School Insurance of Florida
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Orange County Public Schools
Athletic Accident Insurance
The Orange County Public School Board strives to provide a safe learning environment for all students. Sports accidents that happen during practice or play are not usually the fault of the school. Schools are not required by law to purchase coverage for accidental injuries. As a service, the School District purchases a basic sports accident insurance policy to assist families with some of the medical expenses that may result from a school sports related injury during the regular school term. This coverage will not pay for 100% of all charges incurred as a result of an accidental injury. It is the Parents responsibility to pay for any expenses not covered by the school insurance plan or any other insurance plan.
FHSAA (Florida High School Athletic Association) Sports coverage is provided as sanctioned by the FHSAA and scheduled by the FHSAA. Off season practices, summer camps, club sports or outside leagues are not covered. When a teams season is officially over, the coverage terminates for that team. Offseason weights and cardio may continue during the regular school term and summer conditioning.
For a listing of the policy benefits, terms, provisions and exclusions, please click the following link:
HOW TO FILE A CLAIM FOR SCHOOL SPORTS RELATED ACCIDENTS
If your student has suffered a sports related accident please follow these steps:
1) File your claim with your primary insurance first and stay within your primary insurance network.
2) Please download and complete the Sports Claim Form within 90 Days of an accident.
3) Please refer to our list of preferred providers when seeking treatment for sports related injuries.
Click Here to Download a Preferred Providers Listing- (If you have primary insurance stay in your primary network)
PLEASE REMEMBER: If a student has any primary insurance (HMO, PPO, private insurance, group coverage through parents employment, Blue Cross, Tri-care, Champva, etc...) they should stay in that primary insurance network even if they have a deductible. They must file a claim with any primary insurance coverage first in order to be eligible for the student accident insurance even if they have a deductible. If they do not stay within their primary network, School Insurance of Florida may reduce benefits payable as if they did stay inside the primary network.
If there is no primary insurance coverage, students may seek medical treatment from any licensed hospital or licensed physician and be eligible to receive the stated school policy benefits that are outlined in the enrollment application or summary of insurance. School Insurance of Florida has set up a Preferred Provider Network. These providers of service have agreed, in most cases, not all cases, to accept the stated policy benefits as outlined on the summary of insurance. It is the parent or student's responsibility to ask the Doctor or provider of service if they are participating in the network and what out of pocket expense they may be held accountable for paying. Please refer to the top part of Summary of Insurance for a summary listing of policy benefits, limitations and exclusions. The Insurance Company cannot regulate how much doctors or other providers of service charge. Doctors and Hospitals are allowed to establish and charge their own fee levels. Doctors and Hospitals may charge more than what the School Insurance of Florida accident insurance policy pays. The insurance benefits will be paid based upon the stated policy provisions. Please retain a Summary of Insurance for your records. If you have any questions please contact School Insurance of Florida. 1-800-432-6915. Please do not contact the school. Schools do not keep claim records or process claims. Contact the insurance agency, School Insurance of Florida.
FREQUENTLY ASKED QUESTIONS ORANGE COUNTY PUBLIC SCHOOLS
1- Who is eligible for the Orange School District Athletic Insurance Policy benefits? Orange County Public High and Middle School sponsored interscholastic sports teams that are practicing for or competing in Florida High School Athletic Association (FHSAA) sanctioned sports. The policy covers athletic participants during regular school term practices and competitions that are Orange County School District sponsored, scheduled, funded and directly supervised by a paid school district employee. Coverage will extend for off-season weightlifting and exercise on school premises while under the direct supervision of a school coach and during the regular school term. This policy provides coverage during summer conditioning as defined by the FHSAA.
2- Are summer activities covered under the school plan? No. Summer is not included under the school's policy. Students must secure their own coverage for sports leagues or camps.
3- How is off-season weightlifting and exercise defined and what is covered in the off-season? The FHSAA definition for off-season weightlifting and exercise is used to define covered activities. The definition is 1) the use of free weights, stationary exercise apparatus, Plyometrics, and stretching exercises; 2) cardiovascular distance and interval training. Only cardiovascular exercise and weightlifting are eligible off-season activities. Student injuries during off-season that occur while a school coach is teaching sport specific skills and drills, pick-up games, camps or during the use of sport specific equipment such as starting blocks, blocking dummies, hurdles, rebounders, ball machines, bats, balls, rackets, etc., does not comply with FHSAA regulations and those injuries would not be covered by the school policy.
4- Are regular school classes, extra-curricular and classroom activities covered under the athletic insurance policy? No. Regular school classes, extra-curricular and classroom activities are not covered under this policy. A separate policy is available for parents or students to purchase to cover accidents during these activities. A voluntary basic accident insurance brochure is distributed to all Orange County students at the beginning of the year. Parents can enroll students online or mail enrollment application and premium directly to the insurance agency office. The school is not involved in the collection of enrollment applications or payment of premiums. The cost for basic accident protection while attending school sponsored and school scheduled activities during the regular school term is $12.00. Or, a 24 Hour Plan is available to extend coverage while at home, on weekends and during the summer months for $48.00. The voluntary plans do not provide coverage for injuries that may occur during high school sports or sports leagues or summer camps. Please click on Important Links above to review the voluntary coverage that is available for purchase. Or, Click Here to Purchase Insurance Now.
