TACKLE FOOTBALL POLICY SUMMARY
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TACKLE FOOTBALL ACCIDENT INSURANCE SUMMARY
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 and due to the high risk of football injuries, the School District has negotiated with an insurance company to offer parents the option of purchasing a low cost Tackle Football Accident Insurance Plan. Parents are not required to purchase the optional football accident insurance play. The Plan is made available to financially assist parents that may be without insurance. The policy also provides supplemental coverage that may help parents pay for some the expenses not collectible from family insurance plans due to high deductibles and co-pays.
WHEN FOOTBALL PLAYERS ARE COVERED:
The Tackle Football Accident Plan provides eligible medical benefits for injured students if injured during football try-outs, practices and games that are scheduled and organized by the school district and under the direct supervision of the school employed football coach. Football team members are also covered while traveling as a team n a school bus or school van to and from school premises and a covered school sponsored football game site. Individual travel and travel in privately owned vehicles is not covered by the policy. Foot ball insurance coverage expires after the last game of the football season.
FOOTBALL INSURANCE COST:
$85.00 per player.
To be eligible to enroll in the football insurance plan, applications and full payment for football insurance must be received by the insurance company by September 1, 2020. Football insurance applications and payments received after September 1, 2020 are not eligible for coverage and will be returned to parents. Football insurance premium payments are non-refundable after participation in the first day of football try-outs.
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 above. If a student is eligible to receive medical benefits from family insurance, an HMO, PPO, pre-paid medical services plan or other source of coverage, the school policy may provide supplemental 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 covered accident subject to the following limits
Deductible:
No Deductible
Physician Non-Surgical Visits/Consultations:
Pays up to $60 for the initial visit; up to $35 for each follow-up day's 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 for the Anesthesiologist and CRNA
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 X-Ray, Radiology, MRI, CAT or Similar Scans:
Pays up to $300 total for all services including reading/interpretation fees
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 Benefits:
Subject to the above-described policy benefits not to exceed $500
POLICY EXCLUSIONS:
The Football Accident Insurance Plan will not pay for medical treatment due to the following:
Participation in school classes and sports, (except School Tackle Football); club sports, sports camps, clinics or classes that are operated by colleges, private entities or Associations; 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 school football injury; mental conditions; orthodontic treatment; any condition not due solely to an identifiable tackle football accident occurring while this policy was in force. Medical treatment by a licensed doctor must be required and 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:
Lawrence E. Smith & Associates Agency
Address: P.O. Box 411216, St. Louis, Missouri 63141-1216
Email: lucyw@lesmith.net <> FAX: 636-532-1737 <> Phone: 800-325-1350
