School Insurance of Florida

Insuring Florida's kids for over 40 years.

Tuesday 25th of February 2020 08:58 PM

Affordable Insurance Protection!

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Parents, Students and School Administrators

Sarasota County Public Schools

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

HOW TO FILE A CLAIM

1) This insurance plan is secondary excess coverage. You must file a claim with your primary family insurance first even if you have a deductible. If your son or daughter has an accident at school and you have purchased the student insurance program, please obtain a claim form from the school principal's office or the athletic office where your son or daughter attends school.

2) Part B of the claim form will need to be filled out by the school official only if the injury happened at school.

3) 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. Claims must be filed within 90 Days of an accident.  

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.

5) Mail all claim information to School Insurance of Florida's office, (address at top of the claim form). It is the Parent/Legal Guardian’s responsibility to file a claim 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. 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 HMO or PPO plans or group coverage through your employer. If the student’s injury occurred during a school activity the school principal’s or athletic office will need to complete section B of the claim form. 

**If the injury happened away from school complete part A and mail the form to School Insurance of Florida**

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.

IMPORTANT: When contacting School Insurance of Florida's office about a claim, please state the full name of your injured son or daughter and the COUNTY 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.

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."

WHERE TO SEEK MEDICAL TREATMENT

If you have any other insurance, (excluding official Medicaid coverage), you must file your claim with that other insurance company first to be eligible for the student accident insurance benefits. In order to receive the maximum benefits, you must stay in the primary insurance network even if you have a deductible. If no other insurance exists, 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. Please refer to the top part of the enrollment application 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. A summary of insurance is available on this website under the "Excess Student Accident Insurance Overview” link. Please retain this policy summary for your records.

FREQUENTLY ASKED QUESTIONS (Effective and Expiration Dates are for the 2019-2020 School Year)

♦ Why should I buy the school insurance?   Click Here to Purchase Insurance NOW!

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.

 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 your high deductible or 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. However, all students that want to participate in school sports must show proof of basic insurance coverage to the school coach before they will be allowed to participate in sports practices and games. Purchasing the student accident insurance plans offered by School Insurance of Florida can serve as proof of basic coverage; or you may elect to show your family or employer provided insurance policy or ID card as valid evidence of coverage.

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

The school insurance plan is available only to students enrolled in The Sarasota County Public School District in grades Kindergarten through 12th grade. The plan can also be purchased by students attending the vocational technical schools and the "before and after-school programs" that are sponsored, funded, scheduled and directly supervised by The Sarasota County School Board. 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.

 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. Click on "Excess Student Accident Insurance Overview" to view a summary of the accident insurance plan.

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

For a complete summary of the policy terms and provisions please review a "Summary of Insurance".

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, 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 2019-2020 school term, August 2020.

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 2019-2020 school term, May 2020.

Tackle Football Programs are not covered under the School Time or the 24 Hour accident plans. Please contact your school coach for football information.

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

NO. Tackle Football Accident Insurance may be purchased separately for an additional cost. Please contact your school athletic office for a football insurance enrollment application that explains the football rates and coverage options. The School Time and 24 Hour Accident provide coverage for all other Sarasota County Public School's interscholastic sports practices and competition, (except senior high tackle football) while under the direct supervision of a school coach during the regular school term.

 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 he or she attends, and the name of the County where you reside. 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 2-3 business days. If you choose to enroll on-line, you will receive an ID card after your enrollment is processed and charge account is validated.

 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; or you can enroll online. School Insurance of Florida cannot accept enrollments or bind coverage over the telephone or by fax.

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

Coverage under the Student Accident Insurance Policy becomes effective on the later of the following dates: 1. At 11:59 P.M. (EST.) on the date completed application and premium payment is postmarked by the USA postal service or if no postmark, received by School Insurance of Florida's office, or; 2. At 12:01 A.M. (EST.) on the first day of scheduled school classes for the 2019-2020 regular school term. Coverage will be effective during  FHSAA sanctioned, school organized and school supervised pre-season interscholastic sports practice sessions on July 29th, 2019 provided the student insurance coverage application and applicable premium payment is received by School Insurance of Florida's office prior to the time and date of July 29th, 2019 pre-season interscholastic sports practice injury. No policy benefits are available for treatment of injuries or the reocurrence or aggravation of injuries or conditions that occurred prior to the policy effective date.

The School Time Plan will terminate on the last day of school in May 2020 and the 24 Hour Plan will terminate on the last day of summer in August 2020. Please read a summary of insurance for more complete policy terms, benefits, provisions and exclusions. The tackle football coverage does not provide any coverage for private schools, charter schools, private leagues or private football camps.

 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. 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?

NO. You may seek medical treatment from any licensed hospital or licensed physician and be eligible to receive any available policy benefits. The School Insurance of Florida policy benefits may not cover all the medical expenses. You should ask your doctor or hospital if they are willing to accept the School Insurance of Florida policy benefits as payment in full, or will you be required to pay for treatment charges not covered by the insurance program.

 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 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 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.

Click Here for Excess Student Accident Insurance Overview and Application