Parents, Students and School Administrators

Pasco County Public Schools

How to File a Claim /Seeking Medical Treatment/Q&A

HOW TO FILE A CLAIM

1) Report the accident to a school official immediately.  For school sports related injuries click here.

2) This coverage is secondary, 'Excess Insurance' and will not pay for 100% of billed charges. You must file a claim with any primary family insurance first. If your son or daughter has an accident at school and you have purchased the student insurance program download a claim form below.

3) Part B of the claim form will need to be filled out by a school official if the injury happened at school. The Parent is required to complete Part A and mail to School Insurance of Florida's claim office. Please follow the instructions printed on the claim form.

4) You will need to attach copies of all itemized medical bills. If you have other primary insurance you will need to file a claim with your primary insurance carrier and include a copy of the letter or statement from your primary insurance indicating the payments provided by them or their reasons for refusal to pay benefits to you.  

It is the Parent/Legal Guardian’s responsibility complete PART A and file a claim with the insurance company within 90 days from the date of accident. The school is not responsible for filing claims. However, they will provide you with a claim form or you can download one from this website or contact School Insurance of Florida to obtain a claim form. Please forward the completed claim form to School Insurance of Florida no later than 90 days after the date of accident to be eligible to receive any available policy benefits. You must file a claim with any other primary insurance, even if you have a deductible. This includes HSA, HMO or PPO plans.  Complete the form and mail to School Insurance of Florida, P. O. Box 784268, Winter Garden, FL 34778-4268. For additional information call 1-800-432-6915.

WE CANNOT ACCEPT CLAIMS SUBMITTED ON-LINE because a school official’s signature and the parent/legal guardian signature are needed on the form. You only need to submit ONE completed claim form for each accident. You do not have to send another claim form if you are submitting additional bills that come in later. PLEASE DO NOT CALL THE SCHOOL ABOUT THE STATUS OF A CLAIM PAYMENT OR TO ASK QUESTIONS ABOUT COVERAGE. Contact: SCHOOL INSURANCE OF FLORIDA if you need answers to claim or coverage issues. The school does not keep records regarding claims. All claims are processed by School Insurance of Florida's claim office.

When contacting School Insurance of Florida's office about a claim, please state the full name of your injured son or daughter and the SCHOOL DISTRICT where he or she attends school. We need the school name to reference the claim information for you. Generally, valid claims are processed within 7 working days after receipt of completed claim information.

WHERE TO SEEK MEDICAL TREATMENT

If a student has any primary insurance (HMO, PPO, private insurance, group coverage through parents employment, Blue Cross, Tri-care, Champv, 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. 

FREQUENTLY ASKED QUESTIONS

♦ Why should I buy the school insurance?

The school district is not obligated to pay for medical expenses due to school related accidents. Parents must assume financial responsibility for their children’s medical expenses for accidents that may occur due to no fault of the school. Purchasing the low cost student accident insurance policy can help pay some of the doctor, hospital and other medical bills due to accidental injuries. Click Here to Purchase Now

♦ Why should I buy this insurance if I already have family insurance or coverage through an HMO, PPO or my place of employment? 

The school insurance program is a low cost way for parents to supplement their existing insurance policies and help pay some of the "out-of-pocket" deductibles or other medical expenses not covered by your family or employer provided insurance plans. The school insurance plan can blend with your family insurance policy. If you purchase the School Insurance plan as a supplement to your other primary insurance, you can file a claim with your other primary insurance and then be eligible for supplemental benefits from the school insurance policy. The student insurance plan is not intended to duplicate or replace your primary insurance plan. However, it could provide a low cost way to pay for some of the medical costs not covered by your primary insurance plan.

♦ If my son or daughter wants to participate in school sports are we required to purchase this basic student insurance coverage from School Insurance of Florida?

NO. High School and Middle School sports grade are not covered under these insurance plans. The school district purchases a separate plan to provide coverage for high school and middle school sports. Please contact your athletic department regarding interscholastic sports insurance.  

