Fort Smith Student Accident Insurance Policy Summary

The Fort Smith School District has purchased a group accident insurance program covering all students in Pre- Kindergarten through 12th grade. 

 

Students are covered by the accident policy while they are participating in school sponsored and scheduled, school supervised and school funded classes, sports and activities during the regular school term and while attending summer school class sessions. Students are also covered while being transported in a school bus or van, operated by a licensed driver over age 21, directly to or from the insured student's residence and school for regular classroom sessions, and while traveling as a school sponsored group in a school assigned bus or van  to and from school and a covered school event site. Injuries that may occur during individual travel or travel in any vehicle that is not owned or operated by the Fort Smith School District is not covered by the policy.

 

Arkansas schools are not required to buy insurance or pay for student medical expenses associated with school injuries.  The school purchases the accident insurance policy as a public service to assist parents that may be without insurance or need to supplement their own personal insurance program. 

 

The school policy will not provide 100% reimbursement for all medical expenses incurred. The school insurance policy is not intended to replace family or group health insurance policies. The school policy has limitations as outlined below.  The school cannot assume responsibility for payment of students' medical expenses that are not covered by the school accident insurance policy. Parents are ultimately responsible for paying for their child's medical expenses.

 

If you have other insurance, you must first file to obtain benefits from your other source of primary coverage. This school accident insurance policy is designed to consider payment of the eligible expenses that are not paid or collectible from other insurance sources, including HMO’s or PPO’s.

If you do not elect to use your family health insurance or HMO, PPO participating physicians and providers of service, the benefits available from the Fort Smith School District student insurance policy will be reduced to cover only 50% of the stated school policy benefits. 

Parents must assume financial responsibility for paying any expenses not covered by the limited student accident policy purchased by the school.

 

SUMMARY OF SCHOOL ACCIDENT INSURANCE POLICY BENEFITS

If a student is injured during a school sponsored activity and the injury requires treatment by a licensed physician within 90 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 $25,000 per covered accident, subject to the following limits:

 

Policy Deductible:

No deductible applies to interscholastic sports injuries;

A $100 deductible applies to all other covered school

related injury claims

 

Non-Surgical Doctor Visits/Consultations:

Pays up to $50 for first visit;

Pays up to $30 for each necessary follow-up visit

 

Surgery/Fracture Care (scheduled benefits): 

Pays up to 80% of usual and customary fees based on Ingenix Fee Schedule

 

Anesthesia Administration Fees:

Pays up to 20% of the allowable surgery benefit  for anesthesia administration fees

 

In-Patient Hospital Expense:

Pays for overnight stays in a semi-private room up to $350 per day; plus up to $500 per day for intensive care room; operating room expenses payable up to $2,000 maximum; all other miscellaneous inpatient expenses including drugs, lab, x-ray, therapy, supplies, etc. (except personal convenience items, T.V., phone, etc.); are payable up to a maximum limit of $500 per day of overnight confinement in the hospital

 

Emergency Room Charges:

Pays up to $250 for all ER billed charges including miscellaneous supplies, lab, etc. 

(separate policy benefits apply to fees charged by attending physicians) 

 

Outpatient Hospital charges or Surgi-Center:

(when major surgery is performed on an outpatient, 'same-day surgery' basis)

The policy pays up to $2,000 for all hospital or Surgi-Center facility billed charges

           

Outpatient X-ray Benefit:

Pays up to $150 (includes reading and interpretation fees)

 

Diagnostic Imaging for MRI/bone scan/CT Scan:

Pays up to $500 per covered accident (includes reading and interpretation fees)

 

Out-Patient Therapy/Manipulations/Adjustments:

or similar treatment/office visits:

Pays up to $30 per daily visit, not to exceed a total of $500 per accident

 

Orthopedic Appliances/Casting/Braces/Etc.:

Pays up to $100

 

Take-Home Drugstore Prescriptions:

Pays up to the usual and reasonable expense for

outpatient prescribed prescription drugs

 

Dental Benefits:

Pays up to $350 per injured tooth; (orthodontic procedures & treatment of previously damaged or decayed teeth are not covered by the school policy)

                       

Licensed Ambulance Service:

Pays up to $500 for the initial emergency trip by air or ground transport

 

For any Covered Motor Vehicle Related Injury:

The policy will pay up to a maximum benefit of $500 for all medical treatment expenses in the aggregate associated with a covered motor vehicle related injury. 

                     

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 90 days from the covered accident date to be eligible for policy benefits.  This description is a summary of the policy terms.  Benefits will be determined by the actual policy provisions.

For a listing of the additional policy exclusions and limitations CLICK HERE

 

HOW TO FILE A CLAIM If a student is injured in an accident during a school activity, report the accident to the principal's office immediately to obtain claim filing instructions.   For specific information on 'How to File' a Claim CLICK HERE

 

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

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, Inc. 

Phone toll free:  1-800-325-1350 Fax: 636-532-1737

To contact by email, CLICK HERE.  The claims office address is: Box 411216, St. Louis, MO  63141. 

 

IMPORTANT: The school accident insurance policy is supplemental insurance.  This means if you have other insurance or sources of coverage such as an HMO, PPO, Blue Cross, Tri-Care, employer provided coverage, you must first file a claim with your other primary 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 other sources.

 

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