Student Accident Insurance

Annual Premium	Coverage Descriptions
$79	FULL-TIME COVERAGE Covers the student 24 hours a day until school starts next year. Includes coverage while at home, at school, weekends, and summer vacation. DOES NOT cover participation in interscholastic sports for students in grades 7-12. The Medical Benefits and Exclusions apply to this coverage.
$163	FULL-TIME COVERAGE WITH MAJOR EXPENSE After the maximum benefit has been paid under the FULL-TIME COVERAGE and the non-covered expenses exceed $3,500, the Company will pay 70% of the remaining Usual and Customary charges up to a maximum of $15,000 per injury. The Exclusions apply to this benefit. This benefit will apply to sports, if the additional premium has been paid. See FULL-TIME WITH ALL SPORTS AND MAJOR EXPENSES and FOOTBALL COVERAGE descriptions.
$133	FULL TIME WITH ALL SPORTS In addition to the FULL-TIME COVERAGE shown above, the ALL SPORTS coverage protects the student wile practicing or participating in school-sponsored and school-supervised interscholastic sports, including travel in school-provided transportation for grades 7-12. It DOES NOT cover football for grades 9-12. The Medical Benefits and Exclusions apply to this coverage.
$217	FULL-TIME WITH ALL SPORTS AND MAJOR EXPENSE After the maximum benefit has been paid under the basic plan benefits and the non-covered expenses exceed $3,500, the Company will pay 70% of the remaining Usual and Customary charges up to a maximum of $15,000 per injury. The Exclusions apply to this benefit. The Major Expense Benefit will also apply to football grades 9-12, if the additional $148 premium has been paid.
$14	SCHOOL TIME COVERAGE Protects the student while: a) attending regular school sessions, b) participating in or attending school-sponsored and supervised extra-curricular activitiesc) traveling directly to and from school for regular school sessions, and while traveling to and from school-sponsored and supervised activities in school-provided transportationDOES NOT cover participation in interscholastic sports for students in grades 7-12. Coverage ends the first day of school next year. The Medical Benefits and Exclusions apply to this coverage.
$68	SCHOOL TIME WITH ALL SPORTS In addition to the SCHOOL-TIME COVERAGE shown above, the ALL SPORTS COVERAGE protects the student while practicing for or participating in school-sponsored and supervised interscholastic sports, including travel in school-provided transportation, for grades 7-12. It DOES NOT cover football for grades 9-12. The Medical Benefits and Exclusions apply to this coverage.
	Optional Coverage
$6	EXTENDED DENTAL ACCIDENT COVERAGE Provides up to $5,000 in benefits for any dental accident. Covers the student 24 hours a day until school starts next year. Treatment must begin within 60 days from the date of injury. Benefits are limited to expenses actually incurred within one year from the date of accident. However, if within the one-year period following the date of accident, the insuredÕs attending dentist certifies that dental treatment and/or replacement must be deferred beyond one year, the plan will pay the estimated cost of such deferred treatment, but not to exceed $200 for each tooth. No benefits will be allowed for orthodontics or dental disease and benefits for prostheses are limited to $500 per injury, including procedures performed to install them. Dental prosthesis includes, but is not limited to, crowns, caps, bridges and implants. The Major Expense Benefit will not apply to this coverage. Endorsement GHR-181(95).
$148	FOOTBALL COVERAGE (GRADES 9-12) Protects the student while practicing for or participating in school-sponsored and school-supervised interscholastic football, including travel in school-provided transportation. The Medical Benefits and Exclusions apply to this coverage.