The school has purchased insurance coverage to protect all interscholastic athletes, band members, flag carriers, cheerleaders, and all students in the district while in scheduled physical education classes, intramural sports, and non-sport related extracurricular activities.
The insurance plan is Excess coverage, i.e., you must submit all bills to your own insurance first, and the school policy will pick up the unpaid balances, up to the limits of the policy.
Although this coverage is very broad, there are restrictions, limitations, and exclusions in this policy. In some situations, medical bills may not be covered in full. Parents should understand that medical expenses are their own responsibility, not the schools. Some of the important benefits and limitations of the plan are:
1.Maximum Medical Benefit is $25,000, along with a $5,000,000 catastrophic plan with a $25,000 deductible through AIG.
2.Treatment must commence within 90 days of the date of injury, or there is no coverage.
3.Physical Therapy Treatment (including chiropractic) has a limit of $500. (A letter of Medical Necessity is required.)
4.Benefits are payable for up to 2 years from the date of injury on the base plan.
All injuries should be immediately reported to a coach, nurse, or faculty advisor. Claim forms will be provided by the school, but it is the parents’ responsibility to:
1.Submit the claim form with Part 1-B filled out completely (any omissions will delay the processing of the claim).
2.Submit all itemized bills (monthly statements will not do).
3.Submit the statement (EOB-Explanation of Benefits) received from your own insurance company showing amounts paid and balances due, or, a letter of denial stating the claim is not covered (one of these is required for any payments to be made).
If you have no other medical insurance, you will receive a letter from the company requesting employer information. Fill this out and return it to the company immediately and the claim will be processed. Failure to return this letter will result in a delay or denial of the claim.
It is your responsibility, and to your benefit, to submit the necessary papers as soon as possible, as the claim cannot be paid until all papers are submitted. Only one claim form per accident is required.
All claim forms, bills, and the letters from other insurance companies are to be forwarded to, and questions regarding the coverage answered by:
BMI Benefits, LLC
P.O. BOX 511, 76 MAIN STREET,
MATAWAN, NJ 07747
NOTE: The School Athletic Trainer will keep a log to record dates when each step of the process occurs.