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Accident Insurance Plan

Academic Year 2013-2014

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All full-time Knox students are automatically enrolled in an accident insurance plan that provides specified medical benefits in the event you are accidentally injured either on or off campus. An annual $90 fee (prorated for students beginning in winter $60 and spring term $50) is assessed to all students for this coverage.  This fee is madatory and may not be waived.  Please note the Knox policy number is 13-0255-2014.

The accident insurance plan only covers medical expenses due to a covered accident with no deductible. No benefits are available to pay for medical tests or care due to sickness, illness, or any pre-existing conditions. The accident plan benefits are subject to limitations and exclusions and may not pay for 100 percent of all medical expenses.  

Note: We are committed to helping you find the right option to ensure your well-being, which is why all Knox students are strongly advised to have comprehensive health insurance while in college. While basic health care is available through Health Services on campus, chronic or extended medical conditions, prescriptions, x-rays, lab tests, emergency medical care, and hospital visits are your financial responsibility. Under the new federal Affordable Care Act (ACA) guidelines, you can remain on family plans until age 26. If you have a primary insurance provider or are enrolled in a voluntary health insurance program, please bring that provider card/information with you to campus.

Voluntary Health Insurance: Although Knox does not administer or provide comprehensive health insurance for students, we have identified options through Lawrence E. Smith & Associates, Inc. for international and U.S. students. International students can learn more about the plan and receive a cost estimate by visiting HTH Worldwide. For U.S. students, www.ehealthinsurance.com, for information on how to obtain voluntary health insurance options.

If you have questions about the accident insurance plan, or student health services, contact the Office of Student Development at newstudent@knox.edu or 309-341-7863.

 Accident Insurance Policy Terms, Conditions, and Exclusions

No policy benefits will be paid to cover any expense or loss not caused exclusively by a covered accidental injury or any expense or loss resulting from, or for:

  1. Damage to other than whole, sound, vital, and natural teeth or to existing dental bridges, crowns, restorations, or braces; orthodontic procedures and services. Treatment for injury or function of tooth caused either by decay, infection, or the breakdown of a dental restoration.
  2. Boils; athlete’s foot; impetigo or similar skin infection; rashes; poisonous vegetation reactions; warts; blisters; calluses; cramps; muscle spasms; allergies or allergic reactions; ingrown nails; appendicitis; hernia of any kind, however caused; infections occurring other than as a result of such injury; detached retina; or psychiatric care.
  3. Any form of illness, sickness, or disease, including but not limited to the following: pathological stress fractures, Perthes’ Disease, Osgood-Schlatter’s Disease, osteomyelitis, osteochondritis, osteogenesis imperfecta, slipped capital femoral epiphysis, thrombophlebitis, hysterical reactions, or similar conditions.
  4. Any form of fighting, brawling, criminal or felonious assault, or the Insured being engaged in an illegal occupation.
  5. Services or treatment rendered as a part of the Member school service by a hospital, physician, or person employed or retained by the Member, or by a person related to the Insured by blood or marriage.
  6. Riding in or on, being struck by, being towed by, boarding or alighting from, or operating any motorized or engine driven vehicle. Eligible medical expenses not collectible from other valid coverage will be payable up to $2,000.00 in total.
  7. Intentionally self-inflicted injury.
  8. War or any act of war; (raids by air, land, or sea shall be deemed an act of war); civil disobedience; riots or insurrection.
  9. Injuries sustained by the Insured for which benefits are paid or received under any Workmen’s Compensation or Employer Liability Laws.
  10. Aviation in any form except while the Insured is riding as a passenger in a licensed airplane provided by an incorporated passenger carrier on a regularly scheduled passenger flight and route.
  11. The use of or while under the influence of drugs unless administered as prescribed by a physician.
  12. The existence or aggravation of physical or mental infirmity, condition, or disease whether infectious, congenital, secondary, or acquired in origin. Conditions or the aggravation of conditions that originated prior to the Insured’s policy effective date are not covered.
  13. Expense resulting from participating in activities for which benefits would be payable, in the absence of this insurance, under any other insurance policy or trust fund is expressly excluded from coverage.
  14. Snow skiing, water skiing, surfboarding, hydro sliding, jet skiing, rodeo, boxing/martial arts training or competition.
  15. Participating in organized league sports, semiprofessional, amateur, or professional sports that are not exclusively supervised, scheduled, and funded by Knox College.
  16. Any expense for which a benefit is not listed.

