As your student-athlete prepares for another exciting year of school competition at Pioneer High School, please take a moment to review the following statements regarding student-athletes injuries and medical insurance protocol.
Over the past several years, everyone has been made acutely aware that medical costs for everyone is spiraling. The athletic department has become increasingly concerned about the cost of medical care as we strive to provide the best possible service for each of our student-athletes. Pioneer provides some of the best preventive conditioning programs, through our coaching and athletic training staff. Pioneer High School has a team physician who visits on a regular basis, at no cost to the athlete.
Covered athletic injury or illness are those that occur while playing in athletics which are accidental in nature. When an athlete becomes injured, and it is a covered athletic benefit expense, the personal insurance that the family has will be in force and considered the primary insurance. First Agency (the secondary insurance carrier for the school system) will pay balances on claims directly related to a covered athletic injury.
There is confusion sometimes about what type of expenses First Agency will pay on an insurance claim or outright as a primary payer. Non-permissible is defined as those that occur outside of athletics and those totally covered by the primary insurance agency. If the athlete’s family does not have a primary insurance than First Agency become the primary payer, for those athletic injuries or illnesses that occur while playing in Pioneer athletics.
After a season has ended, an athlete may have an unresolved injury or illness. It is the athlete’s and parents responsibility to follow-up with the athletic trainer. First Agency will pay bills regarding a covered injury or illness if it is reported to them prior to the one-year anniversary date.
Below is the address of the secondary insurance carrier. Within the athletic department, ask for the secretary. If you ever have any questions or concern that you would like to discuss, please contact her immediately.
Insurance Company:
First Agency, Inc.
5071 West H Avenue
Kalamazoo, MI 49009
(616) 381-6630
Assumption of Risk
By participating in high school athletics, a student assumes certain risks and responsibilities in addition to those assumed by the institution. These include an obligation to safe conduct during practice and competition and a strict adherence to the rules of the sport that are designed to safeguard the well-being of the participants. Each student-athlete also has an obligation to inform athletic trainer and team physician of any medical problems encountered on or off the field of play. The risk of occasional injury or illness is a part of athletic participation. Participation may also include paralysis and death.
Q & A About Athletic Benefit/Insurance
Contact the athletic department secretary first. She will walk you through the process and prepare initial documents to be sent to First Agency.
What expenses will First Agency pay?
First Agency can pay only those expenses that have resulted from an accident while participating as an athlete at Pioneer High School.
What is the duration of coverage after an accident?
First Agency will pay bills regarding a covered injury or illness if it is reported to them prior to the one-year anniversary date.
What if I only have other insurance?
You must submit bills to your primary insurance company before First Agency will consider your claim. You will need a copy of all your insurance statements indicating balances owed after the primary insurance has been completed.
What if I don’t have any insurance and my son or daughter is injured in an athletic activity?
First Agency becomes the primary insurance company and covers the expenses of the accident.
What if I have insurance that covers every expense; do I have to pay the athletic benefit fee?
All students must pay the benefit fee. Public Act 16 states “Boards of Education … shall have the authority to establish policies regarding provisions for care for injuries sustained while participating in interscholastic athletic activities. Boards of Education . . . have a right to receive payment for all or part of the cost of participation in mutual benefit programs or insurance programs while a student is participating… shall have the right to require a fee from participants in such programs for all or part of the cost of medical care, mutual benefit programs, or insurance program to insure protection for students, providing that no student shall be barred from participation in interscholastic athletic activities because of inability to pay the fee.”Please note that 100% participation is required. There have been cases where a family has had full coverage, and then lost their insurance. First Agency will be there for all families.
If my child gets cut or drops our from a team, can I get my money back?
Once a child plays (no matter how long or short) the benefit fee has been paid and is non-refundable.
If my child plays in more than one sport do I pay the benefit fee again?
There is a one-time fee of $30 no matter how many sports a child chooses to play that school year.
If I have two children playing a sport do I pay for both?
Each child must pay the one-time fee for that school year.