♦ Who is eligible to be covered by the school insurance plan?

The school insurance plan is available only to students enrolled in Pasco County Public School District in grades Kindergarten through 12th grade (except High School and Middle School Sports); Please CLICK HERE for more information about school sports.  If an application is received for a person that is not eligible for coverage, the insurance company’s only obligation is to return the insurance payment to the ineligible person applying for coverage. No claims can be paid for ineligible applicants. Coverage under the School Time Basic Accident Insurance Plan is effective only while students are participating in activities that are exclusively school sponsored, school scheduled, school supervised and school funded during the regular school term.  High school and Middle school (6th-12th grades) interscholastic sports are not covered under these policies.

♦ What does the school insurance plan cover?

A detailed description of the benefits, limitations, exclusions, terms and cost options are provided in a descriptive insurance brochure available from your school. Or, you can download the insurance brochure from this website. The Summary of Insurance/Applications are available to view and print. Please remember the 24 Hour and the School Time plans do not provide coverage for any high school and middle school interescholastic sports.

♦ What is the difference between the 24-Hour Basic Accident Insurance Plan and the School Time Basic Accident Insurance Plan?

The 24-Hour Basic Accident Insurance Plan provides protection for students 24 hours a day, seven days a week, while at school, during school sponsored and school supervised activities (except high school and middle school interscholastic sports 6th-12th grades) and also while students are at home, on the weekends, during holidays and vacation periods and during the summer months in the United States. Coverage under the 24 Hour Plan stops after the last day of summer for the 2017-2018 school term, August 2018. The School Time Basic Accident Insurance Plan provides protection only during school sponsored and school supervised classes and school funded activities during the regular school term. Coverage under the School Time Plan stops after the last day of classes for the 2017-2018 school term in May 2018.

♦ Does the School Time or 24 Hour Accident Insurance Plans cover senior high school tackle football injuries?

NO. The School Time and 24 Hour Accident Insurance Plans do NOT provide coverage for any high school interscholastic sports practices and competition. Please contact your school athletic office for football insurance. No coverage is provided during summer football practices, drills or for any summer league sports. 

♦ Do the school insurance plans cover all medical expenses, including visits to the doctor and hospital?

The school insurance policy may not pay for 100% of all medical expenses due to the limits of the policy as described in the student enrollment application. The insurance company does not have control over the amounts charged by doctors, hospitals and other medical service providers. The payment of benefits that you will receive from the school insurance policy will be based on the plan you select as stated in the school insurance enrollment application. Specific policy limits, terms and provisions that affect your benefit levels are explained in the school insurance enrollment application. 

♦ Do the school accident insurance plans cover medical expenses due to an illness or sickness?

NO. The 24-Hour Basic Accident Insurance Plan and the School Time Basic Accident Insurance Plan provide benefits only for covered medical expenses due to accidental bodily injury. No benefits are payable for any form of a sickness, illness or disease. However, you can purchase the In-Hospital Sickness Benefit Option as explained in the School Insurance of Florida enrollment brochure. (Please read the insurance brochure for complete details about the In-Hospital Sickness Benefit Option).

♦ Does the In-Hospital Sickness Benefit Option cover outpatient treatment at the hospital or visits to the doctor’s office?

The In-Hospital Sickness Benefit Option only provides benefits if your child is hospitalized overnight as an inpatient due to a covered illness or disease. No benefits are available for outpatient medical expenses or visits to the doctor's office for illness, sickness or disease treatment. (Please read the insurance brochure for complete details about the In-Hospital Sickness Benefit Option).

♦ How can I obtain an insurance identification card for my child after I purchase the school insurance plan?

To obtain an insurance card, write to School Insurance of Florida, P.O. Box 784268, Winter Garden, Florida 34778-4268, and indicate the full name of your child, the school district he or she attends. You must also include a self-addressed, stamped envelope along with your request for an ID card. You may also email the company and they will reply within 1-2 business days. Email: info@schoolinsuranceofflorida.com

♦ Can I enroll my child in the school insurance plan by phone or on-line?

