Attachment Three.pdf
PDF 78 KB Posted
- Attached to
- STUDENT ACCIDENT INSURANCE RE-BID
- Solicitation number
- 5400018023
- Issued by
- Horry County, South Carolina
About this file
This document is a Schedule of Benefits & Premium Quotation for student accident insurance coverage submitted by Berkley Life and Health Insurance Company for Coastal Carolina University's athletic program renewal for the 2018-19 academic year. The insurance program provides coverage for 15 intercollegiate sports including baseball, basketball, beach volleyball, cheerleaders, cross country, football (fall and spring), golf, lacrosse, soccer, softball, tennis, track and field, and volleyball. The proposed effective date is August 1, 2018, with coverage including accidental death and dismemberment (AD&D) benefits of $10,000 per specific injury with a $500,000 aggregate maximum, expanded medical coverage, re-aggravation and reinjury of pre-existing conditions, heart and circulatory coverage through HMO/PPO, coverage for guest recruit participation including Professional Sports Association tryouts, and secondary coverage inclusion. The initial treatment period is 180 days with a benefit period of 104 weeks.
The total program cost consists of an annual premium of $40,000, administration fees of $24,000, and total hard costs of $78,000, with a recommended upfront funding of the claims account of $118,000 (negotiable). The specific deductible is $10,000 with an insured percentage of 100 percent and an aggregate deductible of $38,000. Claims administration is managed by A-G Administrators Inc., with Dissinger Reed serving as broker and program coordinator. The quotation represents a binding proposal contingent upon the carrier's receipt of a completed Notice of Acceptance with authorized signature, though final binding of coverage does not occur until confirmation from the insurance carrier is received.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Invitation to Bid.docx | DOCX document | |
| Attachment Four.pdf | ||
| Attachment One.pdf | ||
| Attachment Two.xlsx | XLSX spreadsheet |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .