Arizona/Nevada Voluntary Student Accident & Sickness Plans for the School Year

Transcription

1 Arizona/Nevada Voluntary Student Accident & Sickness Plans for the School Year Arranged and administered by: AZ/NV -123

2 PLAN DESCRIPTIONS Our voluntary participation plans are a low-cost way for parents to provide protection for their children. They can be used on a standalone basis for those with no other health coverage or as gap coverage to assist with the high deductibles, high co-pays and other inside limits common to many of today s health plans. They offer complete freedom of choice of provider! Student Accident & Sickness Plan Covers Injuries sustained and Sickness commencing while covered under the plan. Coverage protects your student 24 hours a day, anywhere in the world, including participating in all interscholastic sports, except high school tackle football. Repatriation and Medical Evacuation benefits are included. $200,000 maximum coverage per Injury $50,000 maximum coverage per Sickness $10,000 accidental death benefit There is a $50 deductible per Injury or Sickness if enrolling prior to December 1, If enrolling on or after December 1, the deductible per Sickness is increased to $500 unless enrollment occurs within: 1) 30 days of student s transfer into a participating School; 2) 30 days of loss of prior health coverage; 3) 5 days of participation in the first official day of practice for any interscholastic sport. Any student of a participating School or School District, grades P-12, is eligible to purchase the Student Accident & Sickness Plan. The first payment provides coverage for the remainder of the month premium is received by the Company plus the following month. Thereafter, premium is billed and payable every two months. If subsequent payments are not made for any reason, the student s coverage under the Student Accident & Sickness Plan will end. However, the student will be covered under the School-Time Low-Option Plan, with a $1,500 maximum per injury, for the remainder of the School Year. Tackle Football Accident Plans Covers injuries caused by accidents occurring: While practicing or playing in interscholastic high school tackle football activities which are School-sponsored and directly supervised, including spring practice and summer conditioning, weight training and passing league; and While traveling for football in a School Vehicle or traveling directly and without interruption between School and off-campus sites for such activities provided travel is arranged by and is at the direction of the School. NOTE: Football coverage can be made effective as early as May 1st, Full-Time (24/7) Accident Plans Covers injuries caused by accidents occurring 24 hours a day, anywhere in the world, except while participating in interscholastic tackle football. Note: Faculty/staff are also eligible for this plan! School-Time Accident Plans Covers injuries caused by accidents occurring: While on School premises during the hours and on the days when the School s regular classes are in session, including one hour immediately before and one hour immediately after regular classes, while the Covered Person is continuously on the School premises; While participating in or attending School-sponsored and directly supervised School Activities including interscholastic athletic activities and non-contact spring football (except interscholastic high school tackle football); While traveling directly and without interruption: to or from residence and School for regular attendance; or School and off-campus site to participate in School-sponsored and directly supervised School Activities provided travel is arranged by and is at the direction of the School; While traveling in School Vehicles at any time. Dental Accident Plan Covers injuries to teeth caused by accidents occurring anywhere in the world, 24 hours a day, including participation in all sports and all forms of transportation. The Benefit Period under the dental plan provides accident dental benefits for up to one year from the date of first Treatment. However, the benefit period for an Injury may be extended each year, provided that: coverage is renewed prior to October 1, the student remains enrolled in grades P-12, and written notice is received by the Company at the time of injury that further Treatment will be deferred to a later date. Coverage is not limited to treatment of sound, natural teeth. We pay a maximum of $75,000 up to 100% of the Usual, Customary and Reasonable charges for Treatment of injured teeth, including repair or replacement of existing caps and crowns. (We do not pay for damage to or loss of dentures or bridges or damage to existing orthodontic equipment.) Pharmacy SmartCard Available to students, their families and school staff through our partnership with National Pharmaceutical Services (NPS), the SmartCard offers savings of up to 95% of prescription drug costs and is accepted at over 63,000 pharmacies nationwide. In addition, the program can provide Instant Alerts to potential medication interactions to better protect your family along with unique Proof of Savings reports mailed directly to you every six months. After payment has been processed, NPS will send an ID card that can be presented each time a member needs a prescription filled. All members of the household may participate. The SmartCard is not an insurance product and is not insured by BCS Insurance Company.

