4-H Excess Health Insurance
TO: 4-H Youth Development Agents
FR: State 4-H Office
RE: Questions about 4-H Excess Health Insurance
You must use it for all out-of-state trips.
Parent and/or guardian carries Primary Insurance. CIGNA, University of Kentucky Excess Insurance is now the Secondary Insurance.
IN ALL CASES WHERE (PARENT) IS USED WE ARE REFERRING TO THE PRIMARY CARE GIVER. AN INDIVIDUAL RESPONSIBLE FOR FINANCIAL SUPPORT OF THE CHILD.
How does this accident insurance differ from past years?
American Income Life Insurance, the company who in the past carried our policy, was PRIMARY, meaning that American Income Life paid the bill first, before a family policy or other policy kicked in. CIGNA our new insurance company, will not provide primary coverage protection, but functions as an EXCESS policy. This means that the family policy owned by the parent(s) and which covers the child becomes the PRIMARY policy. (It pays first)
How will the Physician's Office or hospital know if the family has a health insurance policy.
Every child who registers for 4-H Camp and/or Activity will have to be sent a camp/activity medical form by the county extension office. (camera ready copy enclosed) This form must be completed and returned with a photocopy of the parents health insurance card. Both the front of the card and the back of the card will need to be copied. These will be required before the child can attend camp/activity.
What would happen if I brought a child to camp without the above information and they became sick or were injured?
Unless it was a life threatening illness or injury the clinic or hospital would not treat the child. The parents would have to be called.
What if the family does not have private medical insurance?
CIGNA then becomes the PRIMARY and will pay expenses up to $25,000.
What if the family policy has an individual $500.00 deductible and that deductible has not yet been met? Is the family out the 1st $500?
No. CIGNA will pay the deductible or that portion of the deductible left that ordinarily would be the responsibility of the family up to the deductible limit which in this case is $500.00 If the total medical bill exceeds the deductible the family policy then becomes responsible.
If a child must purchase a prescription at a local drug store and the parents policy does not cover prescriptions, who must pay for the drugs?
CIGNA will pay for the prescription if the parents policy excludes them.
What if the family policy will pay for prescriptions, but there is a $10.00 Co-payment? Who pays the Co-Payment?
CIGNA will pay the co-payment, and the parent's policy will pay the remainder.
Will pre-existing conditions be covered under the University policy?
No. None of the expenses would be approved for payment if the child had pre-existing conditions. Responsibility would fall totally upon the family. This is the same as the situation that has existed with our policies in the past.
Are volunteer leaders covered by CIGNA the same as camp/activity participants?
Yes. Volunteers would need to complete the medical form, but a photocopy of their insurance card would not be necessary, since they would be carrying it with them.
How will claims be handled with Dr offices, clinics hospitals or drugstores?
A copy of the family medical card will be given to each provider. We will provide a copy of the CIGNA claim form. Instructions on the CIGNA claim will indicate that this insurance will cover only (1) unpaid deductibles (2) co-payments, and (3) co-insurance, or in the case where a family has no insurance it will cover expenses up to $25,000.
Who is responsible for submitting claims?
In most cases the medical clinic or the hospital will process and submit most claims for payment. Where they or private physicians refuse to submit claims, it becomes the responsibility of the parents to submit the claim forms. Very few if any drug stores prepare claims and that responsibility remains with the parents.
Bills are made out in who's name?
All bills are made in the name of the patient, but since camp/activity participants are minors the bills will be sent to the parents or owner of the insurance card presented.
How will parents obtain claim forms from CIGNA to apply for deductible payment, co-payments, or full coverage where the family has no insurance?
A copy of that claim form is enclosed. It can be sent home from camp/activity with the child,or sent to the parent upon request after having arrived home from camp/activity .
Does all of the above information hold true for environmental camp/activities, day camp/activities held at one of our 4-H camps or other overnight events held at any University of Kentucky 4-H Camp/activity?
Yes.
Can I still use American Income Life or another insurance company to insure club and activity programs conducted at the county or area level.
Yes.
Does CIGNA apply to the Diederich summer 4-H Camp/activity .
Yes.
CONDITIONS FOR EXCESS MEDICAL / ACCIDENT INSURANCE
(CAMPS, FIELD TRIPS, AND ACTIVITIES)
Not all camps, field trips, and other activities are eligible to be insured by the University. In order to be eligible, an activity must meet both of the following conditions:
1. The activity must be sponsored by the University and supervised by University personnel. That is, some department of the University must take responsibility for the organization, hosting, and (usually) funding of the activity. Student organizations activities, or activities held on University property but sponsored by an outside organization, do not meet this condition, and are not eligible for insurance.
2. The activity must meet at least one of the following criteria.
Please indicate each item that applies to this excess insurance request:
( ) a. It is a summer camp.
( ) b. It is a sports activity.
( ) c. It is an out of state field trip.
( ) d. It involves participants who are under the age of 18.
( ) e. It is not any of the above, but it exposes participants to a risk of injury that is not ordinarily present in an academic setting. Examples: A rock climbing trip, a firearms safety class, or a carpentry workshop involving the use of power tools.
We hope that these conditions are largely self-explanatory and will cover most situations that arise. However, if you have questions about the eligibility of a particular activity, feel free to contact Risk Management, (859) 257- 3708.
| UNIVERSITY OF KENTUCKY | Summary of Coverage |
Excess Accident Insurance for All State Level 4-H Camps/Events &Activities
Insurance Carrier: CIGNA
Coverage: Insurance coverage is on an excess basis only. The participants' personal health insurance policy will be primary and provide coverage for accident and sickness. The excess policy will cover any out-of-pocket expense not paid by the participant' personal insurance up to the limits of the policy listed below. (This includes payment of the deductible and co-insurance amounts if applied under the participant' personal policy.) The sickness medical expense will be limited to $500 on an excess basis. The benefit period is one year. The first expense must be incurred within 60 days of the accident or sickness. If the participant does not have personal health insurance coverage, this excess policy will pay first dollar, up to the limits of this policy. Pre-existing conditions are not covered. A pre-existing condition is any condition for which a prudent person should have sought treatment or was treated in the previous six months.
Coverage Benefits & Limits:
Accident Medical Expense (Excess) - $25,000
Accident Dental Expense (Excess) - Included
Deductible: None
Sickness Medical Expense (Excess) - $500
Deductible: None
AD&D and Paralysis, Principal Sum - $10,000
Benefit Period: One Year
Effective Date: January 1 of current year
Expiration Date: December 31 of current year
LINK TO BENFEFIT, MEDICAL AND CONSENT FORM FOR YOUTH AND ADULT PARTICIPANTS
UNIVERSITY OF KENTUCKY
ACCIDENT CLAIM FORMS
Agents: You should prepare a packet of the following information for any leaders or adults traveling with your group.
Last Revised: 7/29/03