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For Parents and School Administrators

Questions and Answers

Following are Questions and Answers about the student accident insurance policy.

 

Question: When specifically are students covered by the student accident insurance policy purchased by the school district?
Answer:
The policy protects students while they are practicing for and competing in Missouri State High School Activities Association sanctioned activities. The sanctioned activities are: Interscholastic Sports, Sideline Cheerleading, Spirit Team performances, Target Shooting, Bowling, Chess, Marching Band and Choral Group Activities, Scholar Bowl, Speech and Debate Teams. Coverage is in effect during practices and competitions that are exclusively school district scheduled, school district organized and directly supervised by a paid school district designated coach during the various sports and activities seasons practices and competitions.

 

Question:
If a student is injured during classes or other school activities that are not listed as Missouri High School Activity Association sanctioned activities, will the school pay for an injured students medical bills?
Answer:
Missouri School Districts are not required by state law to purchase insurance or pay for medical expenses due to school related accidental injuries. Parents are ultimately responsible for payment of their children’s medical expenses and any expenses that are not recoverable from the school’s insurance policy or any other insurance plan. However, parents can purchase additional insurance protection for accidents that may occur during school classes and while students are away from school, at home, during the weekends and vacation periods including the summer months. For more information regarding optional accident insurance protection plans, CLICK HERE

 

Question:
How can parents obtain an Accident Insurance I.D. Card to present to doctors or hospitals?
Answer:
Individual student medical insurance I.D. cards are not issued or available. If a student is injured during a covered school activity, you can provide the doctor or hospital with the address of this website to obtain more details regarding the student insurance program.

 

Question:
Do students have to go a particular doctor or hospital to obtain benefits from the school’s sports accident insurance policy?
Answer: NO. Students can obtain medical treatment from any licensed doctor or hospital to be eligible for policy benefits. The school policy pays the same benefits to all licensed doctors and other medical service providers. To be eligible for policy benefits, a student must be seen and treated by a licensed doctor of medicine within 30 days from the original verified school accident date. If an injury is not evaluated by a licensed doctor within the 30 days following the date of a covered school accident, no benefits will be available from the school policy.

 

Question:
What if parents have family insurance through work or other sources of coverage such as an HMO or PPO? Can parents collect from both the school policy and other policies?
Answer:
If students are covered by other insurance or collectible sources of coverage, the school accident policy could help pay for some of the parent’s out-of-pocket deductibles, co-pays and other expenses that may not be covered by other insurance plans. The school accident insurance policy is a ‘supplemental’ policy and is not intended to replace parent’s primary insurance or allow double coverage or profiting as a result of a school related accident. To be eligible to collect benefits from the school policy, parents must first file a claim for benefits with any other collectible insurance or coverage sources. The school policy will then consider payment of covered medical expenses that are not collectible from any other primary insurance or sources of coverage.

Question:
Will the school accident insurance policy pay for all medical bills in full if a student is injured during a school sports activity?
Answer:
NO. The school accident insurance policy does not guarantee to pay 100 percent for all medical bills. Doctors, hospitals and other medical service providers are free to establish their own fees and charges resulting in a wide range of charges. The benefits paid by the student insurance policy will be paid based on the terms and specific benefit levels and limits that are stated in the policy. CLICK HERE for a summary of policy terms and benefits. In some cases, doctors, hospitals or other medical service providers may ‘write off ‘ the amounts not paid by insurance. However, any expense that is not covered by the school insurance plan must be paid by parents. The school does not accept financial responsibility for paying any expenses due to student injuries.

Question:
If a student needs ongoing treatment due to an injury that did not originally happen during a covered school activity, will the school policy pay for ongoing medical treatment or surgery?
Answer:
No. The school policy is designed to cover eligible medical treatment expenses that are due solely and directly to accidental injuries that originally occurred while participating in covered school activities while the school policy was in force. The policy does not cover any medical expenses for the treatment of conditions that originated prior to the policy effective date or when the student was not a participant in a covered school activity. The policy will not cover treatment expense due to the reoccurrence of, complications of, aggravation of or reinjury of medical conditions that originated while the school policy was not in force. For example, if a student had a knee injury during the summer or on the weekend at home and the knee continues to cause pain and discomfort while in gym class or sports, the school policy is not going to cover medical expenses attributed to or associated with the aggravation, reoccurrence of or reinjury of the knee condition. Medical bills for the treatment of ‘pre-existing’ conditions are not covered by the policy.

Question:
What if a student has on-going medical treatment expenses after a covered school activity injury?
Answer:
The school accident insurance policy will cover medical treatment expenses that are necessary and directly due to a covered school injury for up to one year from the date of the covered school accident date that originally caused the injury. If a student subsequently reinjures or aggravates the original injury by returning to sports or a covered activity without the written consent of the attending physician, the school policy may not cover on-going treatment expenses.

Question:
What if a student becomes ill or sick during a covered school activity? Will the school policy pay for treatment of conditions such as the flu, sore throat, fainting, asthma or other types of illnesses or medical conditions?
Answer:
No. The school policy will not pay for any treatment due to an illness or disease, regardless of whether or not the illness or disease was contracted at school.
The school accident insurance policy only considers claims that are as a direct result of a sudden, unexpected, specific, identifiable accident that occurs during participation in interscholastic sports or a covered school activity.

Question:
What if a student is involved and injured during a fight at school?
Answer:
School fights are not considered a ‘covered school sponsored activity’. Therefore, students injured during a fight would not be eligible for school accident insurance policy benefits. Parents would be financially responsible for their child’s injury expenses due to fighting at school or during a school activity.

Question:
Does the school policy provide policy benefits if a student is injured while walking to or from home and school or while a student is riding a bike or traveling in a personally owned vehicle?
Answer:
NO. The school policy only covers students while they are actually riding in a school bus or school van that is operated by a school designated, licensed adult driver to and from school premises and a covered event site. Injuries that may occur while waiting for the school vehicle or on home premises before or after disembarking from a school bus or van are not covered by the policy.

FOR ADDITIONAL INFORMATION regarding the school policy, click on the 'IMPORTANT LINKS' tab in the menu bar at the top of this page.

If you have additional policy or claim questions after reviewing this website, please call the insurance agency that handles the program at 800-325-1350 or email info@lesmith.net .

 

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