INFORMATION FOR PARENTS

Your child has been injured at school. What to do next:

When your child is injured in a school sponsored activity, you have 90 days from the date of injury to seek medical treatment. Obtain a claim form from the district and submit itemized bills to Pupil Benefits Plan in a timely manner.

This plan is a secondary, non-duplicating policy. If you have medical or dental insurance that covers your child, charges must be submitted to your primary insurance first. Submit the explanation of benefits or rejection from your carrier along with itemized bills to Pupil Benefits Plan. Expenses resulting from injuries to sound and natural teeth should be submitted to your medical insurance even though dental coverage is not available. When an accidental dental injury occurs, your medical coverage will consider charges first.

Please answer all questions on the claim form. Blank spaces are not acceptable. Please write legibly and remember, when submitting additional bills at a later date, include the school district, child’s name, and the date of injury.

Other important information:

Unfortunately, there are some exclusions and limitations under this plan. There are no benefits provided for cosmetic surgery. Please note cosmetic surgery does not include reconstructive surgery when such service is incidental to or follows surgery resulting from trauma of the involved part.

There are no benefits provided for intentionally self-inflicted injuries, or injuries sustained during participation in a felony or riot. This policy does not provide coverage for sickness, pre-existing conditions, disease or orthodontia. Pupil Benefits Plan, Inc. provides student accident insurance only.

Pupil Benefits Plan’s student accident insurance assures prompt medical attention and assists with expenses which revert to the parent, since no school may be held legally responsible for them. If medical bills are in excess of our benefit payments, the difference is the responsibility of the parents. If you need special assistance, please contact us, and we will be happy to help you in whatever way we can.

FREQUENTLY ASKED QUESTIONS

What schools are eligible?

All New York State schools (pre-K to 12) can participate. We also insure private and parochial schools as well.

School chairs

What is typically covered?

Our plans offer a full range of coverage for in-school activities such as classroom incidents, activities on school grounds, gym class, sports, cheerleading, recess, after school activities.

Off-premises activities are also covered, including travel to and from school sponsored events in school vehicles, away sports games, field trips, cultural activities, and more.

Why choose Pupil Benefits?

Our customers receive personalized 1-on-1 service and rates that are a better value than competing plans. Pupil Benefits Plan, Inc. operates as a not for profit service governed by the member schools.

Schools across New York know us as a market leader in affordable, quality accident insurance solutions for students. Unlike most of our competitors, we focus solely on the unique needs of New York State students, from pre-K to grade 12.

What is the claims process?

We’ve streamlined our claims process to be as fast and efficient as possible. When your child is injured in a school sponsored activity, you have 90 days from the date of injury to seek medical treatment. Obtain a claim form from the district and submit itemized bills to Pupil Benefits Plan in a timely manner.

This plan is a secondary, non-duplicating policy. If you have medical or dental insurance that covers your child, charges must be submitted to your primary insurance first. Submit the explanation of benefits or rejection from your carrier along with itemized bills to Pupil Benefits Plan.

What is our company history?

We have been in business for more than 8 decades, and currently insure 400 school districts statewide with a total enrollment of approximately 700,000 students. The first athletes were covered in the fall of 1932 for $.40 cents per student. Sixty schools bought coverage for 1255 students being offered by the New York State Public High School Athletic Association.

You can have confidence in knowing we are a solid, stable and reliable company that has been insuring New York students since 1932. How long ago was that? That was the same year Franklin D. Roosevelt defeated Herbert Hoover to become the 32nd U.S. President!

Is this a responsive company?

Pupil Benefits Plan prides itself on being an extremely responsive, customer service oriented company. Our goal is to be a friendly partner that can get you the answers you need and the service you deserve.

Our team consists of 10 dedicated employees — large enough to know the ins and outs of the industry, and small enough to provide you with personalized service. Specialization has it’s benefits: we only offer student accident insurance to New York schools. We’re highly knowledgeable of changing coverage needs, and we will work closely with you to find just the right plan for your district and your budget.

Can you customize a plan for us?

Yes, we have many customizable options that can be tailored to your needs.

We offer 4 primary plans:

Coverage R
Coverage R25 and Coverage R25D offer blanket coverage
Coverage P offers blanket or individual coverage and 3 additional options.

And we can further customize your coverage as needed.

Top 10 School Injuries

  1. Knee and Leg Injuries
    Ankle sprain, groin pull, ACL tear, hamstring strain, ligament tears, pulled muscles, shin splints, Patellofemoral syndrome
  2. Ankle and Foot Injuries
  3. Finger Injuries
    Sprains, dislocations, fractures
  4. Hand & Wrist Injuries
  5. Back Injuries
    Lower back injuries from weight training, impact injuries, twisting or repetitive injuries, spinal
  6. Cuts and Lacerations
  7. Concussions and Other Head Injuries
  8. Shoulder and Elbow Injuries
    Shoulder dislocations, rotator cuff tears, impingement syndrome, biceps injuries, labral tears, thrower’s shoulder, rugby shoulder, swimmers shoulder, tennis elbow (epicondylitis)
  9. Burns
  10. Eye Injuries

Top 15 Injury-Prone Sports

  1. Basketball
  2. Football
  3. Soccer
  4. Baseball
  5. Gymnastics, Cheerleading, Dance
  6. Wrestling, Boxing, Martial Arts
  7. Softball
  8. Volleyball
  9. Ice Hockey
  10. Snowboarding
  11. Weightlifting
  12. Track and Field
  13. Lacrosse
  14. Horseback Riding
  15. Ice Skating

HEALTH & WELLNESS LINKS