3 VOLUNTARY BENEFITS We offer two distinct schedules of benefits for the District to choose from. Each schedule includes several levels of accident coverage: a School- Time, Full-Time (24/7) or Tackle Football only basis. In addition, we offer a Student Accident & Sickness Plan, Dental Accident Plan and Pharmacy SmartCard. We will pay benefits only for covered Injuries sustained or Covered Sickness commencing while insured under this School Year s plan. Benefits payable will be based on the Usual, Customary and Reasonable charges incurred for covered medical and dental services, as defined by the Policy, subject to exclusions, requirements and limitations. We do not pay for a service or supply unless it is Medically Necessary and listed in the Description of Benefits, below. Applicable benefits mandated by the state of residence will be included in the covered expenses. Applies to all voluntary plans except the Dental Accident Plan. The Provider Network Discount (PND) Package The Scheduled Benefit Package Covered Benefit Levels Low Option Mid Option High Option Low Option High Option Student Accident & Sickness Plan Plan Name MAXIMUMS PER ACCIDENT MAXIMUMS PER ACCIDENT Tackle Football Accident Plan $25,000 $50,000 $75,000 $25,000 $75,000 Full-Time 24/7 Accident Plan $50,000 $100,000 $150,000 $50,000 $150,000 School-Time Accident Plan $25,000 $50,000 $75,000 $25,000 $75,000 $50,000 Maximum per Sickness $200,000 Maximum per Accidnet Deductible Per Covered Accident/Sickness $250 $100 $50 $0 $0 $50/$500* Covered Expenses BENEFIT MAXIMUMS BENEFIT MAXIMUMS BENEFIT MAXIMUMS Hospital Room & Board - Paid up to 80% 80% 90% $400/Day $650/Day 80% Semi Private Room Rate Inpatient Hospital Miscellaneous Charges. Services described below are paid as scheduled. All other miscellaneous charges - Paid up to 80% to $2,000/Day 80% to $2,500/Day 90% to $3,000/Day $750/Day $1,600/Day 80% to $4,000/Day Intensive Care Unit - Paid up to 80% to $2,000/Day 80% to $2,500/Day 90% to $3,000/Day $1,300/Day $2,200/Day 80% Hospital Emergency Room (room & supplies) incurred within 72 hours of an Injury 100% 100% 100% 100% 100% 100% Outpatient Surgical (room & supplies) 80% to $2,000 80% to $2,500 90% to $3,000 $750 $1,600 80% to $4,000 Physician Non-Surgical Treatment & Exam (excluding Physical Therapy) First Visit 80% 80% 90% See benefits below $50 $75 80% Each Follow Up Visit See benefits above $25 $40 80% Consultation (when referred by attending Physician) $150 $250 80% Surgeon Services 80% 80% 90% 50% 80% 80% Assistant Surgeon Services 80% 80% 90% 25% of Surgical Allowance 80% Anesthesiologist Services 80% 80% 90% 25% of Surgical Allowance 80% Physiotherapy (includes related office visits) when prescribed by a Physician 80% to $400 80% to $750 90% to $1,000 $40/Visit to $480 $65/Visit to $780 80% to $2,000 X-Ray Examinations (including reading) 80% to $400 80% to $750 90% to $1,000 50% to $500 80% to $500 80% Diagnostic Imaging MRI, Cat Scan 80% 80% 90% 50% 80% 80% Ambulance (from site of an emergency directly to hospital) Laboratory Procedures, Registered Nurse Services, and Rehabilitative Braces 100% 100% 100% 100% 100% 100% 80% 80% 90% 60% 100% 80% Durable Medical Equipment 80% to $400 80% to $750 90% to $1,000 60% to $ % to $800 80% Out-Patient Prescription Drugs (for Injuries only) Dental Services (including dental x-rays) for Treatment due to a covered Accident Eyeglass Replacement (for replacement of broken eyeglass frames or lenses resulting from a covered Accident requiring medical attention) 60% 80% 100% 60% 100% 80% 80% 80% 90% 60% 90% 80% $300 $300 $300 $300 $300 80% Medical Evacuation & Repatriation $0 $0 $0 $0 $0 100% to $10,000 *If enrolling on or after Dec. 1, deductible per sickness is increased to $500. See Student Accident & Sickness description, on page 2, for exceptions.

4 VOLUNTARY RATES Accident Plan Rates (One-Time Payment Per Student for Entire School Year) Provider Network Package Scheduled Benefit Package COVERAGE OPTIONS Low-Option Mid-Option High-Option Low-Option High-Option Interscholastic Tackle Football $235 $295 $339 $199 $338 Full-Time (24/7) $225 $276 $328 $210 $299 School-Time $53 $68 $79 $55 $77 Dental Accident Coverage is $16 if purchased separately or $12 when added to any purchased Plan(s). Pharmacy SmartCard is $36 for the entire family for 1 full year. Rates: $208 First Payment covers the remainder of that month in which it was paid and the month following $338 Subsequent payments cover additional two-month periods Effective Dates Coverage begins at 11:59 pm on the day that the Company receives a completed enrollment form and payment of premium. Coverage for all plans may begin as early as May 1, Termination Dates Full-Time (24/7) and Dental coverages end at 12:01 am on the date School begins regularly scheduled classes for the School Year. Interscholastic High School Tackle Football and School-Time coverages end at 11:59 pm on the closing date of regular classes for the School Year. Student Accident & Sickness coverage ends at 11:59 pm on the last day of the month for which payment has been made. Coverage may be continued for up to 12 calendar months, or through September 30, 2016, whichever comes first, provided the required payments are made. Additional Benefits Accidental death, dismemberment, loss of sight, paralysis and psychiatric/psychological counseling benefits (applies to all voluntary plans except the Dental Accident Plan). In addition to medical benefits, if, within 365 days from the date of Accident covered by the policy, bodily injuries result in any of the following losses, we will pay the benefit set opposite such loss. Only one such benefit (the largest) will be paid for all such losses due to any one Accident. Accidental Death $10,000 Single dismemberment or entire loss of sight in one eye $20,000 Double dismemberment or entire loss of sight in both eyes or paraplegia or hemiplegia or quadriplegia $30,000 Counseling In addition to the AD&D benefits, we will pay 100% of the Usual, Customary and Reasonable costs of psychiatric/psychological counseling needed after covered dismemberment, loss of sight or paralysis up to: $5,000