5- When does the plan go into effect and when does the plan expire? Coverage becomes effective on the first sanctioned FHSAA sports practice date in August. Coverage is effective only while students are participating in interscholastic sports that are exclusively school sponsored, school scheduled, school supervised and school funded during the regular school term and as sanctioned by the FHSAA. The plan terminates on the last official FHSAA game day during the regular school term, except coverage will continue for supervised off-season conditioning exercise and weightlifting on school premises during the regularly scheduled school term, as defined in question #3. Off-season practices/drills or camps are not covered under the policy.
6- Does the school insurance plan pay for all medical expenses due to a school related sports injury? No. The school policy will not guarantee to pay 100% for all medical bills. The insurance policy is designed to help families of injured students pay for some of the medical bills due to sports injuries. Please refer any inquiry regarding coverage to our office for a response. Please do not say or think ‘everything will be covered'. The school does not accept financial responsibility for paying any expenses due to school related accidents.
7- What does the athletic accident insurance policy cover? A detailed description of the policy benefits, limitations, and exclusions can be downloaded (above) from the School Insurance of Florida website www.schoolinsuranceofflorida.com. A printed Summary of Insurance can be obtained from the high school athletic office.
8- 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? No. The school policy only covers students while actually riding in a school approved bus or school van that is operated by a school designated and licensed adult driver to and from a sanctioned competition site. Individual travel in privately owned vehicles are not covered.
9- Will all student athletes receive a medical insurance ID card? Individual student ID cards will not be issued to all student athletes. Participating Doctors and hospitals will be notified by School Insurance of Florida regarding the terms and provisions of the Orange County School District athletic insurance policy. See how to file a claim.
10- Are injuries in Club Sports and privately run summer camps covered by the policy? No. Injuries while participating in Club sports, summer camps, off-season practices or sports leagues are not covered.
11- If my son or daughter is injured in a school sport, do I have to take them to a specific hospital or doctor to receive benefits under the athletic insurance policy? Treatment is required within 30 days of an accident to be eligible for policy benefits. Parents are free to take their child to any doctor or hospital to receive medical treatment. However, School Insurance of Florida has established a listing of ‘preferred providers’ of doctors and facilities in Orange County that have agreed to provide services at a discount. The listing of ‘preferred providers’ can be viewed in this website. Parents should ask medical providers what their charges are and understand that any fees in excess of what the Orange County School District athletic insurance policy pays or in excess of any other insurance must be paid by the parents. It is the parents’ responsibility to inquire as to what, if any, out-of-pocket expense they may be responsible for paying. Coaches and trainers should be cautious about referring parents to a particular physician or medical service provider without explaining that the school policy may not pay for all of the billed charges. It is suggested that coaches and trainers never guarantee that all bills will be paid by the athletic insurance policy.
12- 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? It is not intended to allow double coverage or profiting as a result of a school accident. If students are covered by other insurance, the school accident policy could help cover some of the parents’ insurance deductibles, co-pays and other expenses that may not be covered by another insurance plan. The school accident insurance policy is a ‘supplemental’ policy and excess of all other insurance. To be eligible for coverage under the school policy, parents must first file a claim for benefits with any other collectible coverage source. The school policy will then consider payment of covered medical expenses that are not collectible from any other primary coverage source.
13- How do I file a claim? When filing a claim for the athletic policy benefits, parents must disclose all other possible sources of primary insurance on the claim form. Failure to provide true and accurate information will prolong the time for claim processing and may jeopardize rights to receive benefits from the District policy. It is the responsibility of the parents to file claims. The school may assist in the claim filing procedures. But, it is ultimately the parents’ responsibility to submit the claim within 90 days from the date of accident and supply all the necessary itemized bill copies and other necessary data. Privacy laws apply. The claim form has two parts. Part A - must be filled out by the parents. Part B - must be filled out and signed by a school athletic director or designated school employee. The parent must mail the completed claim form to the claims office address listed on the claim form. Claim forms are located at the top of this page. Please be sure to download a listing of providers and ask if they are participating or not.
14- Who do we contact for answers regarding claims or coverage? The schools do not process claims or keep records regarding claims. All claims are processed by School Insurance of Florida's claim office in Orlando. Therefore, coaches and trainers should refer parents to SCHOOL INSURANCE OF FLORIDA to obtain prompt answers to claim or coverage questions. To avoid confrontational or possible liability issues, do not make any promises or guarantees to parents about claim payments or coverage. Please refer all claim and coverage related questions to: School Insurance of Florida, Toll Free: 1-800-432-6915 Fax: 407-798-0296 Address: P. O. Box 784268 Winter Garden, Florida 34778-4268
*The questions and answers stated above are intended to provide a general, brief explanation of the school student accident insurance policy. The policy summary contains a more detailed summary of provisions and terms. The County School District will receive a master policy that contains all terms and provisions from which all claims benefits will be determined. The insurance policy contains specific definitions and terms that may not be included in these descriptions and are not fully explained by the school. For answers to more specific questions, please contact School Insurance of Florida, P.O. Box 784268, Winter Garden, Florida 34778-4268. Phone 800-432-6915.
FLORIDA LAW requires us to inform you that: "Any person who knowingly and with intent to injure, defraud or deceive any insurance company, files a statement of claim containing any false, incomplete or misleading information is guilty of a felony of the third degree."
For more information, please click on 'IMPORTANT LINKS' above