Elizabeth City Pasquotank County Schools 2018-2019 Athletic Accident Insurance

Summary Of Benefits:

Maximum Benefit $25,000
Accidental Death Benefit $10,000
Accidental Paralysis Benefit $10,000
Crisis Death Benefit $10,000 up to $100,000 aggregate
Deductible $0
Coverage Secondary to other insurance, primary if none
Benefit Period One year from the date of injury
Initial Treatment Within 60 days of injury
Room & Board 100% to $150 per day
Impatient Hospital Miscellaneous 100% to $500
Outpatient Hospital Miscellaneous 100% to $750
Physician's Visits $30 first visit then $25 thereafter
Physiotherapy $30 first visit then $20 thereafter 5 visits maximum
Medical Emergency 100% to $150
X-Rays 100% to $200
CAT Scan or MRI 100% to $200
Laboratory 100% to $50
Prescription Drugs 100% to $50
Orthopedic Braces & Appliances 100% to %75
Surgeon's Fees 100% to $750
Anesthetist/Assistant Surgeon 20% of surgical benefit
Ambulance 100% to $200
Dental 100% to $100 per tooth

Special Notes:

  • This Accident insurance is on all students participating in school sponsored and supervised interscholastic sports.
  • This Accident Insurance policy is SECONDARY and pays on accident claims after other insurance has paid. If there is no other available insurance this accident insurance policy becomes primary.
  • This Accident Insurance provides LIMITED BENEFITS. Parents should consider purchasing the voluntary School Time, 24 hour or Football Accident Insurance for additional Accident Insurance coverage.
  • Voluntary student Accident Insurance can be reviewed and purchased online at www.k12studentinsurance.com.
  • If an insured student has an accident a school administrator should complete and sign the designated area on the accident claim form and send it to the parent to complete the parent’s portion. It is the parent’s responsibility to send the claim form along with all itemized bills, to the claims office by email, fax or mail (addresses on the claim form).
  • For questions pertaining to a claim contact the claims office at 1-866-409-5734 or at K12claims@hsri.com.
  • This is a summary of the district purchased student Accident Insurance. For complete details consult the master policy on file in your district office. Any conflicts between this summary and the master policy the master policy will prevail.