5 LIMITED ACTIVITIES COVERAGE The following coverages may be provided to your district at no additional charge in consideration of your district s application and diligent efforts to provide the voluntary Student Accident Coverage materials to the parent/guardian of every student in the district and maintenance of a proper system of signed waiver/proof of insurance (where required by law). Some of these coverages are designed to assist with district compliance of Education Code requirements where applicable. NOTE: To receive these coverages, please complete the Limited Activities Agreement attached to the application. Interscholastic Sports Oversight Coverage Covers injuries to interscholastic athletes who: 1) did not purchase student accident insurance because district personnel inadvertently failed to offer student accident insurance plans to the injured athlete as required by Education Code (where applicable) and 2) did not file a Waiver of Student Insurance, and 3) participated in interscholastic athletics without any insurance coverage. Benefits are paid at 100% of Usual, Customary and Reasonable charges up to a maximum of $1,500 per Accident. Non-Competing Participants Coverage Covers injuries occurring while traveling in School-provided and operated vehicles to and from athletic events for which they have been selected by the district to directly assist in the noncompetitive activities associated with the events, e.g., members of school bands, cheerleaders, pompom girls and team managers. Benefits are paid at 100% of Usual, Customary and Reasonable charges up to a maximum of $1,500 per Accident. One-Day Field Trip Coverage Covers injuries which occur while your students are attending or participating in School-sponsored one-day field trips which are under the direct and immediate supervision of School personnel. In order to qualify as a bona-fide Field Trip, the district must be fully responsible for the students while they are participating in the outing. Benefits are paid at 100% of Usual, Customary and Reasonable charges up to a maximum of $1,500 per Accident. Students attending or participating in interscholastic events are not covered under this plan. Blanket Accidental Death Coverage Provides a $2,500 accidental death benefit for all of your students and district employees for loss resulting from covered injuries occurring while attending School or participating in activities sponsored and under the direct and immediate supervision of the School during the regular School Year, including all sports and while being transported in a School-provided and operated vehicle. Felonious Assault (Counseling Benefit) Coverage Provides up to a $1,500 psychiatric or psychological counseling benefit for all of your students for counseling required after a felonious assault. Benefits are provided for any student whose injury occurs during the regular School Year while: traveling directly to or from School; participating in a School-sponsored and supervised activity; or on the School s premises. A felonious assault is an act of violence directed against a student, which results in a bodily Injury for which a student requires and seeks medical Treatment, and the School files a written report with the police within 24 hours of the assault.

6 OPTIONAL COVERAGES The following Blanket (100% participation required) coverages are available for District/School purchase. For more details, you may call our office for applicable coverage enrollment forms. School-To-Work Coverage Covers students for injuries which occur while at an approved worksite and under direct supervision, and while traveling directly and without interruption, at the direction of the School, between School and the worksite and between the worksite and home. Benefits: 100% Usual, Customary and Maximum per Injury $25,000 Reasonable charges for covered expenses Rate: $6.00 per participant Minimum premium required: $250 Short-Term 24-Hour Coverage Both the frequency and severity of injuries tend to increase when students are not directly supervised. Covers students round-theclock when participating in School-sponsored, but not necessarily directly supervised activities, such as: ski trips, camping, overnight, amusement parks, etc. Adult chaperones may be added at the same rate. Basic Benefits: 100% Usual, Customary and Maximum per Injury: $25,000 Reasonable charges for covered expenses Maximum per emergency sickness: $1,000 as underwritten by BCS Insurance Company. Catastrophic Benefits as underwritten by Maximum per Injury: $1,000,000 excess medical Ace American Insurance Company*. Rate: $1.75 per person per day Minimum premium required: $35 NOTE: Includes Benefits for Emergency Sickness, Remains Repatriation and Medical Evacuation! Interscholastic Tackle Football Tryout Coverage Covers all students trying out for interscholastic high school tackle football, including non-contact spring football practice and/or while traveling in a School Vehicle to and from football practice. Benefits: 100% Usual, Customary and Maximum per Injury: $1,500 Reasonable charges for covered expenses Rate: $6.00 per person per coverage term Minimum premium required: $50 Powder Puff Football Coverage Covers students participating in Powder Puff Football activities. Coverage provides for up to two weeks of practice and one game. Benefits: 100% Usual, Customary and Maximum per Injury: $1,500 Reasonable charges for covered expenses Rate: $10.00 per participant Minimum premium required: $50 Elementary Competitor's Team Coverage Covers students for injuries which occur during elementary level after-school team sports while participating in School-sponsored and School-supervised interscholastic athletics (except interscholastic high school tackle football). Coverage is provided for after-school sports practice, sports contests, and travel in School-provided and operated vehicles to and from sports practice and contests. Benefits: 100% Usual, Customary and Maximum per Injury: $1,500 Reasonable charges for covered expenses Rate: $5.00 times estimated number Minimum premium required: $200 of participants in grades K-8