You can choose to enroll by directly mailing the enrollment form and payment to School Insurance of Florida. School Insurance of Florida cannot accept enrollments or bind coverage over the telephone, by email or by fax.

♦ When will the policy take effect and how long will coverage continue?

If you enroll early, coverage for the new school year will begin on the first day of class for the 2017-2018 school term. Otherwise, coverage becomes effective at 11:59 P.M. according to the USA postmark date on the enrollment envelope and or when the premium is received by School Insurance of Florida, whichever is the later date. The School Time Basic Accident Insurance Plan coverage terminates at 11:59 P.M. on the last day of classes for the regular school term in May 2018. Coverage under the School Time Basic Accident Insurance Plan is effective only while students are participating in activities that are exclusively school sponsored, school scheduled, school supervised and school funded during the regular school term. The 24-Hour Basic Accident Insurance Plan and In-Hospital Sickness Benefit Plan policy benefits terminate at 12:01 A.M. on the first official day that school classes resume for the next school term in August 2018. Coverage under the 24-Hour Basic Accident Insurance Plan and the In-Hospital Sickness Benefit Plan provide continuous protection 24/7 through the summer months until the policy terminates in August 2018.

♦ Can students enroll in the school insurance plan at any time during the school year?

YES. Students can enroll at any time during the year. However, coverage does not take effect until School Insurance of Florida receives your application and payment. The effective and termination dates of coverage stay the same as stated above. So, you should enroll your child as early as possible. No discounts are available for late enrollees. No Refunds are permitted after the first day of coverage.

♦ If my son or daughter is injured, do I have to take them to a specific hospital or doctor to receive benefits under the school insurance policy?

These insurance plans are secondary, Excess insurance. If you have other valid primary insurance you must stay within your primary insurance network. If you go outside your primary insurance network the school insurance will still pay benefits for an eligible claim as if you stayed in your primary network. When filing a claim for school policy benefits, parents must disclose all other possible sources of primary insurance on the claim form. Failure to provide true and accurate information may jeopardize your rights to receive benefits from the school policy. Please be sure to ask your doctor, clinic or hospital what charges you will be responsible for paying. For Interscholastic Sports injuries, please CLICK HERE.

♦ How do I file a claim?

You must file a claim with School Insurance of Florida within 90 days from the date of accident to be eligible for policy benefits. Obtain a claim form from the school office or you can download a Claim Form from the School Insurance of Florida website. Carefully follow the instructions on the claim form and MAIL the completed claim form along with copies of itemized medical bills to: School Insurance of Florida P.O. Box 784268 Winter Garden, Florida 34778-4268.
Please Note: If you have other primary family insurance or insurance through your employer you must first file a claim with your primary insurance, HMO or PPO. Then mail your claim to School Insurance of Florida along with a copy of the worksheet from your primary source of coverage indicating that all bills were submitted to them and what your primary insurance will or will not pay. If you have questions concerning claims, please contact School Insurance of Florida's office at 1-800-432-6915. 
Do not contact the school regarding claim issues. The school does not keep records regarding claims and will not be able to answer claim questions. Please contact School Insurance of Florida for all questions regarding claims or any questions regarding insurance coverage.

♦ What is the name of the insurance company that backs the school insurance plan? Is the insurance company financially sound? 

The school insurance plans are insured by The Reliance Standard Life Insurance Company. The insurance company has assets in excess of $2 billion and has a rating of ‘A Excellent’ by an independent insurance company rating firm. Claims are handled by School Insurance of Florida’s office in Winter Garden, Florida.

 

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."When filing a claim for school policy benefits, parents must disclose all other possible sources of primary insurance on the claim form.  Failure to provide true and accurate information may jeopardize your rights to receive benefits from the school policy.

Click Here for Excess Student Accident Insurance Overview and Application

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