Student Accident Insurance Information | Concussion Management
Student Accident Insurance Information
New York State does not mandate its schools to provide Student Accident Insurance. However, effective January 1, 2022 the New Hartford Central School District does offer a SUPPLEMENTAL Student Accident Insurance Policy through Wellfleet Special Risk Company.
Visit the Wellfleet Special Risk Company website.
This insurance policy is set up SOLELY as additional coverage to a parent(s)/guardian(s) insurance coverage and pays claims based on a Schedule of Benefits. If the parent(s)/guardian(s) does not have any health insurance coverage, the school will only cover the allotted amount set by the Schedule.
Therefore, Student Accident Claims will NOT be covered at 100%. After the school’s insurance processes the claim, if there is a remaining balance to be paid, the parent(s)/guardian(s) are responsible for payment.
Claim Filing Instructions
The school’s policy is an accidental medical plan and is intended to cover accident related expenses. This is not a liability insurance policy. In order to claim expenses, the following steps must be followed:
Claim Form must be fully completed by School Official and by Parent/Guardian and submitted within 90 days from the date of accident. Claim Forms not fully completed can cause Claim Representative to return Claim Form and cause processing delays.
Submitting the appropriate documentation is essential for timely adjudication of your claim expenses. If you are receiving treatment, please request an itemized bill (CMS 1500 form from a physician or a UB04 from hospital is preferred). All itemized bill(s) must include:
- Provider’s name and address;
- Provider’s Tax ID Number;
- Diagnosis Code (ICD- IO);
- Date(s) of service;
- Types of service or procedure code;
- Provider charges for each procedure.
Please notify all healthcare providers that have or will be treating your child and provide them with insurance information about the school’s accident plan. Please ask them to bill at the following claims mailing address:
Wellfleet Special Risk
P.O. Box 15369
Springfield MA O1115-5399
(877) 657-5039
specialriskcs@welIfleetinsurance.com
Fax: (413) 733-4612
Also note that if you have other insurance, you must first submit the expenses to your Primary insurance. The primary insurance Explanation of Payment must be included with the itemized bill. If you do not have Primary insurance, then only the itemized bills are needed.
Please feel free to Wellfleet Special Risk at (877) 657-5039 between the hours of 8:30 am and 5:00 pm ET with any questions.
Concussion Management
The Board of Education of the New Hartford Central School District
recognizes the importance of raising awareness about concussion throughout the school community and to educate students, parents and others about how to prevent, recognize and respond to concussions.
Return to School and/or Activity
A. The student shall resume athletic activity only after he/she has been symptom free for not less than twenty-four hours, and has been evaluated by and received written and signed authorization from a licensed physician.
B. The school District medical director will make the final decision on return to activity including physical education class and interscholastic athletic activity.
C. Authorization shall be kept on file in the student’s permanent health record.
D. The District shall follow any directives issued by the student’s treating physician with regard to limitations and restrictions on school attendance and activities for the student.
E. Any student who continues to have signs or symptoms upon return to school and/or activity must be removed from school sponsored class, extracurricular activity, or interscholastic athletic activity and re-evaluated by a licensed physician.