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student accident insurance

Offer of Student Accident Insurance

Lebanon City School District has made arrangements with Student Protective Agency to provide student accident insurance for those wishing to purchase coverage this year. Please note the coverage shown on the application. Covered losses less than $250 are paid without regard to other insurance.

Senior High football coverage requires an additional premium. All other school supervised sports are covered under the plan. On claims over $250 this is an excess coverage policy for which benefits are payable only for that part of the loss not covered by other collectible insurance. If a person has no other insurance, the Company will pay the covered medical expenses incurred within one year, up to the specified limits of the policy.

Click here to download the Student Accident Insurance application.

Complete the application and check the boxes for coverage desired. Tear off and keep the rest of the application, as it shows not only the coverage but the exclusions and limitations of the policy.

Mail the applications directly to Student Protective Agency, 300 Coshocton Avenue, Mount
Vernon, OH 43050 along with a money order or check payable to Student Protective
Agency. The school will be notified as to who takes out coverage. 

Click here to download a claim form.

In case of an accident the student or parent should immediately go to the building principal

who will sign and provide the claim form if only school time coverage is taken out. 24 hour
coverage needs no signature. The policy number shall be provided by the school for the
claim or you can call 800-278-2544. You may give that policy number to the doctor or
hospital but the bills should be sent to the parent or guardian who attach them to the claim
form. Once completed, mail to the claims office at Guarantee Trust Life Insurance, PO Box
1148, Glenview, IL 60025. If you have any further questions regarding a claim, please call
1-800-622-1993. It is the responsibility of the parent or guardian to file the claim.