Green Hope has purchased a student athletic Accident Insurance plan for 2014-2015 to provide benefits for all students in grades 9-12 who participate in school sponsored and supervised interscholastic athletics. This athletic plan in underwritten by Monumental Life Insurance Company, an "A+ Superior" rated company. The plan is serviced by The Young Group with their main office located here in Wake County.
This Athletic Accident Insurance plan is a Limited Benefit Secondary Policy. This means it has maximum limits on benefit categories and it pays after any Primary Insurance pays. This plan may not pay 100% of the medical bills for an athletic injury or even the balance after your primary insurance pays. Please note the benefit limits within the policy.
Additional Coverage: For the best insurance coverage we recommend you purchase either the school time or 24 hour Student Accident Insurance offered through Green Hope. This inexpensive coverage will help increase the benefits you receive should your student athlete be injured during an athletic event. You may purchase the student insurance online at www.BollingerSchools.com or email Young Group at
for an electronic copy of the application to be emailed to you.
There is a separate coverage for football athletes. When you sign up you must request football if your son plays football. The 24 hour and school time only will not cover football injuries.
How to File a Claim for an Athletic Injury:
1. The student should seek treatment from a licensed medical provider within 60 days of an injury.
2. Obtain an accident claim form by downloading from the insurance company website: www.BollingerSchools.com. Print out the claim form and the instruction page. The claim cannot be processed without a full completed claim form.
3. Follow the instructions included with the claim form. Fill in all the information on the claim form and SIGN IT. A school official must also sign the claim form. Send the claim form and itemized bills to the claims address that is on the top of the form. Send claim form to the claims office within 90 days of the injury.
4. Send Itemized Bills (Form UB-04, UB-92 or CMS 1500) with CPT/Diagnostic Codes from each provider. CPT codes are required for processing a claim.
5. If you have other applicable insurance you must also file with that company. When you receive your Explanations of Benefits (EOB's) from your Primary Insurance, forward these to the Bollinger claims office. Be sure to Keep A Copy of all paperwork for your records.
Filing a claim after an injury is your responsibility. Do not assume that the provider or school official will do this for you. Under HIPAA privacy laws, the school or agent cannot obtain information from an insurance company or provider without you written permission.
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