Parents, Students and School Administrators

Hillsborough County Public Schools (Tampa)

Maximum Benefits/Provisions/Exclusions

The Summary of Insurance summarizes the basic insurance policy provisions and benefits for the 2017-2018 school term. This policy will not pay 100% of all incurred medical expenses. Policy limits and exclusions apply. Policy benefits are payable, subject to the limits specified below, for accidental bodily injury resulting from a covered accident. The company will pay the reasonable cost of covered eligible medical charges not to exceed the maximum benefits listed in the policy that is summarized in this website.

If an eligible student is injured accidentally during a District Sanctioned/FHSAA activity the policy will pay up to a maximum of $25,000.00 in the aggregate for a covered injury.  The policy is subject to the following policy provisions, terms and benefit limits:

POLICY DEFINITIONS, TERMS, BENEFIT LIMITS AND EXCLUSIONS  Purchase Online Now!!!

 The policy requires treatment within thirty (30) days after the date of injury by a licensed physician. The policy will provide coverage for up to one year (365 days) after the original date of an accidental injury.  

“Covered Accident” means bodily injury of the insured that results directly and independently of all other causes from a covered accident occurring while the policy is in force. Self-inflicted injuries caused by prolonged over exertion, stress or strain, or disease process or aggravation of an existing condition is expressly excluded from coverage under the accident policy. “Covered Charges” means reasonable charges which are not in excess of usual and customary charges; not in excess of the maximum benefit amount payable for services specified below; services and supplies which are not excluded from coverage; and services and supplies which are a medical necessity for treatment of the covered accident. “Pre-Existing Condition” means any physical condition for which the existence of symptoms would cause a normally prudent person to seek medical care or advice. Physical condition includes any complication or residual of a prior illness, condition or disease the person was advised or treated for in the six (6) months before the effective date of the Insured’s coverage under the policy. “Hospital” means a licensed or properly accredited general hospital which is open at all times and operated primarily and continuously for the treatment of and surgery for sick and injured persons as inpatients under the supervision of one (1) or more legally qualified physicians available at all times with continuous, twenty-four (24) hour nursing services by Registered Nurses on duty or call. “Hospital” does not mean a facility that is primarily a clinic, nursing, rest or convalescent home, or an institution specializing in or primarily treating mental or nervous disorders, alcoholics or drug addicts. "Accident Coverage" applies while a covered person is in attendance at a school-scheduled, school-sanctioned interscholastic sports practice or competition at or away from school premises, during the hours and on the days that school is in session; participating in activities, except as a spectator, which are exclusively school-sponsored, school-funded, school-supervised and scheduled by the school on or away from school premises, during or after school hours; Traveling directly to and from the school and a covered interscholastic sports competition site in a school designated bus or van driven by a licensed adult driver. Additional policy terms aNd provisions apply which are stated in the Master Blanket Accident Insurance Policy issued to the school district and on file for your review. “Effects of Other Coverage” means the insurance coverage provided under the policy shall be “EXCESS” to any other collectible insurance or plans, including but not limited to auto P.I.P. and auto medical payments, HMOs or PPOs, subject to limits stated in the policy. Third party subrogation rights are reserved. Total payments by all insurance plans, including HMOs or PPOs, shall never exceed the total medical expenses incurred."JROTC and BAND Coverage" The policy provides basic insurance for SDHC JROTC and Band Unit registered distrcit students during JROTC or band activities that are exclusively scheduled, organized and sponsored by the SDHC and supervised by a JROTC designated instructor during the regular school term. If a JROTC or band registered student is injured during an activity that is fully or partially organized, scheduled and/or controlled by a third party other than the School District Hillsborough County, policy coverage is not in effect for that student during that activity. Injuries that occur during the regular school day classes or activities such as physical education class, shop class, lunch time or walking to or from classes are not covered by the policy.

Conditioning is defined as "Weight training is the use of free weights and stationary apparatus. Cardiovascular conditioning is distance and interval training. Plyometrics is the use of pre-set conditioning programs. Conditioning IS NOT teaching sport specific skills and drills, and DOES NOT involve the use of sport specific equipment (i.e. starting blocks, hurdles, rebounders, ball machines, bats, balls, rackets, etc.) and is not covered under this policy. 

