Insured : Knox County Schools PO Box 2188 Knoxville, TN 37901
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Policy No: 18310120 - 0 Insured : Knox County Schools PO Box 2188 Knoxville, TN 37901 Policy Period : 07-01-2018 - 07-01-2019 COVER SHEET Thomco Accident Health POLICY NUMBER: 18310120 - 0 MIC INVOICE(01/95) Markel Insurance Company Payment Schedule MK-12 100-TN(06/06) BLANKET STUDENT ACCIDENT POLICY MK-12 101(01/04) SCHEDULE OF INSURANCE MK-12 102(01/04) SCHEDULE OF COVERAGE PARTS, NATIONAL MK-12 CP(01/04) COVERAGE PARTS MIL1214(09/17) TRADE OR ECONOMIC SANCTIONS MK-12 128(01/04) OFF SEASON MK-12 BR(01/04) BENEFIT RIDER MK-12 UC(01/04) USUAL & CUSTOMARY ADMINISTRATION (SEVEN CORNERS) MK12-CF-7CO(04/14) K-12 CLAIM FORM SEVEN CORNERS K12 MPIL1007(03/14) PRIVACY POLICY MPIL1083(04/15) U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL Insured Copy Payment Schedule Account #: PI0371041 Account #: PI0371041 Billing Date: 07-09-2018 Knox County Schools Policy Number: 18310120 - 0 PO Box 2188 Policy Period: Knoxville, TN 37901 07-01-2018 - 07-01-2019 Policy Type: Accident and Medical Gross Premium: $ 0.00 Agent #: 89438 Arthur J Gallagher Risk Mngt Serv Inc Gallagher Student Health & Special Risk 500 Victory Road North Quincy, MA 02171 1-617-770-9889 Due Date Transaction Description __A_m__o_u_n_t Full Pay THIS IS NOT A BILL. INVOICES WILL BE ISSUED SEPARATELY FOR ANY AMOUNTS DUE. If you would like to pay now, please choose one of the options below. - On-line: www.markelinsurance.com/paymybill Make a single payment or sign up for electronic payments using (credit, debit or electronic check). It's secure, easy, and convenient. No hassles, no stamps, and no forgetting to pay your bill. - By Phone: 1-866-665-4983 (English/en Espanol) - By Mail: Markel Specialty Commercial, P.O. Box 79652, Baltimore, MD 21279-0652 Payment Inquiries: Toll-free 1-888-642-4968 8:00 a.m. to 8:00 p.m. EST JBE Insured Our commitment to you Our commitment to you begins the moment you choose Markel as your insurance company. You expect quality coverage-that's why you buy insurance. But good service, someone who really wants to help you? That almost seems too much to hope for. From the minute you pick up the phone and talk with our receptionist (a real person, not an automated system!), you'll notice what separates us from the pack-our people. Our underwriters, claims associates, loss control representatives, and administrative associates are real people, too. We treat you the way you want to be treated: respectfully, courteously, and professionally. When you have a question, we get the answer. When you leave a message, we call you back. You get service, not the run-around. Our claims staff is experienced, efficient, and effective-everything you expect. What you may not expect is how our loss control and risk management specialists suggest improvements that can help you avoid losses and accidents altogether. How else is Markel committed to you? Our prudent, conservative approach to fiscal management makes us financially stable, so you have greater assurance of our ability to pay claims when you need it. Our commitment to you is simple. We treat you right. We deliver what we promise. We are a partner you can rely on for many years to come. Matt Parker, President 4600 Cox Road Glen Allen, VA 23060 800-431-1270 www.markelinsurance.com A STOCK COMPANY MARKEL INSURANCE COMPANY Deerfield, Illinois 60015 BLANKET STUDENT ACCIDENT POLICY THE ATTACHED SPECIAL POLICY CONDITIONS, FORMS, AND ENDORSEMENTS COMPLETE THIS POLICY POLICY CANCELLABLE BY THE COMPANY RENEWABLE AT THE OPTION OF THE COMPANY WE WILL NOTIFY YOU WITHIN 60 DAYS PRIOR TO CHANGING THE PREMIUM RATE MK-12 100-TN (6/06) SECTION 3 DEFINITIONS Insured Person means a member of the class(es) of person(s) as shown in Section 2, while they are covered under this Policy. Accident means an unexpected and unintended event, resulting in Injury to an Insured Person. Accident does Loss means medical Expense sustained by an Insured not include a Loss caused by disease or sickness. Person that is covered by this Policy. Ambulatory Surgical Center or Ambulatory Medical Medical Supplies means equipment or devices, which Center means a licensed facility providing ambulatory are: 1) prescribed by a Physician; and 2) primarily and surgical or medical treatment, other than a Hospital, customarily used to serve a medical purpose; and 3) clinic or Physician's office. generally not useful to a person in the