| Oregon
Migrant Education Service Center
| Student Accident Insurance Program |
What is the
Migrant Student Accident Insurance?
The Migrant Education Program
provides insurance to help with the cost of treatment for injuries caused by
accidents. It covers accidents that occur 24 hours a day, all year. The
insurance covers part, but not all, of the cost. The insurance does not
cover treatment for illness or previously existing conditions.
If a migrant family
has other insurance, the Migrant Student Accident Insurance covers part of
the cost not covered by the other insurance plan. Parents should send a
claim form to their other insurance company first, and then to the Migrant
Education Program.
top
Who
is eligible for the Migrant Student Accident Insurance?
To be covered, children must be
eligible for the Migrant Education Program in Oregon and currently enrolled
on Oregon Migrant Student Information System (OMSIS). The insurance covers
children between the ages of 3 and 21 years of age. The insurance is for
Oregon residents only. If a student moves out of Oregon, coverage runs out
in 30 days.
top
When
does the eligibility of the Migrant Student Accident Insurance end?
Migrant children and youth are covered until their eligibility in the
Migrant Education Program ends, they receive a diploma or GED, turn 22 years
old, or the family moves out of Oregon. Children do not need to be enrolled
in a school or pre-school program to receive the accident insurance. The
policy year runs from September first to August 31st and is
renegotiated each year.
top
What does the Accident
Insurance cover?
The insurance covers injuries due
to accidents 24 hours a day, anywhere in the world, as long as the child is
an Oregon resident. The insurance covers accidents from all interscholastic
sports. The policy pays the expenses incurred for treatment, care and
services within 52 weeks after the date of accident. The first expense must
be incurred within 30 days after the accident. The insurance covers 50% up
to a maximum of $5,000. Some benefits are limited; for example, emergency
room care is covered 50% up to a maximum of $200. The insurance has a
deductible of $100 which comes out of the first treatment bill (but does not
have to be paid up front). Parents are responsible for the costs not covered
by the accident insurance.
Here are some of
the things that the insurance will cover:
·
Death claims and injury
claims from auto accidents
·
Sports injuries
·
Bicycle accidents
·
Playground accidents
·
Dental work if teeth were
injured by an accident
·
Surgery due to an
accident, up to one year after the accident
·
Bee stings and animal
bites
·
Injuries from sexual
assault
·
Injuries from fighting
that was not initiated by the victim
Not Covered:
Exclusions for the Student Accident Plan
Benefits are not payable under
the Policy for any of the following or loss that results there from:
-
Dental care or
Treatment for damage to a loss of dentures or bridges or damage to
existing orthodontic equipment. This exclusion does not apply to care
of teeth and gums required due to an Injury resulting from an Accident
while the Insured person is insured under the Policy.
- War or any act of war, declared or
undeclared.
- Participation in a riot or civil
disorder; fighting or brawling, except in self-defense; commission of or
attempt to commit a felony or violating or attempting to violate any
duly enacted law.
- Suicide, attempted suicide or
intentionally self-inflicted injury while sane or insane.
- Injury contributed to by the use of
alcohol or drugs unless taken in the dosage and for the purpose
prescribed by the Insured Person’s Physician.
- Practice or play in intercollegiate
sports; semi-professional sports; or professional sports.
- Injury covered by Work’s
Compensation or Employer’s Liability Laws, or by any coverage provided
or required by law including, but not limited to group, group type, and
individual automobile “No Fault” coverage (excluding School Vehicle
coverage).
- Treatment, services or supplies
provided by the School’s infirmary or its employees, or Physicians who
work for the School, or by any member of the insured Person’s immediate
family; or for which no charge is normally made.
- Mental or nervous disorders (except
as specifically provided by the Policy).
- Treatment of Sickness, ailment, or
infections (except pyogenic infections or bacterial infections which
result from the accidental ingestion of contaminated substances).
- The diagnosis and treatment of
non-malignant warts, moles and lesions, acne or allergies, including
allergy testing.
- Injury sustained as a result of
riding in or on, entering or alighting from, a two or three wheeled
motor vehicle.
- Treatment of osteomyelitis,
pathological fractures, hernia or detached retina (unless directly
caused by an injury).
- Any Expenses related to the
treatment of hernia, tonsils, adenoids, epilepsy, seizure disorder,
congenital weakness, congenital anomalies and conditions arising or
resulting directly there from (expect as specifically provided by the
Policy)
top
What to do in case of an
accident
If your child is injured, contact
a Migrant staff person at your school or at the local Migrant Education
Office to request a claim form. If your child is not currently enrolled in
school you may still contact the local Migrant Home School Consultant for
assistance.
You may go to the provider or the
facility of your choice. The first physician’s visit must be within 30 days
after accident.
A Migrant staff person would be happy to
assist you in filling out the claim form. Parents or guardians are
responsible for sending the completed form to the insurance company within
90 days after the date of first treatment. Additional medical bills for the
same injury must also be sent in to the insurance company, but do not
require a second claim form.
At the same time, please file a claim
with your other family health and/or accident carrier. Any questions you
have about particular claims should be directed to Myers-Stevens & Toohey &
Co. Inc.
Follow ALL claims form instructions,
attach all itemized bills and send to:
Myers-Stevens & Toohey & Co. Inc.,
26101 Marguerite Parkway
Mission Viejo, CA 92692-3203
(949) 348-0656 or (800) 827-4695
Fax (949) 348-2630
www.myers-stevens.com
top
Frequently asked Questions…
Q: Where should I call if I have questions about a claim I have filed?
A: You should call the insurance company and ask for someone who works with
the Oregon Migrant Student Accident Insurance. The toll-free number is
1-800-827-4695. The company has bi-lingual analysts who can take the calls
in English or Spanish.
Q: Can I take my child to any doctor or hospital?
A: YES!
Q: Does the Accident Insurance cover a tonsillectomy or other surgery?
A: NO. Only surgery which is due to an accident is covered.
Q: Does the Insurance cover the
medical exam my child needs to participate in sports at school?
A: NO. Only treatment for injuries from accidents is covered.
Q: Is a migrant student covered
for accidents while drinking or using drugs?
A: NO. If the student is accidentally injured due to being under the
influence of alcohol or drugs, he or she is not covered.
Q: My child was injured in another state while we were on our way to
Oregon to work. Is this covered?A: NO. Only a few states provide insurance for migrant students, even
though all states have migrant programs. The Migrant Education Program
Accident Insurance provided by the State of Oregon covers only those
accidental injuries which happen while a student resides in Oregon.
Q: What is included in the term
“dismemberment”?
A: Loss of both hands, loss of both feet, loss of sight in both eyes or
paraplegia or hemiplegia or quadraplegia is covered for $30,000. Loss of one
hand, loss of one foot or loss of sight in one eye is covered for $20,000.
The loss must result within 365 days after the injury date.
Q: Does the parent receive a copy
of the insurance policy?
A: No. The Migrant Education Service Center (MESC) holds the policy.
Parents receive a flyer with information about the insurance program.
Q: What if my child is injured
during the summer and there is no one at the school to help me file a claim?
A: You may complete the form yourself. Claim forms are available at the
local Migrant Education Office or at the Migrant Education Service Center (MESC).
You may call MESC at (503) 385-4678.
|
