Our school provides accident coverage for all athletes. Outlined below is important information regarding this coverage. It is intended as a brief description for reference only, and is not the policy.
Only ACCIDENTS that occur in school-sponsored and supervised interscholastic sports are covered.
DEFINITION OF ACCIDENT: An unexpected, sudden and definable event which is the direct cause of a bodily injury, independent of any illness, prior injury or congenital predisposition.
Conditions that result from participating in an activity do not necessarily constitute accidents. For example, illnesses, diseases, degeneration, conditions caused by continued stress to a particular area of the body, and existing conditions aggravated by an accident are not covered.
A. This plan of insurance is EXCESS ONLY. It will not duplicate benefits paid or payable by any other insurance or plan including HMO's or PPO's.
B. In the event that an Insured Person is eligible for benefits under this Rider in excess of other medical expense coverage that is primary under a health maintenance organization, preferred provider organization, or similar health service program, a penalty will apply if the Insured Person does not use the facilities or services of the health maintenance organization, preferred provider organization or similar health service program. In such case, the benefits otherwise payable under this Rider will be reduced by 50%. This reduction shall not apply to an Insured Person in connection with any Treatment for which the health maintenance organization, preferred provider organization or similar health service program provides coverage as if the Insured Person used the facilities or services of the health maintenance organization, preferred provider organization or similar health service program. This limitation is not applicable to out-of-network Treatment provided in an emergency situation.
C. Medical treatment for a covered accident must begin within 90 days of that accident. Only expenses incurred within 52 weeks are considered. Benefits are determined on the basis of REASONABLE AND CUSTOMARY for the geographic location where services are performed.
D. Specific exclusions of the policy include, but are not limited to, sickness, disease, or hernia in any form; non-prescription drugs; fighting; and orthotics not prescribed exclusively for rehabilitation (e.g., playing brace, mouth guard).
E. Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
HOW TO FILE YOUR ACCIDENT CLAIM FORM (contact the school athletic office for claim form at 869-4100 or tglover@pentwater.k12.mi.us):
1. Please complete and submit claim form to A-G Specialty Insurance with itemized medical bills AND primary insurance explanation of benefits.
2. Send all claim forms and documents using our secure upload portal: A-G Administrators, Inc. Secure Upload.
3. For general questions, however, please contact A-G Specialty Insurance customer service: customerservice@agadm.com.
A-G Specialty Insurance Claims
P.O. Box 21013, Eagan, MN 55121
Ph: (610) 933-0800, Fax: (610) 933-4122