RIVERHEAD
CENTRAL SCHOOL DISTRICT STUDENT ACCIDENT INSURANCE PROGRAM
Children enrolled in the Riverhead Central School District are
covered against accidental injury under a school-time plan of
insurance. A student is covered while participating in a school
sponsored and supervised activity. The plan will reimburse claimants
for eligible expenses that are not payable by their healthcare
plan or any other insurance plan covering the student. The first
expense must be incurred within 30 days from the date of the accident.
Once the first expense is incurred within the 30-day time frame,
additional expenses may be incurred for three years from the date
of the accident.
Insurance Program Instructions
for Filing a Claim
The Riverhead Central School District’s student accident
insurance plan is designed to cover all enrolled students of the
district while they participate in school sponsored and supervised
activities. The plan will reimburse claimants for eligible expenses,
which are not payable by your healthcare plan or any other insurance
plan covering your child. Therefore, prior to filing a claim against
the district’s policy, you must first file the claim with
your own healthcare plan.
Please observe the following instructions when filing a claim
against the district’s policy:
1. Obtain a claim form from the High School Nurse’s Office.
Only one form is needed for each accident, regardless of the number
of expenses incurred for that particular accident.
2. Part I of the claim form should be completed and signed by
a school official. Part I requests a description of how the accident
occurred. Please check to see that a complete description is provided.
For example, “Wrestling” is not acceptable; however,
“Wrestling and twisted left arm during practice” is
acceptable.
3. Part II of the claim form should be completed and signed by
a parent or guardian of the student. Part II includes the section
entitled “Authorization to Release information.”
4. Part III is on the back of the claim form. This section should
be completed by the physician providing the treatment or services.
Itemized bills may be submitted in place of Part III. Itemized
bills provide the dates of service, the procedure codes, the diagnosis
and the charges. “Balance Due” bills are not acceptable
because they do not provide all of the information needed to properly
examine a claim.
5. Submit copies of the Explanation of Benefits (EOB)
statements from your own healthcare plan. The EOB’s will
show how much your healthcare plan paid for the services rendered
and the amount, which is your responsibility. There should be
an EOB for each Itemized Bill you have submitted for reimbursement.6.
Mail the fully completed claim form, each itemized bill and the
corresponding EOB to the following address:
The Allen J. Flood Companies, Inc., Two Madison Avenue
Larchmont, NY 10538
Please remember that the district’s policy
is an accident insurance policy. It does not provide reimbursement
for illnesses or injuries, which did not occur as a result of
an accident. The policy is subject to exclusions and limitations:
A summary of the benefits and limits under the policy are as follows:
Accident Medical Expenses: (Excess) $100,000. (Per injury)
Deductible: $ 50. (Per injury)
Accidental Death & Dismemberment: $ 3,000. (Per injury)
The plan of insurance is subject to exclusions and limitations,
which are outlined in detail in the policy which is held at the
District Office.
HEALTH
CARE SERVICES
A full-time school nurse is available for emergency health care.
Whenever possible, students should secure written permission from
a teacher before visiting the nurse. The school nurse is the only
member of the staff who can excuse a student from school during
the school day because of illness or injury.
The student should report illnesses or injuries, which occur during
the school day, immediately to a teacher or the school nurse.
If an injury occurs while participating in a sport, the student
must report to the coach and also to the school nurse AS SOON
AS POSSIBLE.
There are no medications available in school. Under certain unusual
circumstances, when it is necessary for a student to take internal
medication during school hours, the school nurse or other school
authorities may cooperate with the family physician and the parents.
Permission slips are available in the nurse’s office, they
include:
1. Written request from the physician prescribing the medication
stating:
a. name of medication
b. dosage
c. time to be given
d. side effects to be observed
2. Written request from the parent.
3. The medication must be in the original container and properly
labeled by the pharmacist. A student may carry no medication.
4. It is the student’s responsibility to report to the nurse’s
office for her/his medication.
The school nurse maintains health records for each student and
advises staff members of health conditions, which may adversely
affect student learning or present a danger to the student.
a. Parents or guardian are responsible for advising the nurse,
in writing, of student health concerns each year in order that
health records may be updated.
b. Health conditions may remain the confidential knowledge of
the school nurse if so requested, in writing, by a parent or guardian.
New York Education Law requires medical examinations of students
upon entrance to the school at grades 1,3,7,10 and at any other
time deemed necessary by school authorities. The school physician
provides medical examinations for students before participation
in interscholastic athletic competition. The school physician
is the medical authority who determines the physical capability
of a student prior to participation in the interscholastic sports
program. Before a student may re-enter a Sport Program after an
injury (or illness lasting 5 days or more) he/she must have a
written release from his/her doctor. The school nurse will then
schedule a visit with the school doctor who makes the final decision
as to the student’s eligibility.
