain a claim form from the principal's or coaches office. The claim form has further instructions  on how to file a claim. The top part of the claim form must  be completed and signed by a school official that witnessed the accident. The bottom section of the claim form needs to be completed by parents. If the injured student is  covered by other collectible insurance or sources of coverage, parents must first file a claim with any other collectible source of coverage  before being eligible to collect supplemental benefits from the school insurance policy.  Be sure to answer all questions and fill in all spaces on the claim form.  Do not leave any spaces blank. Sending incomplete claim information will delay claim processing.   If you have other collectible insurance or coverage, you must forward along with the claim form a copy of the statement received from your other source of coverage that indicates what benefits have been paid and are not collectible.  Falsifying or not disclosing claim information regarding other collectible sources of coverage may result in your claim being denied. The completed claim form must be sent within 90 days to the agency that handles claims to be eligible to receive benefits from the school sports insurance policy. to the agency that handles claims 

IMPORTANT NOTE: The completed claim form must be submitted to the claim processing agency listed below within 90 days from the date of accident to be eligible to receive school sports policy benefits.

FOR ANSWERS TO CLAIMS OR COVERAGE QUESTIONS: Do not contact the school.  The school does not keep claim records or process claims. Contact the insurance agency that processes and pays claims: 

Address: P.O. Box 411216, St. Louis, Missouri 63141-1216

Email: lucyw@lesmith.net <> FAX: 636-532-1737 <> Phone: 800-325-1350