Zeeland Public Schools Secondary Insurance Policy

Zeeland Public Schools carries an accident insurance policy for injuries incurred as a result of participating in a school-sponsored and supervised activity (e.g., interscholastic sports).

Injuries covered under the policy are those that have a sudden and definable mechanism directly resulting from participating in a school-sponsored activity.

Conditions exempt from policy coverage include:

• Illnesses or injuries resulting from preexisting illnesses (e.g., mononucleosis)
• Injuries resulting from preexisting or congenital conditions
• Chronic or overuse injuries

Key points to know regarding injury claims:

• Injuries resulting from athletic participation must be reported to the school athletic trainer within 20 days.
• Medical treatment for injury must begin within 60 days (this does not include treatment provided by the school athletic trainer).
• Medical bills must be submitted to the insurer (First Agency, Inc.) within 90 day after date of treatment.
• Expenses incurred within 1 year of the injury date are considered coverable.
• A $500 deductible is applied to each claim regardless of other valid insurance or plan payments.
• The balance of covered expenses are processed on a 60% payment basis.
• Maximum limits are established for specific services under the policy. Additional information on these limits can be found via the following link: . Further questions can be direct towards Mary Miilu in the District Administration Office.

It is the responsibility of the parent/guardian to request a claim form from the school athletic trainer when an injury occurs and the balance of the claim exceeds the above mentioned deductible. A parent/guardian is also responsible for completing and submitting the claim form along with itemized bills to the insurer as directed. Claim forms and bills should NOT be submitted to the school.

Special considerations:

• Concussions
• Catastrophic Injury
• Medicaid

MHSAA Concussion and Catastrophic Injury Policy

The Michigan High School Athletic Association (MHSAA) also carries injury insurance policies to help offset costs associated with concussions or catastrophic injuries sustained while participating in in-season athletics for grades 6-12.

Concussion Policy:

100% of all medical costs (Limit: $25,000) resulting from a concussion sustained during participation in a MHSAA in-season sport are covered under the MHSAA policy. 100% coverage is a result of personal health, school, and MHSAA insurance policy pay outs.

Sports covered:

• Baseball
• Basketball (Boys and Girls)
• Bowling (Boys and Girls)
• Cross Country (Boys and Girls)
• Football
• Golf (Boys and Girls)
• Competitive Cheer
• Hockey
• Lacrosse (Boys and Girls)
• Sideline Cheer
• Soccer (Boys and Girls)
• Softball
• Skiing (Boys and Girls)
• Swimming and Diving (Boys and Girls)
• Tennis (Boys and Girls)
• Track & Field (Boys and Girls)
• Volleyball
• Wrestling

Excluded sports:

• Water Polo
• Rugby

It is the responsibility of the parent/guardian to request a claim form from the school athletic trainer when a concussion occurs. A parent/guardian is also responsible for completing and submitting the claim form along with itemized bills to the insurer as directed. Claim forms and bills should NOT be submitted to the school.

Catastrophic Injury Policy:

The MHSAA catastrophic injury policy covers up to $500,000 of medical expenses left unpaid by insurers after a deductible of $25,000 per claim in paid medical expenses has been met. Injured student-athletes must fall under the MHSAA rules of participation to be covered.

It is the responsibility of the parent/guardian to request a claim form from the school athletic trainer when a catastrophic injury occurs. A parent/guardian is also responsible for completing and submitting the claim form along with itemized bills to the insurer as directed. Claim forms and bills should NOT be submitted to the school.

Student-Athletes Covered by Medicaid

For cases in which the student-athlete is covered by Medicaid, the Zeeland and MHSAA injury insurance policies become primary to the student's Medicaid policy. In these cases, a parent/guardian must notify the school athletic trainer as soon as reasonably able that Medicaid is involved. A claim will need to be opened as early in the process as possible to avoid any billing or refusal of service obstacles.