7 EXCLUSIONS Benefits are not payable for any of the following or loss that results from them: 1. Damage to or loss of dentures or bridges or damage to existing orthodontic equipment. 2. War or any act of war, declared or undeclared. 3. Participation in a riot or civil disorder; fighting or brawling, except in self-defense; commission of or attempt to commit a felony or violating or attempting to violate any duly enacted law. 4. Suicide, attempted suicide or intentionally self-inflicted Injury while sane or insane. 5. Injury or Sickness contributed to by the use of alcohol or drugs unless taken in the dosage and for the purpose prescribed by the Covered Person s Physician. 6. Practice or play in interscholastic high school tackle football (unless separate football coverage is purchased), intercollegiate sports, semiprofessional sports, or professional sports. (Does not apply to the Dental Accident Plan.) 7. Injury or Sickness covered by Worker s Compensation or Employer s Liability Laws, or by any coverage provided or required by law including, but not limited to group, group type, and individual automobile No Fault coverage (excluding School Vehicle coverage). 8. Treatment, services or supplies provided by the School s infirmary or its employees, or Physicians who work for the School, or by any member of the Covered Person s immediate family; or for which no charge is normally made. 9. Mental or nervous disorders (except as specifically provided by the Policy). 10. Treatment of Sickness, ailment, or infections (except pyogenic infections or bacterial infections which result from the accidental ingestion of contaminated substances). (Does not apply to the Sickness-Only Coverage under the Student Accident & Sickness Plan.) 11. The diagnosis and Treatment of non-malignant warts, moles and lesions, acne or allergies, including allergy testing. 12. Injury sustained as a result of riding in or on, entering or alighting from, a two or three-wheeled motor vehicle. (Does not apply to the Dental Accident Plan.) 13. Treatment of osteomyelitis, pathological fractures and hernia. (Does not apply to the Sickness-Only Coverage under the Student Accident & Sickness Plan.) 14. Detached retina (unless directly caused by an Injury). (Does not apply to the Sickness-Only Coverage under the Student Accident & Sickness Plan or the Emergency Sickness Benefit.) 15. Any expenses related to the Treatment of tonsils, adenoids, epilepsy, seizure disorder or congenital weakness; or expenses for Treatment of congenital anomalies and conditions arising or resulting directly there from. 16. Supplies, except as otherwise provided in the Policy. Requirements and Limitations Aggravations of Injuries which did not occur while insured under this plan are paid up to $500 maximum benefit per policy term. Injuries sustained as a result of riding in or on, entering or alighting from or being struck by a Motor Vehicle are limited to a $5,000 maximum benefit (up to $10,000 if vehicle is a School Vehicle). Some Motor Vehicle Injuries are not covered see Exclusions above for details. School-Time and Interscholastic High School Tackle Football Injuries must be reported to the School within 72 hours of the date of Injury. The first Physician s visit must be within 120 days after the Accident occurs. This insurance does not apply to the extent that trade or economic sanctions or regulations prohibit us from providing insurance, including but not limited to, the payment of claims. A claim form must be filed with Myers- Stevens & Toohey & Co., Inc. within 90 days after the date of loss. The plan pays for covered expenses incurred within a year from the date of the first Physician s visit. However, should the Injury sustained require the removal of surgical pins, continued treatment for serious burns, or treatment of a non-union or mal-union fracture, the benefit period will be extended to 104 weeks. Each covered condition may be subject to a deductible see plan details. Non-Duplication of Benefits (Excess Provision) In order to keep premium as affordable as possible, these plans pay benefits on a non-duplicating basis. This means, if a person is covered by one or more of these plans and by any other valid insurance or health agreement, any amount payable or provided by the other coverages will be subtracted from the covered expenses and we will pay benefits based on the remaining amount. (In Arizona: Does not apply to the Sickness-Only coverage under the Student Accident & Sickness Plan) This brochure contains a brief description of the benefits available. Rates shown in this brochure include all administrative expenses, commissions and taxes. Plans arranged and administered by: Myers-Stevens & Toohey & Co., Inc. CA License # Student Accident and Sickness Plans underwritten by: BCS Insurance Company Oakbrook Terrace, Illinois Rated A (Excellent) by A.M. Best, an independent insurance company rating agency. Policyholder: Family Insurance Trust, sitused in District of Columbia Short-Term 24-Hour underwritten by ACE American Insurance Company 2014 Best rated A++ (Superior) (A.M. Best Rating ranges from A++ to D) This rating is an indication of the company s financial strength and ability to meet obligations to its insureds.

