Accident Insurance Policy Information


    Waterloo Central School’s
    Accident Insurance Policy


    The school district has available student accident insurance for your child as a member of the district. The coverage provides payment for medical expenses incurred as a result of an accidental injury while attending school; traveling to and from school or participating in school sponsored activities.


    Student accident insurance coverage is “excess” coverage. This means that your family’s health insurance is primary and you must submit all claims to your primary carrier for payment prior to submitting to the school’s carrier. It also means that you MUST FOLLOW THE RULES OF YOUR PRIMARY CARRIER. The school’s insurance plan is not an alternative to your regular health insurance. The intent of a student accident policy is to cover any out of pocket expenses such as co-payments and deductibles. If your family does not have health insurance, the school’s policy will act as primary.


    Please contact the school health office for forms.


    How to file a claim:

    1. Complete Part B of the “Notification for Injury” form (claim form) which is provided to you by the school district.

    2. Submit the “Notification of Injury” (claim form), you do not have to wait for bills or “Explanation of Benefits Statement” or “Explanation of Payment” from your insurance carrier to submit the claim.

                 Submit the claim to:   Pupil Benefits Plan, Inc.

                                                 101 Dutch Meadows Lane

                                                 Glenville, NY  12302

    Submit the claim form within 90 days from the date of injury. Additional charges can be submitted by sending the bills, receipts and “Explanation of Benefits” as they are received. The claim form only has to be submitted with the initial charges.


    Please Note:  You should make a photocopy of all correspondences, receipts, claims, etc. for your records prior to submitting. If you have any questions regarding claim form, call 1-800-393-3301 or 518-377-5144. The Claims staff will be able to assist you with any questions. It is not necessary for you to call the school.