The Most Frequently Asked Questions about Student Accident Insurance and Pupil Benefits Plan, Inc.

1. Are all NYS School Districts required to carry student accident insurance?

No. It is not mandated by NYS law. It is an elective. School districts choose to purchase student accident insurance to help parents with out of pocket expenses and to improve districts’ relationships with their communities.

2. How does student accident insurance work?

Student accident insurance assures prompt medical attention and assists with expenses which revert to the parent. If medical bills are in excess of the benefit payments, the difference is the responsibility of the parents. When a child is injured while participating in a school board approved, employee supervised activity, benefits will be allocated according to the policy chosen by the district. Student accident insurance covers interscholastic sports, work study, noon hour, field trips and altercations, pre-k through 12th grade. Parents must submit bills to their primary insurance first. Then they send in a claim form, itemized bills and a copy of the explanation of benefits from the primary insurance to coordinate benefits with us. Student Accident Insurance is primary only to Federal funded insurance programs.

3. What impact does the student’s family insurance have on a claim?

Student Accident Insurance is a secondary, non-duplicating policy that coordinates benefits with the family’s primary insurance. It reimburses co-pays and coinsurance according to the policy in place. Student Accident Insurance is
primary to any Federal funded policies (Medicaid, Child Health Plus, etc.) An explanation of benefits from the primary insurance must be submitted to student accident to determine out of pocket expenses and reimbursements. There is no immediate effect because health plans are community rated.