8 Student Accident & Sickness Insurance Plans administered by

9 ABOUT OUR COMPANY Founded in 1970, Myers-Stevens & Toohey & Co., Inc. provides its clients with superior customer service, stateof-the-art technology and over 45 years of experience and knowledge in the very specialized area of student accident and sickness insurance. As a fully licensed Managing General Agency/Third- Party Administrator (MGA/TPA), we provide carefully integrated insurance solutions to thousands of school systems throughout the Western and Midwestern states. Our clients include school districts, private and charter schools, colleges, consortiums, JPAs, amateur/youth sports programs, foundations, booster clubs and similar organizations serving the needs of young people. Why Myers-Stevens & Toohey is the superior choice We are a full-service administrator with on-site claims adjudication and personal customer assistance Accident-only, as well as accident & sickness options Plans and benefit levels designed to minimize out-of-pocket costs Additional coverages provided gratis to further protect the district Freedom to seek care from any licensed provider Optional access to extensive networks to further reduce costs A variety of easy and convenient enrollment options including online, fax, and U.S. mail Convenient direct billings to help prevent coverage lapses Bilingual customer service 2

10 BLANKET PROGRAMS FOR P-12 SCHOOLS AND COMMUNITY COLLEGES Whether they occur in a public or private P-12 school, community college or day care center, student injuries can represent big problems for families as well as the educational institutions involved. This is especially the case when the student is otherwise uninsured or under-insured. Accessing care can be an issue and risk of litigation against the school may increase. Noncompliance with applicable state or local law may present further challenges. Providing some level of our blanket student accident insurance can be the solution! Our programs allow institutions the flexibility to implement accident medical expense coverage terms and emergency sickness benefits to best address their own unique needs. Changes in the delivery of healthcare Despite what many may think about the evolution of health care delivery in the U.S., there remain a significant number of students who are completely uninsured for a variety of reasons. Another segment consists of those covered as dependents through either individual or employerprovided health plans where deductibles and co-payments have increased dramatically. Choice of providers has become more limited when families discover their doctors and facilities are no longer participating in their network. And, while many students may be covered under Medicaid, lower reimbursement levels mean that a significant number of providers do not accept Medicaid patients. Why student insurance is more important than ever Blanket student accident insurance covers all enrolled students and can: Mitigate liability exposure and related costs resulting from uninsured or under-insured school-related injuries Facilitate compliance with applicable state law or local board policy Greatly lower the cost of coverage per student due to better spread of risk Reduce the administrative load for your staff Help families avoid serious financial hardship Remove financial barriers for children looking to participate in extracurricular/co-curricular activities Foster positive relationships within the community 3

11 CATASTROPHIC COVERAGE Even with the best of precautions... Students may still sustain serious or fatal injuries while going to school, playing sports, attending field trips, or simply being in class. Traumatic brain injuries, coma, paralysis, and loss of life are examples of the catastrophic losses that can occur. Such injuries typically come with medical bills and other expenses that far exceed those associated with injuries that are not life altering. By providing Catastrophic Injury Coverage, schools and districts can help seriously injured students and families ease their financial concerns. In addition, Catastrophic Injury Coverage allows students and families to access the care they need, reduce potential liability costs for the school or district, provide for final expenses when needed and promote healing of the community as a whole. Catastrophic accidents do not limit themselves to sports Many governing bodies for sports already require member schools to carry a catastrophic injury policy for athletics and a number of school property and casualty pools and consortiums have followed suit. The need for catastrophic coverage is clear and although they are most commonly associated with athletic participation, these injuries are not relegated to sports activities alone. The transportation of students, specialized electives, physical education, natural disasters and on-campus violence are just a few examples of how these injuries can occur in areas other than the playing field. Help beyond medical bills Depending on the options selected, our catastrophic plans can pay covered accident medical expenses on an excess basis at 100% of Usual and Customary charges up to $5,000,000 after a $25,000 deductible. The deductible is waived and coverage starts from dollar one if the student suffers a presumptive disability. For the most serious of injuries, the plan can also provide up to $1,000,000 in additional cash assistance. The program also provides blanket accidental death & dismemberment, loss of sight, speech, and hearing benefits. No one likes to talk about it On-campus violence is an issue that cannot be ignored. Violent acts on campus don t affect just those directly involved, but the community as a whole. If a student is killed as a result of criminal violence while participating in a covered activity, the Crisis Management Benefit can provide additional funds to help the school or district deal with the aftermath as best fits their needs (i.e. counseling for staff and students, additional security measures, etc.) 4

