CHILD CARE, PRESCHOOL, AND HEAD START
PARTICIPANT ACCIDENT INSURANCE
No matter how safe an environment you provide, accidents will happen. Philadelphia Insurance Companies Accident
Insurance puts you in a better position to avoid lawsuits and protect each child when accidental injuries occur during
supervised and sponsored activities including group travel.
• $100,000 Accident Medical Expense benefit
• $50,000 Total Paralysis benefit
• $50,000 Accidental Dismemberment benefit
• $25,000 Accidental Death benefit
• $10,000 Crisis Death benefit
Accident Medical Expense Benefits
Payable services and supplies prescribed by a physician for injuries
sustained in a covered accident include:
• Hospital bills, including room and board
• Emergency room and outpatient treatment
• Medical or surgical treatment by a licensed doctor
• Prescription drugs and medicines
• Services of a licensed or graduate nurse
• Dental care for injury to sound and natural teeth
• Ambulance expenses from the covered accident site to the hospital
Accident Benefits
Benefits are payable for injuries that result - directly and independently
of all other causes - from a covered accident, while coverage is in effect,
up to the maximum benefits stated.
$100,000 per person per accident: With either option, up to $100,000
will be paid for eligible medical expenses. The first eligible expense
must be incurred within 180 days after the date of the covered accident.
Eligible accident medical expenses must be incurred within one year
of the covered accident.
Choice of Primary or Full Excess Options
Primary Option: Accident Medical Expense benefits will pay eligible
medical expenses regardless of any other health insurance the covered
person has.
Full Excess Option: Claimants are reimbursed for eligible expenses that are
not payable by any other valid and collectible insurance in the possession of
the claimant. If a claimant is not covered by any other valid and collectible
insurance, then the accident insurance plan becomes the claimant's primary
insurance coverage. When a claimant has other coverage (e.g. coverage
through a parent's employer-employee plan), then the accident plan will
reimburse the claimant for eligible expenses not payable by the primary plan.
Examples of out-of-pocket expenses not covered by the primary plan include:
deductibles, co-pays, coinsurance, and expenses excluded by the primary
plan, but covered by the accident plan.
Plans Include Accidental Death, Dismemberment,
and Paralysis (Plegia) Benefits
If within one year from the date of a covered accident a covered person
suffers any of the losses specified, we will pay a benefit for one of the
conditions listed below. If the same accident causes more than one of these
losses, we will pay the largest amount that applies.
• Loss of Life
• Total paralysis of upper and lower limbs, both lower limbs, or upper
and lower limbs on one side of the body
• Loss of any combination of two: hands, feet, eyesight, speech,
and hearing
• Loss of one hand, one foot, sight in one eye, speech, or hearing
• Loss of thumb and index finger of same hand
Crisis Death Benefit
Benefits are payable, subject to all applicable conditions and exclusions, if
the Covered Person’s death results, directly and independently of all other
causes, from another person’s use of a gun or a knife to commit an act of
violence while insurance under this Policy is in effect. Such an act of violence
must occur on School premises during Normal School Hours or during a
Covered Activity.
For purposes of this benefit: Normal School Hours means a scheduled
period of instruction beginning one half hour before the first scheduled
period of instruction of the day begins and ending one half hour after the
last scheduled period of instruction of the day ends. If the Covered Person is
serving a detention after Normal School Hours, the period is extended until
one half hour after the end of the period of detention for that day.
Benefits will not be payable if: The act of violence occurs while the Covered
Person is traveling to and from School, or to and from a Covered Activity or
the act of violence is committed by a parent or sibling
General Definitions
Benefit Percentage - means the percentage of Covered Expenses We pay
that are Incurred by the Covered Person after he satisfies any applicable
Deductible. Benefit Percentages are shown in the Schedule of Benefits
Covered Accident - means a sudden, unforeseeable, external event that
results, directly and independently of all other causes, in an injury or loss
and meets all of the following conditions:
1. Occurs while the Covered Person is insured under this Policy;
2. Is not contributed to by: disease, sickness, or mental or bodily infirmity, and
3. Is not otherwise excluded under the terms of this Policy.
Usual and Customary Charge means the normal charge, in the absence
of insurance, made by the provider of any treatment, but not more than the
prevailing charge in the area:
1. For a like service by a provider with similar training or experience; or
2. For a supply that is identical or substantially equivalent.
Covered Expenses - means the lesser of the usual and customary charge
and the maximum benefit shown, for services or supplies listed, in the
Schedule of Benefits and described in the Accident Medical Expense
Benefits section of this Policy. Covered Expenses must be Incurred by a
Covered Person for treatment for injuries sustained in a Covered Accident.
Coverage will become effective on the date requested, provided the
application is received and accepted by Philadelphia Insurance Companies.
Coverage is paid for by the policyholder. 100% participation is required.
This information is a brief description of the important benefits and features
of the Blanket Accident Medical Insurance underwritten by Philadelphia
Indemnity Insurance Company. It is not a contract. Full terms and conditions
of coverage, including effective dates of coverage, benefits, limitations,
and exclusions, are set forth on your policy form. Any policy Philadelphia
Indemnity Insurance Company offers to issue will be subject to the laws
of the jurisdiction in which it is issued. Philadelphia Indemnity Insurance
Company may (1) not be able to offer this coverage in all states and (2)
elect at its sole discretion not to offer or quote any specific benefit amount
or risk. Please contact your agent or local administrator for the availability
of coverage in your state.
How to Bind Coverage Now
• Just complete the Participant Accident Insurance
form at the end of this brochure
• E-mail or mail your completed Participant Accident Insurance Form
E-mail: info@ajfusa.com
Mail: Philadelphia Insurance Company
500 Mamaroneck Ave, Suite #402
Harrison, NY 10528
Questions? Call 800.734.9326
Child Care, Preschool, and Head Start Annual Rates
Per Participant
Primary Plan $8.22
Full Excess Plan $4.11
Minimum premium $300.00
This plan is available for customers with up to 750 participants.
Please contact the Program Administrator if the customer has more
than 750 participants.
