NPSD Student/Athletic Accident Insurance

Student/Athletic Accident Insurance

Your school has purchased accident coverage to protect all students involved in PE classes, athletics, and extra-curricular activities against accidental injury or death occurring while the policy is in force.  Coverage is provided by Clyde Paul Agency via A-G Sports Insurance Specialists.  Usual & Customary benefits are provided on a full excess basis. 

If your primary medical coverage is a PPO or similar plan, you must follow their rules for obtaining benefits.  If your primary medical coverage is not utilized, benefits otherwise payable under this policy may be denied.

Following is an example of how a Full Excess claim is handled.  

A student incurs medical expenses of $100.00 for treatment of an injury sustained during a school sponsored event.  The student’s parents have private group insurance.  The medical bills must first be submitted to the parent’s insurance, being the primary carrier.  The primary insurance pays $65.00 of the bill and sends an explanation of benefits (EOB) to the parents.  The parents then submit a copy of the original bills along with a claim form and the primary insurance EOB to A-G Administrators, who may then pay up to $35.00 (the amount of covered expense that is “in excess of medical expense paid by another plan providing medical benefits.”)

 Claims Instructions

In case of an accident, notify the school immediately. You may obtain a claim form from the school or you may download one from https://www.bobmccloskey.com.

FORMS:

• ACCIDENT INSURANCE FORM

• ACCIDENT INSURANCE FORM (SPANISH VERSION)

   The claim form must be submitted within 90 days from the date of accident.

•   Treatment must commence within 90 days from the date of injury.

•   Attach itemized bills (CMS-1500 form for physicians & UB-04 forms for Hospitals) showing treatment, date of treatment, and charges.  Balance due bills will not be accepted.

•   Attach copies of the corresponding primary insurance’s explanation of benefits (EOB). 

•   If there is no primary insurance through the parent or guardian’s employer, a statement of verification from the employer on their letterhead must also be submitted.

•   Itemized bills and explanation of benefits must be submitted within 90 days from the date of treatment.

•   Send all claim forms and documents using A-G Administrators' secure upload portal: upload.agadministrators.com. Alternatively, submit documents to claims@agadm.com.

•   Please note the name of the school district on all bills and correspondence.  NO ADDITIONAL CLAIM FORM IS NECESSARY.

•   It is the parent’s responsibility to complete the claim form and submit the claim form to A-G Administrators.

•   Do NOT leave the original claim form at the hospital or physician’s office.

•   For questions, however, please contact A-G Administrators: customerservice@agadm.com.

•   If you have any questions, you may call the Clyde Paul Agency at 201-991-7598.