Student Accident Insurance
HEWLETT-WOODMERE UNION FREE SCHOOL DISTRICT
STUDENT ACCIDENT INSURANCE PLAN
Although there is no requirement that School Districts provide any insurance coverage for students, the District has elected to provide Student Accident Insurance for many years.
This is a secondary or excess insurance plan, which means that benefits are payable for covered accidents only after a claim has been made through the family’s primary health insurance program and there is a remainder left unpaid. The secondary accident insurance plan then pays 100% of what is known as ‘usual and customary’ charges for covered expenses. The schedule for ‘usual and customary’ charges varies by region. Some medical costs may be billed at rates higher than ‘usual and customary’. In that case, this accident insurance plan will cover only up to the applicable scheduled ‘usual and customary’ amount for covered expenses.
Student Accident Claims
The following will assist parents/guardians with submitting a Student Accident claim. The claim should be submitted within 90 days of the date of the accident, even if all the needed documentation is not yet available. If the claim form is not submitted within 90 days of the date of the accident, the claim could be denied for late filing. To expedite claim processing, it is important that all required information is provided — see details below. Please include the school name and student
accident policy number on any documentation submitted for the claim.
- Claim Form — This form can be obtained from the school. The school can print out the form for the parents/guardians. The school can also email the form to the parent/guardian, as most of the information can be typed into Claim form, which is a fillable PDF.
- SCHOOL’S REPORT OF ACCIDENT — All information related to the student,
parents/guardians, and accident/injury must be included. This section must be signed by the parent/guardian and a school official such as a coach, athletic trainer or nurse.
PHYSICIAN’S OR DENTIST’S REPORT — Doctor’s office must complete this section with the signature of the doctor as well. If non-tooth related injury, questions 9 & 10 do not need to be answered.
HOSPITAL REPORT - Parent/guardian needs to complete this section including their primary health insurance information, employer and signature. If the parents/guardians do not have medical/dental insurance, this must be noted on the form. To avoid delays in claim processing, the “other insurance” section of the claim form must be completed in full.
2 Itemized Bills (include school name and policy number) — This can be obtained from the treating physician’s or dentist’s office. It will include the name and address of the provider of service, date of service, type of service and the related charges. Even though account statements or “balance due” statements are helpful, they do not contain all the information needed to process the charges. To avoid delays in claim processing, an Itemized Bill should be provided.
3.Explanation of Benefits (EOB) (include school name and policy number) - If the student has health insurance, all medical bills must first be submitted to their primary health insurance carrier. A copy of the “Explanation of Benefits” form provided by the primary carrier, must be submitted with the claim. If the student does not have primary medical insurance, the need for an “Explanation of Benefits” will not be applicable to the claim, and only the Claim Form, along with the Itemized Bills, should be submitted.
- Once all information is completed on the Claim form, and all the necessary documents have been gathered, the claim can be submitted via mail, email or fax to the third-party administrator, A-G Administrators, Inc., by the parents/guardians.
A-G Administrators, Inc.
P.O. Box 979
Valley Forge, PA. 19482
Include school name, policy number and student name in the Subject.
Include school name, policy number and student name on the cover page of the Fax.
- Claims Status - To find out the status of a claim, parents/guardians can contact A-G
Administrators, Inc. as follows:
Phone: (610) 933-0800
Toll free: (800) 634-8628
The parent/guardian can also visit A-G’s website and complete a form electronically. A member of A-G’s team will then be in touch with the parent/guardian.
The link to the form is: https://agadministrators.com/services/check-a-claim-status/