2018-2019 Intercollegiate SOB.pdf
PDF 78 KB Posted
- Attached to
- STUDENT ACCIDENT INSURANCE
- Solicitation number
- 5400017351
- Issued by
- Horry County, South Carolina
About this file
This is a Schedule of Benefits and Premium Quotation for intercollegiate student accident insurance for Coastal Carolina University in South Carolina, prepared by Berkley Life and Health Insurance Company with A-G Administrators Inc. serving as the claims payer and Dissinger Reed as the broker/program coordinator. The insurance program covers 15 intercollegiate sports including baseball, basketball, football, soccer, volleyball, and track and field, among others. The policy provides accidental death and dismemberment benefits of $10,000 per specific injury with a $500,000 aggregate maximum, includes expanded medical coverage for re-aggravation and reinjury of pre-existing conditions, and covers guest recruit participation and Professional Athlete (PSA) tryouts. The initial treatment period is 180 days with a benefit period of 104 weeks, and coverage includes HMO/PPO denials as secondary coverage. The proposed effective date is August 1, 2018, with specific deductibles of $38,000 and aggregate deductibles of $10,000, providing 100 percent insured coverage.
The total hard costs for the program are $40,000 in annual premiums plus $24,000 in administration fees, resulting in total hard costs of $64,000. The university's recommended upfront funding of the claims account is $78,000 (negotiable), bringing the total initial funding request to $118,000 and the total potential maximum annual cost to $118,000. The quotation was dated June 14, 2018, and is subject to change if any assumptions and conditions are altered. Binding of coverage is not finalized until received by the carrier, and acceptance requires completion of the Notice of Acceptance section with an authorized signature.
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Other files
| File | Type | Posted |
|---|---|---|
| Invitation To Bid.docx | DOCX document | |
| No Award Statement-No Responsive Bids.docx | DOCX document | |
| Detailed Student Accident Loss Runs 2014-2019.xlsx | XLSX spreadsheet | |
| Final Award Extension.doc | DOC document | |
| Amendment One.docx | DOCX document | |
| Paid Claims Experience Reoprt.pdf | ||
| Student Accident Policy Dec 2018-2019.pdf | ||
| Award Extension.doc | DOC document | |
| Amendment Two.docx | DOCX document |
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Text version
Maximum Benefit per Injury Aggregate Deductible Specific Deductible Insured Percentage Initial Treatment Period Benefit Period Accidental Death and Dismemberment (AD&D) $10,000 per specific injury, $500,000 aggregate maximum Expanded Medical Re-aggravation/Reinjury of Pre-Existing Conditions Heart & Circulatory HMO/PPO Denials Guest Recruit Coverage (including PSA tryouts) Proposed Effective Date
Annual Premium Administration Fees Total Hard Costs Recommended upfront funding of claims account (negotiable) Total initial funding request Total potential maximum annual cost
Insurance Carrier: Berkley Life and Health Insurance Company Claims Payer: A-G Administrators Inc.
Broker/Program Coordinator: Dissinger Reed
SECONDARY
Included Included Included
$38,000
$10,000 100%
180 days 104 weeks
Included
Schedule of Benefits
Baseball, Basketball, Beach Volleyball, Cheerleaders, Cross Country, Football (fall), Football (spring), Golf, Lacrosse, Soccer, Softball, Tennis, Track & Field, Volleyball, Covered Intercollegiate Sports
$90,000 $80,000
This is a summary of coverage. It does not contain all provisions, limitations and exclusions.
Should any of the above assumptions and conditions change, we reserve the right to alter the quote.
Available
Notice of Acceptance By completing this Notice of Acceptance section with an authorized signature, you are confirming your intention to accept the above proposed insurance policy terms and conditions. Binding of coverage not finalized until received by the carrier.
August 1, 2018
Program Information
$14,000 $24,000
$40,000 $78,000
$118,000
Name
Signature Date
Title
Carrier and Claims Payer Information2018-19 Schedule of Benefits & Premium Quotation
6/14/2018 Coastal Carolina University - Athletic Insurance Renewal 2018-19 Page 9 of 20
File details come from the government source that posted it. Updated .