Affordable Insurance Protection!
FORT WAYNE COMMUNITY SCHOOLS
Optional Voluntary Student Insurance
The Everest Reinsurance Company offers a reasonably priced optional student accident insurance plan that can help Ft. Wyane Community Schools parents pay for some of the medical expenses due to accidents that may occur while away from school, including the weekends and all vacation periods including the summer months. The FULL TIME / 24-HOUR AT SCHOOL protection is available for a one-time payment to have coverage while at school, at home, during vacation periods including the summer months. Families that already have primary insurance may utilize these plans as a supplement to help pay some of their out-of-pocket expenses due to high deductibles or copay amounts. Families without any insurance protection should consider purchasing these optional plans to help pay for some of their children's medical bills in the event of accidents.
Note: The optional coverage plans are only available to insure students enrolled in grades Pre-Kindergarten through grade 12 in the school district. The coverage options are not available to high school graduates, college students, children that attend other school districts or adults. The policy benefits are limited and will not provide full 100% payment for all doctor and hospital billed charges.
The school purchases a group insurance policy that may help cover some of the expenses incurred during school activities and sports. To view information regarding the sports plan Click Here
CHOICE OF OPTIONAL STUDENT ACCIDENT INSURANCE PLANS
24-HOUR FULLTIME PLAN $65.00
Accident Insurance 24 hours a day until the beginning of next school year, while at home, at school, on vacation. Also, while participating in sports, including amateur sports, except Senior High tackle football.
SHORT-TERM EMERGENCY SICKNESS $40.00
Covers Expenses incurred for treatment of an Emergency Sickness that occurs during a Covered Activity. Requires care and treatment rendered in a hospital, urgent care or other appropriately licensed medical facility as certified by the local authorities where the Emergency Sickness first manifested itself during the period of coverage or by a Physician. Provides Up to $5,000 of coverage.
MAXIMUM POLICY BENEFITS FOR REGULAR OPTIONAL VOLUNTARY PLAN
The maximum medical benefits will not exceed $25,000.00 per covered athletic injury, subject to the policy limits. The sports policy may not pay for all sports accident-related medical expenses. Some bills may exceed the limits of the policy. The maximum policy benefits are listed below. For a claim to be considered eligible for policy benefits, an injured student must receive medical treatment by a licensed physician within thirty (35) days after the date of the original covered accident. The policy will pay for necessary, eligible medical treatment expenses that are rendered and billed within 52 weeks after the date of a covered accident subject to the following policy limits:
PLAN BENEFITS
| Accidental Death | $10,000 | Accidental Dismemberment | $10,000 |
| Maximum Medical Expense Benefit per Covered Accident | $25,000 | Emergency Room | 100% URC up to $25,000 |
| Hospital Room and Board Daily |
100% URC up to $25,000 |
Anesthesia | 100% URC up to $25,000 |
| Intensive Care Room and Board |
100% URC up to $25,000 |
In-Hospital Physician’s Visits | 100% URC up to $25,000 |
| Hospital Miscellaneous (Inpatient and Outpatient) |
100% URC up to $25,000 |
Out-of-Hospital Physician’s Visits | 100% URC up to $25,000 |
| Pre-Admission Testing |
100% URC up to $25,000 |
X-Ray MRI/CAT |
100% URC up to $25,000 100% URC up to $25,000 |
| In-Patient Surgical – Primary Surgeon |
100% URC up to $25,000 |
Laboratory Expenses | 100% URC up to $25,000 |
| In-Patient Surgical – Assistant Surgeon |
100% URC up to $25,000 |
Registered Nurse | 100% URC up to $25,000 |
| Outpatient Surgery – Primary Surgeon |
100% URC up to $25,000 |
Outpatient Physiotherapy | 100% URC up to $25,000 |
| Outpatient Surgery – Assistant Surgeon |
100% URC up to $25,000 |
Air & Ground Ambulance | 100% URC up to $25,000 |
| Outpatient Surgery – Surgical Facility |
100% URC up to $25,000 |
Dental Treatment for Injury Only | 100% URC up to $25,000 |
| Orthopaedic Appliance |
100% URC up to $25,000 |
Prescription Drug | 100% URC up to $25,000 |
LIMITATIONS and EXCLUSIONS
1. Suicide, self-destruction, attempted self-destruction, or intentional self-inflicted Injury while sane or insane.
2. War or any act of war, declared or undeclared.
3. An Accident which occurs while the Covered Person is on Active Duty in any Armed Forces, National Guard, military, naval or air service or organized reserve corps.
4. Injury sustained while in the service of the armed forces of any country. When the Covered Person enters the armed forces of any country, We will refund the unearned pro-rata premium upon request.
5. Participation in a riot or insurrection.
6. Any Injury requiring treatment which arises out of, or in the course of fighting, brawling, assault, or battery.
7. sickness, disease, bodily or mental infirmity or medical or surgical treatment thereof, bacterial, or viral infection, regardless of how contracted. This does not include bacterial infection that is the natural foreseeable result of an Accidental external bodily injury or accidental food poisoning.