Where to Seek Treatment and Claim Filing Information Click Here

INSURANCE MAXIMUM BENEFITS   

√ Non-Surgical Doctor Visits/Consultations: Pays up to $45 for the first day of care and up to $30 for each day of follow-up

√ Emergency Room Charges: Pays up to $350 (applies to injuries requiring emergency treatment within 72 hours of an accident) 

√ Surgery Fees: Pays benefits as listed in the Florida Workers Compensation Fee Schedule (Part A 2007 edition)

√ Out-Patient or ‘Same-Day Surgery’ Hospital: Pays up to $4000 for the hospital/facility charge in the aggregate when major surgery requiring general anesthesia is performed

√ Anesthesiologist Fee: Benefit based on the 2007 Florida Workers Comp Fee Schedule. CRNA or Observation of Administration: Not covered

√ Out-Patient X-rays, CAT Scans, MRI’s (including reading fees) X-Rays; maximum $150 for fractures,  non-fracture $75; $300 all CAT Scans; $200 EEG/EKG’s; MRI’s up to $600 in the aggregate; Injections: Not Covered.

√ In-Patient Hospital Expenses: Pays up to $750 per day for semi-private room and all other in-hospital charges (except personal convenience items, T.V., phone, etc.).

√ Out-Patient Therapy / Manipulations / Adjustments: Pays $30 per day for up to 10 days of treatment

√ Intensive Care: Pays up to $1000 per day of confinement in Intensive Care

√ Accidental Injury Dental Benefit: Pays up to $300 per injured tooth (orthodontic procedures & treatment of previously damaged or decayed teeth not covered)

√ Licensed Ambulance Service: Pays up to $500 for initial trip to the closest medical facility (air or ground)

√ Motor Vehicle Related Injuries: Maximum Benefit for motor-vehicle related injuries is $2,000 in the aggregate

EXCLUSIONS - WHAT THE POLICY DOES NOT COVER          Purchase Online Now!!!

1. Any organized sports leagues or camps, club sports, martial arts or boxing schools. Summer practices or open gyms. Non-district sports or sports that are not sanctioned by the FHSAA.

2. Damage to other than whole, sound, vital and natural teeth or to existing dental bridges, crowns, restorations or braces; orthodontic procedure and services. Treatment for injury or fracture of tooth caused either by decay, infection or the breakdown of a dental restoration.

3. Boils, athlete’s foot, impetigo or similar skin infection, rashes, poisonous vegetation reactions, warts, blisters, calluses, cramps, muscle spasms, allergies or allergic reactions, ingrown nails, appendicitis, hernia of any kind, however caused; infections occurring other than as a result of such injury; detached retina; or psychiatric care. 

4. Any form of illness, sickness or disease including but not limited to the following: Perthes’ Disease, Osgood-Schlatter’s Disease, Osteomyelitis, Osteochondritis, Osteogenesis Imperfecta, Slipped Capital Femoral Epiphysis, Pathological Stress Fractures, Thrombophlebitis, Hysterical Reactions, or similar conditions.

5. Any form of fighting or brawling or criminal or felonious assault or the Insured being engaged in an illegal occupation.

6. Services or treatment rendered as a part of the member school service by a hospital, physician, or person employed or retained by the member, or by a person related to the Insured by blood or marriage.

7. Riding in or on, being struck by, being towed by, boarding or alighting from, or operating any motorized or engine-driven vehicle; except that eligible medical expenses not collectible from other valid coverage will be payable up to $2,000.00.

8. War or any act of war (raids by air, land or sea shall be deemed act of  war), civil disobedience, plots or insurrection.

9. The use of or while under the influence of drugs unless administered as prescribed by a physician.

10. The existence or aggravation of physical or mental infirmity, condition or disease, whether infectious, congenital, secondary or acquired in origin. Conditions or the aggravation of conditions that originated prior to the Insured’s Effective Date.

11. Expense resulting from participating in activities for which benefits would be payable, in the absence of this insurance, under any high school or association- sponsored catastrophe sports accident policy or trust fund is expressly excluded from coverage.

12. Prescription drugs, injections, miscellaneous supplies, medications, except those administered while hospital-confined or when treated in the ER.

13. Any expense for which a benefit is not listed. Intentionally self-inflicted injury. 

14. Any Injury that is not a direct result of a Hillsborough County school approved interscholastic sports practice or game during the regular school term.

A certificate of insurance summarizes the provisions and benefits of the policy # 09-0132-2018 (filed form # LRS-8985-0100-FL). Any difference between the policy and the certificate will be settled according to the provisions of the policy. Only full time students enrolled in the Hillsborough County School District are eligible to receive benefits under this policy.

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