12 VOLUNTARY STUDENT ACCIDENT INSURANCE For a variety of reasons, many children in the U.S. continue to have no health coverage. For those who do, there are often significant coverage gaps. According to the Department of Health and Human Services (HHS), 85% of new health care enrollees accessing the Marketplace metal plans selected the Bronze or Silver options. These involve co-pay requirements ranging from 40% - 30% and individual deductibles of $5,000 and $2,000 respectively. HHS adds that approximately 12 million individuals between the ages of 5 and 22 years suffer a sports related injury annually and that cost of care can be significant. Charges for a broken arm average nearly $7,700!* Uncovered costs of medical care following a school-related injury can be a serious problem for families and for schools! Myers-Stevens & Toohey can help! Our voluntary participation plans are a low-cost way for parents to provide protection for their children. They can be used on a standalone basis for those with no other health coverage or as gap coverage to assist with the high deductibles, high co-pays and other inside limits common to many of today s health plans. They offer complete freedom of choice of provider! Your school district may also offer our voluntary options in conjunction with our recommended blanket School-Time plans. Importance to the school or district As with our blanket plans, our voluntary participation plans can help facilitate compliance with applicable state law and/or local school board policy. These plans can also mitigate the liability exposure to the schools associated with uninsured or under-insured injuries. Most importantly, use of the plans can help injured kids get the care they need and get back to school! Voluntary plans offered We offer a variety of voluntary plans so that families have affordable and flexible choices to fit their needs. They include: Tackle Football Accident Plans Student Accident & Sickness Plan School-Time Accident Plans Full-Time (24/7) Accident Plans Dental Accident Plan Pharmacy SmartCard (where available) * 5

13 OPTIONAL COVERAGES The following additional coverages are available for district/school purchase. Contact our office for additional information. Worldwide Exchange Accident & Sickness Plan Available on either a blanket or individually purchased basis. Covers both inbound and outbound international students with limits of up to $500,000 at 100% of Usual and Customary charges. Valuable travel assistance features are also included in this plan. School-To-Work Coverage Many schools offer job shadowing and other employer partnerships meant to help students prepare for the future. Our School-to-Work plan covers students participating in such programs and while traveling directly between school and the approved work site. Short-Term 24-Hour/Specified Trip Coverage Both the frequency and severity of injuries tend to increase when students are not directly supervised. This can create a heightened liability exposure. Our Short-Term 24-Hour/Specified Trip coverage protects your students on an around-theclock basis. It should be strongly considered for high-risk activities or situations where it is impossible or impractical to keep students under constant, direct and immediate supervision. Examples include ski trips, camping excursions, overnight field trips, amusement park visits, out-of-state travel, etc. Covers 100% of Usual, Customary and Reasonable charges up to $1,000,000 per injury. Adult chaperones may also be added at the same rate. Interscholastic Tackle Football Tryout Coverage Though many students are eager to play football, not all make the team. Others may need a little more time to determine if they would like to continue participation. Our Interscholastic Tackle Football Tryout Coverage ensures that all students have the opportunity to try out for interscholastic high school tackle football before committing to full-time participation. Powder Puff Football Coverage Girls play too! Covers students participating in Powder Puff Football activities for up to two weeks of practice and one game. Elementary Competitor's Team Coverage K-8 student athletes are just as susceptible to injury as the older kids. This coverage insures students for injuries occurring during elementary level school-sponsored and supervised interscholastic sports. Special Activities? If you have any unique activities or concerns, please call our office so that we may custom-tailor a coverage plan that best suits your needs! 6

14 SPECIAL RISK INSURANCE Participant injuries can lead to litigation. We offer a wide range of flexible Special Risk coverages that can be custom-packaged to address your organization s unique insurance needs. Our experience provides insight into the obvious (and not so obvious) risks... and the means to transfer them. Accident Medical Expense Coverage for an organization s staff, volunteers and other participants in the event of a covered accident. Commercial General Liability Designed to protect an organization should lawsuits and property damage claims arise from the use of facilities. Director's and Officer's Liability Protection against breach of duty by directors and officers. This can include coverage for mismanagement of assets, discrimination, harassment, wrongful termination and failure to provide services. Crime Coverage Coverage for losses due to dishonesty, forgery, alteration, theft, disappearance or destruction. Abuse and Molestation This coverage is extremely important for any organization working with minors. Even frivolous and minor claims can cost thousands of dollars and will far exceed the cost of protection. Domestic or International Business Travel Accident Provides employees with both standard and catastrophic protection arising from injury, including terrorism, rioting, kidnapping and ransom. Hired and Non-Owned Auto Liability Designed for employees or volunteers that rent or use their own vehicles for policy-holder business. Inland Marine By extending moveable property and equipment coverage through this policy, costly premium increases that can arise from claims made through a homeowner s insurance policy can be avoided. Our Inland Marine policies includes a wide array of equipment and machinery such as: Musical Instruments Electronics Storage Containers Sports Equipment Display Units Portable Food Prep Devices Theatrical Sets and Props Costumes Custom Built Equipment Our clients range from small volunteer groups to large consortiums and organizations Professional Associations Non-Profits Booster Clubs Fraternal Organizations School Carnivals Photo Shoots Educational and Scholarship Foundations Church Groups Dance Studios Summer Camps and Summer League Weddings and Graduations Jr. Lifeguards Community Services Groups Sports Conditioning Team Sports Off-Season Sports Programs Theater and Performing Arts Groups Concerts Martial Arts Exhibitions and Tournaments Other Special Events And more! 7

