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Student Accident Insurance Form

Student Accident Insurance

Office of the Superintendent

Long Branch Public Schools

540 Broadway, Long Branch, New Jersey 07740 

Dear Parent/Guardian:

The Long Branch Board of Education has purchased through BMI Benefits, LLC, student accident insurance for the 2015-2016 school year. This means that all students (to include athletes, band members, cheerleaders, etc.) are automatically covered under this year’s program while in school or participating in school-sponsored activities. Although there are no premium costs to parents/guardians for this coverage, the parent/guardian is responsible for a $2,000 deductible and a 20% co-insurance if you choose to use this policy. Although this coverage is very broad, there are restrictions, limitations and exclusions in the policy.

This policy is considered excess coverage over any other insurance you as the parent/guardian may have. Under this policy, you must submit all insurance claims to your insurance company first with the exception of Medicaid. If you do not have medical insurance or you are on Medicaid, the Board’s policy will act as primary coverage subject to the deductibles and co-pays described above. Please understand all medical expenses are the responsibility of the parent/guardian and not the Long Branch Public Schools. If coverage is deemed applicable, your medical expenses will be covered up to the limits of the policy.

 If you require any assistance please contact BMI Benefits, LLC, P.O. Box 511, Matawan, New Jersey, 07747, Telephone: 1-800-445-3126.

 

Sincerely,

(SGD)

Peter E. Genovese III, RSBO, QPA

School Business Administrator/Board Secretary

_____________________________________________________________________________________________________________

 

HOW TO FILE A CLAIM:

  1. Complete this form within 90 days.
  2. Attach itemized Bills and Primary Carrier Statements
  3. Mail to: BMI Benefits, LCC. PO Box 511, Matawan, NJ 07747 800-445-3126 (P) 732-583-9610 (F)

ANY PERSON WHO KNOWINGLY AND/OR WITH INTENT TO INJURE, DEFRAUD OR DECEIVE AN INSURANCE COMPANY OR OTHER PERSONS FILES A STATEMENT OF CLAIM CONTAINING FALSE, INCOMPLETE OR MISLEADING INFORMATION, MAY BE GUILTY OF INSURANCE FRAUD AND SUBJECT TO CRIMINAL AND SUBSTANTIAL CIVIL PENALTIES

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