 

Policy Definitions

Covered Accident means bodily injury of the student, which results directly and independently of all other causes from an accident. Self-inflicted injuries caused by prolonged over-exertion, stress or strain, illness or disease process, or aggravation of an existing condition are expressly excluded from coverage under this Policy.

Pre-existing Condition means any condition or residual, reoccurrence, complication, or aggravation of a prior condition that occurred before the date that the student is covered under the Knox College Accident Insurance Plan.

 

Excess Coverage Provision

The Knox College accident insurance policy is EXCESS COVERAGE. This means that if an injured student is eligible to receive benefits from any other source of coverage, including parent's insurance, an HMO or PPO, the student must also file a claim with the student's other available source of coverage. The Knox College plan benefits will be limited to the eligible expenses not collectible from other primary coverage sources. If the student elects to or fails to follow the proper procedures to obtain primary coverage from the student's other available source of coverage, the Knox College accident plan scheduled benefits will be reduced by 50 percent.

 

Effective and Termination Dates of Coverage

The accident insurance policy coverage for all full-time students starts August 19, 2013, and ends on August 19, 2014. Any student that is not actively attending classes or withdraws from college within the first 31 days of 2013 scheduled classes will not be eligible for policy benefits. No refunds will be made for any reason.

 

Insurance Company and Claims Office

The accident insurance policy is underwritten by The Reliance Standard Life Insurance Company, Philadelphia, Pennsylvania. All claims will be processed by Lawrence E. Smith and Associates, Inc., P.O. Box 411216, St. Louis, Missouri 63141. Phone: 800-325-1350. All claims and claim questions should be directed to Lawrence E. Smith & Associates, Inc.

 

How to File a Claim

Knox College does not process or pay claims. To obtain a claim form, contact:

Lawrence E. Smith & Associates, Inc.
P.O. Box 411216
St. Louis, Missouri 63141
Phone: 800-325-1350
E-mail: lucyw@lesmith.net

Instructions will be provided with the claim form to assist students in the claim filing process. Any questions regarding accident claims should be addressed to Lawrence E. Smith & Associates, Inc.

 

Basic Accident Insurance Policy Benefits

To be eligible for policy benefits, medical treatment by a licensed physician must be rendered within 90 days from the date of the original accident. The policy will pay the specified policy benefits necessary to treat the covered injuries that are incurred and rendered within one (1) year from the original date of the covered accident. This policy has no deductible.

Coverage Benefits
Maximum Medical Expense (payable per covered accident)
Intercollegiate Sports Related Accidents Maximum Policy Benefit
Motor Vehicle Related Accidents Maximum Policy Benefit
Up to $12,500.00
Up to $1,000.00
Up to $2,000.00
Loss of Life, due to covered accident $2,500.00
Inpatient Hospital Charges
  • Daily Semi-Private Room and Board -- including all miscellaneous charges including supplies, services, operating room, implantable devices, etc.
  • While in Intensive Care -- including all miscellaneous charges, supplies, services, operating room, implantable devices, etc.

$1,000.00/day


$1,250.00/day
 
Outpatient Hospital or Same-Day Surgi-Center Charges
(Including all supplies, implantable devices, and services)
  • When major surgery is performed requiring general anesthesia
  • When major surgery is not performed


$2,500.00
$500.00
Physician's Non-Surgical Office or Hospital Visits, Consultations
(Includes physician's assistant fees if no physician is available to render exam or treatment; 8 visit maximum per accident)
$60 initial visit/
$40 follow-ups 
Physician's Surgery Fees UCR* (see note)
Anesthesiology and Assistant Surgeons Fees 20% of Surgery Fee Benefit
Outpatient Lab, X-Rays, MRI, CAT, and Other Scans
(Includes interpretation and reading fees)
  • Laboratory tests
  • X-Rays, CAT, and other scans
  • MRI


$150.00
$300.00
$500.00
Outpatient Physical Therapy Treatment Visits
(Limited to 10 visits per covered injury)
$40.00 per visit
Emergency Ambulance Service (Air or Ground) $500.00
Drug Store Prescriptions Prescribed by Physician $150.00
Dental Services
(Total amount payable per injured tooth; includes X-rays and supplies)
$300.00 per tooth
Replacement Eyeglasses or Hearing Aids
(If broken during a covered accident requiring medical treatment)
$125.00
Orthopedic Appliances/Braces/Implantable Devices or Equip Rentals
(Payable when physician prescribed for rehab purposes only)
$250.00
*NOTE: 'UCR' refers to 'usual, customary and reasonable' fees as referenced in the Fair Health, Inc. fees survey.