8. Disease or disorder of the body or mind.
9. Mental or Nervous disorders, except as specifically provided in the Policy.
10. Asphyxiation from voluntarily or involuntarily inhaling gas and not the result of the Covered Person’s job.
11. Voluntarily taking any drug or narcotic unless the drug or narcotic is prescribed by a Physician and not taken in the dosage or for the purpose as prescribed by the Covered Person’s Physician.
12. Intoxication or being under the influence of any drug or narcotic.
13. Injury caused by, contributed to, or resulting from the Covered Person’s use of alcohol, illegal drugs or medicines that are not taken in the dosage or for the purpose as prescribed by the Covered Person’s Physician.
14. Driving under the influence of a controlled substance unless administered on the advice of a Physician.
15. Driving while Intoxicated. Intoxicated will have the meaning determined by the laws in the jurisdiction of the geographical area where the loss occurs.
16. Violation or in violation or attempt to violate any duly enacted law or regulation, or commission or attempt to commit an assault or felony, or that occurs while engaged in an illegal occupation.
17. Conditions that are not caused by a Covered Accident.
18. Charges which are in excess of Usual and Customary charges.
19. Expenses incurred for an Accident after the Benefit Period shown in the Schedule of Benefits.
20. Regular health checkups.
21. Any Accident where the Covered Person is the operator of a motor vehicle and does not possess a current and valid motor vehicle operator’s license.
22. Travel in or upon: A snowmobile; A water jet ski; Any two or three wheeled motor vehicle, other than a motorcycle registered for on-road travel;
Any off-road motorized vehicle not requiring licensing as a motor vehicle;
23. Travel or flight in or on any vehicle for aerial navigation, including boarding or alighting from:
While riding as a passenger in any Aircraft not intended or licensed for the transportation of passengers; or
While being used for any test or experimental purpose; or
While piloting, operation, learning to operate or serving as a member of the crew thereof; or
While traveling in any such Aircraft or device which is owned or leased by or on behalf of the Policyholder of any subsidiary or affiliate of the Policyholder, or by the Covered Person or any member of His household.
A space craft or any craft designed for navigation above or beyond the earth’s atmosphere; or an ultralight hang-gliding, parachuting, or bungee-cord jumping
Except as a fare paying passenger on a regularly scheduled commercial airline.
24. Treatment for an Injury that is caused by or results from a nuclear reaction or the release of nuclear energy. However, this exclusion will not apply if the loss is sustained within 365 days of the initial incident and:
The loss was caused by fire, heat, explosion, or other physical trauma which was a result of the release of nuclear energy and The Covered Person was within a 100-mile radius of the site of release either:
At the time of the release; or
Within 24 hours of the start of the release; or
Occurs while the Covered Person is in
25. Elective or Cosmetic surgery, except for reconstructive surgery on an injured part of the body.
26. Services rendered for detection and correction by manual or mechanical means (including x-rays incidental thereto of structural imbalance, distortion, or subluxation in the human body for purposes of removing nerve interference where such interference is the result of or related to distortion, misalignment, or subluxation of or in the vertebral column.
27. Pregnancy; childbirth; miscarriage; abortion; or any complications of any of these conditions. This does not apply if treatment is required as a result of a Covered Accident.
HOW TO FILE A CLAIM
PLEASE SUBMIT A CLAIM TO COMPANY WITHIN 90 DAYS FROM THE DATE OF ACCIDENT. Medical Bills must be submitted within one year from the date of service. Late bills cannot be processed.
Notify school officials immediately. Obtain a claim form from the school or from this website. 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.
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: KIDGUARD INSURANCE (a division of Doxa Programs, LLC) if you need answers to claim or coverage issues. The school does not keep records regarding claims. All claims are processed by KIDGUARD INSURANCE'S claim office.
When contacting the 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 15-20 working days after receipt of completed claim information.
This description of insurance is not a contract and summarizes the Policy provisions, benefits and exclusions. Additional policy provisions and exclusions apply. Any difference between the policy and this description will be settled according to the provision of the Master Policy issued to the School Board.
LAW STATES: Any person who knowingly and with intent to injure, defraud or deceive any insurance company, files a statement of claim or an enrollment form containing any false or incomplete, or misleading information is guilty of a felony of the third degree.
KidGuard is a division of DOXA Programs, LLC, an Indiana limited liability company. All claims activities and services are performed and provided by DOXA Claims, LLC, a Florida limited liability company licensed as an insurance claims administrator in all jurisdictions in which services are provided. For more information regarding DOXA Programs, LLC, or DOXA Claims, LLC please visit our website at www.doxa.com/compliance.
ADDRESS INQUIRIES AND CLAIMS TO ADMINISTRATOR:
KIDGUARD INSURANCE
P. O. BOX 140926
ORLANDO FL. 32814
Phone Number: 407-798-0290