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For Parents and School Administrators

Summary Of Insurance

The purpose of this website is to inform parents about a student accident insurance policy purchased by the school district. School district teachers, coaches and administrators strive to provide a safe environment for students while they are attending school classes and activities. However, accidental injuries can and do occur. School districts are not required by law to provide accident insurance coverage for students. Parents are financially responsible for providing medical insurance or paying for their children's medical expenses. However, as a public service, the school district purchases a student accident insurance policy that may help families pay for some of the medical expenses incurred by students due to school related accidents that may occur during interscholastic sports and other specified activities that are sanctioned by the Missouri State High School Activities Association. The sanctioned activities include interscholastic sports, sideline cheerleading, marching band and choral groups, spirit squad, scholar bowl, target shooting, bowling, chess, drama, speech and debate teams.

The policy purchased by the school has limited benefits and does not guarantee that all medical expenses resulting from accidents sustained in the above listed sanctioned activities will be paid in full. The school district cannot accept liability for payment of a student's medical expenses that are not covered by parent's personal insurance or for expenses that are not covered by the school insurance policy. Parents are ultimately responsible for paying their child's medical bills.

IMPORTANT NOTE:  The policy purchased by the school district DOES NOT cover student injuries that may occur during regular school classes or other activities that are not listed above as Missouri State High School Activity Association sanctioned activities.  HOWEVER, parents can elect to purchase a low cost plan that can provide coverage during all school classes and other school activities and while students are away from school, at home, during the weekends, during vacation periods including the summer months. For more information regarding this low cost plan option, CLICK HERE.

To view additional information regarding the student accident insurance program, click on the 'IMPORTANT LINKS' tab in the menu bar at the top of this page.

SUMMARY OF SCHOOL ACCIDENT INSURANCE POLICY BENEFITS

If a student is injured during a covered school sponsored MSHSAA sanctioned activity and the injury requires treatment and is treated by a licensed physician within 30 days after the date of the school injury, the school insurance policy will pay for necessary hospital, medical, physician's or dental care incurred within one year from the date of injury up to a maximum medical benefit of $50,000 per covered accident, subject to the following  specified dollar limits:

Policy Deductible:
No deductible 

Non-Surgical Doctor Visits/Consultations:
Pays up to $40 for first visit;
Pays up to $25 for each necessary follow-up visit

Surgery/Fracture Care (scheduled benefits): 
Pays up to 75% of usual and customary fees based on the Ingenix Medical Fee Schedule

Anesthesia Administration Fees:
Pays up to $400

In-Patient Hospitalization Expense:
Pays up to $500 per overnight hospital confinement for all hospital billed expenses including but not limited to drugs, lab, x-ray, scans, tests, therapy, supplies, room charges, nursing, equipment rentals, etc. (Does not pay for personal convenience items such as cable T.V., phone, guest meals, etc.).

Emergency Room Charges:
Pays up to $250 for all ER billed charges including miscellaneous supplies, lab, drugs, etc. (separate policy benefits apply to fees charged by attending physicians and radiology services) 

Outpatient Hospital charges or Surgi-Center facility charges:
(when major surgery requiring general anesthesia is performed on an outpatient, 'same-day surgery' basis)
The policy pays up to $1,000 for all Hospital or Surgi-Center facility billed charges.

Outpatient X-ray Benefit:
Pays up to $100 per covered accident for all X-rays including reading and interpretation fees 

Outpatient MRI, CAT, CT, Bone or other diagnostic Scans:
Pays up to $250 per covered accident for scans including reading and interpretation fees

Out-Patient Therapy/Manipulations/Adjustments:
(or other therapy treatments including office visits connected therewith)
Pays up to $25 per daily visit, not to exceed a total of 5 visits per accident

Orthopedic Appliances/Casting/Braces/ Drug Store Prescription Drugs:
Pays up to $100 per covered accident

Dental Treatment Benefits (including X-rays and Scans):
Pays up to $250 per injured tooth; (orthodontic  treatment or procedures & treatment of previously damaged or decayed teeth are not covered by the school policy)

Licensed Ambulance Service:
Pays up to $250 for the initial emergency trip by air or ground transport ot the closest medical treatment facility

For any Covered School Motor Vehicle Related Injury:
The policy will pay up to a maximum benefit of $2,000 for all medical treatment expenses in the aggregate associated with a covered school motor vehicle related injury (subject to the above specified limits)


Policy Limitations, Terms and Exclusions Summary:
The policy will NOT pay for medical treatment due to the following: Illness or any disease process; aggravation of or reoccurrence of conditions that didn't originally happen during a covered school activity; 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 provided within 30 days from the covered accident date to be eligible for policy benefits. This description is a summary of the policy terms. Benefit payments will be determined by the actual policy provisions.
For a listing of the additional policy limitations, terms and exclusions CLICK HERE

How to File a Claim: If a student is injured in an accident during a covered school activity, report the accident to the principal's office immediately to obtain claim filing instructions.The school accident insurance policy is supplemental insurance. This means if you have other insurance or sources of coverage including an HMO, PPO, Blue Cross,  employer provided coverage, coverage through a Union or Association plan…you must first file a claim with your other coverage source before being eligible to collect benefits from the school accident insurance policy. The school accident insurance will not pay for any expenses that could be collected from any other sources.

For more specific information on 'How to File a Claim' CLICK HERE 

IF YOU HAVE MORE QUESTIONS… CLICK HERE to view the Questions and Answers section in this website 

If you have further questions after reviewing the Questions and Answers section of this website, do not call the school. Contact the agency that handles payment of claims and administration of the school insurance policy: 
Lawrence E. Smith & Associates Agency
Phone toll free: 1-800-325-1350  Fax: 636-532-1737  Email: lucyw@lesmith.net
Claims Office Mailing Address: Box 411216, St. Louis, MO 63141. 


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