Middle School Athletic Participation Forms
Athletic Insurance for Middle School Parents
Wake County Schools has purchased Accident Insurance plan to provide coverage for your child while participating in school-sponsored, supervised sports at the middle school and high school level.
The insurance is underwritten by QBE Insurance Corporation – rated "A Excellent" by A.M. Best – and serviced by Wake County-based The Young Group.
This is a Limited Benefit Secondary Policy. That means the policy has maximum limits on benefit categories, and it pays only after any primary insurance pays on an accidental injury. Review the attached list of Accident Only Insurance Benefits.
This plan may not pay 100% of the medical bills for an athletic injury or even the balance after your primary insurance pays. Please note the benefit limits within the policy.
You may wish to purchase another plan through your school. School Time coverage, 24 Hour coverage or Tackle Football accident insurance are offered. Visit www.k12studentinsurance.com or obtain an application by emailing us at: email@example.com or calling us at 919-846-9798.
How to File a Claim for an Athletic Injury
- An injured student should seek treatment from a licensed medical provider within 60 days of an injury.
- Obtain an accident claim form from your school or district website, or download a claim form from our claims administrator's website: www.k12studentinsurance.com. Print off the claim form and the instruction page. The claim cannot be processed without a fully completed claim form.
- Follow the instructions included with the claim form. Fill in all the information on the form and sign it. If a school official witnessed the accident, they should sign the form as well.
- Send the claim form and itemized bills within 90 days of the date of an accident to the claims address located at the top of the claim form.
- Send Itemized Bills (Forms UB-04, UB-92 or CMS 1500) that have the CPT or Diagnostic Codes from each medical provider included. CPT or Diagnostic codes are required for processing a claim.
- If you have other applicable medical insurance, you must also file with that company. Your Primary Insurance will send you an Explanation of Benefits (EOB). The EOB needs to be submitted to the Athletic Insurance provider at the insurance claims address at the top of the claims form. Be sure to KEEP A COPY of all claims paperwork for your records.
- Filing an accident claim after an injury is YOUR responsibility. Do not assume that your medical provider or a school official will file the accident claim form for you.
Questions or concerns? Email firstname.lastname@example.org or call 919-846-9798.