15 ADMINISTRATIVE SERVICES As an MGA/TPA, Myers-Stevens & Toohey provides many services on behalf of our clients and underwriting partners. Those services include, but are not limited to, designing, marketing, and fully administering the plans. In order to deliver those services in a first-class fashion, we must also employ a first-class team. Collectively our team members are wellversed in all of our student accident plans and are able to promptly and professionally assist customer inquiries on the spot. Additionally, we offer bi-lingual support to parents and students who speak Spanish as their primary language. Enrollment made easy! Enrolling thousands upon thousands of students each year is no small feat. Over the years we ve honed in on several different strategies that offer both efficiency and flexibility for our clients. Our online process enables immediate access to our plans for those who are eligible and this has proven to be a crucial tool for clients when time is of the essence. Data submitted is securely processed, with a confirmation of insurance being ed back to the enrollee all in the span of a few minutes! In order to ensure all eligible parties have access to plans, we continue to invest in providing our clients with the printed materials they ve come to rely on. Enrollment may still be submitted manually via , fax and U.S. Mail. Payments may be made in the form of credit card, check and money order. And, yes, we reluctantly still accept cash! We provide all types of premium invoices and payment options including automatic premium payment by credit card, ACH processing (electronic funds transfer), direct billing and group list bills. Plans that require monthly or bimonthly payments are invoiced and mailed 45 days prior to the plan premium due date to help avoid any lapse in coverage. Secure data collection and financial management All data collected is solely used for delivering agreed upon services. These include enrollment of students, billings, claims adjudication and underwriting. We take security and fraud prevention very seriously and ensure that all data records, physical or digital, are stored in compliance with all applicable regulatory statutes in secured & temperature-controlled warehouses. Our systems allow for easy data retrieval with the ability to produce premium, enrollment, and claims reports as needed. When it comes to handling money we seek out partners who are the best at what they do. As such, we are proud to contract with only top-rated rated financial institutions offering the latest in industry technology. We leverage these technologies to guarantee timely and secure transactions which help us cover our clients faster. Reporting tools Our school clients can access real-time enrollment information to verify individual student coverage. We routinely provide our clients with detailed claims reports to help them better evaluate risk exposures and sources of injury at each of their sites. 8

16 CLAIMS ADJUDICATION AND NETWORK PROVIDERS Another aspect of Myers-Stevens & Toohey that we are especially proud of is our in-house claims unit. We have over 100 years of combined experience adjudicating claims! This enables us to carry over our superior customer service from our sales team to the claims experience. Each claim is assigned to one of our experienced examiners who will diligently guide family members, school staff, medical providers and any other parties involved throughout the entire process from A to Z. Day in and day out our examiners apply their specific and highly technical knowledge to ensure accurate and expedited processing. While most of our programs are fully insured, some clients may opt to self-fund all or a portion of their student accident program. We re here for that too! We can operate on an exclusively Administrative Services Only (ASO) basis or seamlessly integrate partially self-funded programs with complimentary, fully-insured coverage corridors and other options. Maximum choice - maximum savings! When an accident or sickness occurs, access to providers is important to our students and their families. In the current healthcare environment, plan choices are becoming more limited as the network provider lists continue to contract. Our plans generally allow parents to seek treatment for their children from the provider or facility of their choice. In addition, we partner with First Health and First Choice; two very extensive provider networks that allow for deep discounts on billed charges (averaging over 40%). This can further reduce parents out-of-pocket costs. The networks provide: Comprehensive coverage in urban and rural markets that eliminates the patchwork approach Over 5,000 hospitals, 90,000 ancillary facilities, and 1 million health care professional service locations nationwide 98% of the U.S. population with access to a network provider Electronic web directories which enable members to find network providers, office hours, languages spoken, hospital affiliation and driving directions Annually, U.S. News & World Report publishes America s Best Hospitals. The great majority of these hospitals are contracted, giving parents access to the best of care and lower costs! 9

17 PRINT AND DISTRIBUTION We will provide your schools with brochures/enrollment forms detailing our many options. Parents/guardians of every enrolled student must receive an enrollment form on or before the start of the School Year for optimal results. You may specify which week(s) you and your staff would prefer to receive materials and we will ensure efficient and prompt delivery at no cost. To further assist in the delivery process, we offer the following services: Convenient packaging by school site our boxes are clearly labeled as Student Insurance Materials Materials are delivered when and where you indicate individual sites, district office or district warehouse Real-time tracking immediate confirmation of shipment status including date, delivery address and signature verification Each shipment includes enrollment envelopes, distribution instructions, claim forms and other necessary documents You may order additional materials anytime at no additional cost ID cards ensure results Many of the families we provide coverage for have little or no financial resources to fall back on during an unexpected emergency. In fact, Federal Reserve Chair, Janet Yellen, recently referenced a Fed survey which found that an unexpected expense of just $400 would force the majority of American families to borrow money, sell something or simply not pay. She went on to say that families with assets can treat financial setbacks as bumps in the road. Families without these assets can end up, very suddenly, off the road. * Myers-Stevens & Toohey & Co., Inc Marguerite Parkway Mission Viejo, CA T: F: E: claims@myer-stevens.com Myers-Stevens & Toohey & Co., Inc. T: Marguerite Parkway F: Mission Viejo, CA E: claims@myer-stevens.com (For claims information, please use this contact) (For claims information, please use this contact) INSURANCE ID CARD INSURANCE ID CARD Name: Jonathan Rearden ID #: Group #: Plan Effective Date Student Accident & Sickness 08/03/2015 Tackle Football Accident Plan 08/03/2015 Dental Accident Plan 08/03/2015 Name: Charles B. Johnston ID #: Group #: Plan Effective Date Student Accident & Sickness 08/03/2015 Tackle Football Accident Plan 08/03/2015 Dental Accident Plan 08/03/2015 This is why every enrollee in our voluntary plans will receive two personalized Insurance Verification cards. We believe proof of coverage is important. With proof of coverage in hand, it is easier for parents to access the care their children need and providers are more inclined to bill the insurance first. Families can focus on recovery rather than fronting the costs of care. * 10

18 STUDENT ACCIDENT CARRIERS Our partnerships with our two student insurance underwriters goes back over 13 years. These long-term relationships give us the trust needed to optimally design our programs to best fit the needs of our schools and students. Additionally, we have the flexibility needed to address special situations as they arise. BCS Insurance Company is owned by all primary Blue Cross and Blue Shield licensees and is rated A- (Excellent) by A.M. Best. ACE American Insurance Company is rated A++ (Superior) by A.M. Best. SPECIAL RISK CARRIERS Rated A++ (Superior) by A.M. Best Financial Size: XIV ($1.5 Billion to $2 Billion) Rated A (Excellent) by A.M. Best Financial Size: XIII ($1.25 Billion to $1.5 Billion) Rated A (Excellent) by A.M. Best Financial Size: XI ($750 Million to $1 Billion) Rated A+ (Superior) by A.M. Best Financial Size: XI ($750 Million to $1 Billion) 11

19 Mission Viejo Marguerite Parkway Mission Viejo, CA Office (800) Fax (949) CA License # Roseville 9075 Foothills Blvd. #4 Roseville, CA Office (800) Fax (916)

20 Douglas County School District 1638 Mono Avenue Minden, Nevada Information Phone: (775) Fax: (775) Administration Lisa Noonan, Ed.D. Superintendent (775) Education Services Christi Hines-Coates Director, Area 1 (775) Brian Frazier Director, Area 2 (775) Rommy Cronin Director, Area 3 (775) Brandon Swain Director, Area 4 (775) Business Services Holly Luna Chief Financial Officer (775) Human Resources Teri White Director (775) Board of Trustees Ross Chichester President Cynthia Trigg Vice President Neal Freitas Clerk Members Karen Chessell Teri Jamin Robbe Lehmann Thomas Moore TO: Parents or Guardians SUBJECT: STUDENT ACCIDENT INSURANCE DATE: July 2015 School accident insurance is made available to all students of the District as a service on an optional basis. The Douglas County School District does not provide medical insurance coverage for school accidents. The premiums for the types of plans are explained in the attached enrollment pamphlet. Before you decide whether or not to enroll, you should thoroughly analyze your existing health and accident coverage. Other key considerations include: 1. GROUP INSURANCE - If you are protected by group insurance and have included your dependents in the coverage, an accident will be covered by the group policy, so this additional coverage may not be necessary. Check your policy to be sure including the level of your deductibles and coinsurance. 2. FAMILY MEDICAL INSURANCE - If your student is covered by a good, comprehensive medical/hospital plan, you might check to see if accidents are covered including your deductible and out-of-pocket expenses. It may not be necessary to enroll in the student accident insurance program if you currently have a comprehensive medical/hospital plan. 3. OTHER INSURANCE - Full-time, year-round accident and sickness coverage through most companies can be a better buy for your premium dollar than school accident coverage, where sickness is not covered. 4. WHEN TO BUY SCHOOL ACCIDENT INSURANCE As a supplement to your existing coverage or when no other alternative is available. IMPORTANT: The Douglas County School District would like parents or guardians to understand that student insurance is a service provided only to the extent that a policy may be obtained; the School District is not responsible in any way except to inform you of the availability of student accident insurance. TO ENROLL: Please read your brochure carefully. If you have questions, please call our agent, Myers-Stevens & Toohey & Co., Inc ((800) Return premium directly to Myers-Stevens & Toohey & Co., Inc., not to your child s school. As parent/guardian of, I understand that the Douglas County School District does not provide medical insurance for student injuries, but does make voluntary student insurance available. I have received the information on this program. I will enroll my child in the program I will not enroll my child in the program Signature Date