absence of an illness or Injury; and 4) only available by prescription. Around the Clock means coverage applies 24 hours a Medical Supplies include all items defined as such and day, whether school is in session or not. Insurance is listed in the most recent edition of the Healthcare provided from the effective date of the Insured Person's Common Procedure Coding System reference. coverage, as indicated in Section 5, to the termination Medically Necessary means medical services, supplies or date of this Policy. treatments authorized by a Physician to treat an Insured Benefit Period means the time during which an Insured Person's bodily Injury which are: a) consistent with the Person's incurred Expense for a covered Injury is eligible symptoms or diagnosis; b) appropriate and accepted for reimbursement. The Benefit Period selected starts on according to good medical practice standards; c) not the date of the Accident. primarily for the convenience of the Insure Person, Physician or other providers; and d) consistent with the Coinsurance means that portion of eligible Expenses most appropriate supply or level of services which can which is payable by Us. Coinsurance does not apply safely be provided to the patient. toward Deductible obligations. Outpatient Benefits means benefits provided to an Deductible means the amount an Insured Person is Insured Person while not confined to a Hospital. required to pay as provided by the applicable coverage Physician means any practitioner of the healing arts, under this Policy in the event of a Loss. licensed by the state in which he/she practices and Durable Medical Equipment means equipment which: 1) acting within the scope of his/her license, including a is prescribed by a Physician, and; 2) which can duly licensed podiatrist, surgeon, osteopath, dentist, withstand repeated use, and; 3) which is primarily and chiropractor, optometrist, physical therapist and customarily used to serve a medical purpose, and; 4) graduate nurse. Physician shall not include a member of which is generally not useful to a person in the absence the Insured Person's Immediate Family. of illness, or Injury, and; 5) which is appropriate for use Physical Therapy means any form of therapeutic in the home. Durable Medical Equipment includes all treatment, whether by machine or hand, by use of items defined as such and listed in the most recent exercise, massage, adjustment, heat or cold, air, light, edition of the Healthcare Common Procedure Coding water, electricity or sound administered by a Physician. System reference. Expense means the Usual and Customary charges for Prescription Medicines means any medicine or drug, Medically Necessary treatment, service or supplies. under applicable state law that is dispensed only with Such Expense shall not include any amount not written prescription from a Physician and has a label customarily charged to persons without insurance. bearing the legend: "Caution: Federal Law prohibits the dispensing without a prescription." It is also any mixed Home Health Care means the care and treatment of an medicine with at least one ingredient bearing the above Insured Person who is under the care of a Physician, legend. only if hospitalization or confinement in a skilled nursing School Time means any period during which an Insured facility as defined in title XVIII of the Social Security Act Person is: 1) in or on Your premises during the days and would otherwise have been required if home care was months when school is in session; 2) traveling directly to not provided, and the plan covering the Home Health or from the Insured Person's residence and school by a Service is established and approved in writing by such vehicle supplied by You; 3) participating in or attending Physician. Home care shall be provided by a certified activities sponsored solely by You that are continuously home health agency possessing a valid certificate of supervised by You, Your official or employee. This approval issued pursuant to public health law. includes supplied and supervised travel directly to and from such sponsored activities. Hospital means a licensed institution including a tax-supported institution of the state, which has on the Sound, Natural Teeth means natural teeth, the major premises, or prearranged access to, medical and surgical portion of the individual tooth is present, regardless of facilities. It must maintain permanent facilities for the fillings or caps, and is not carious, abscessed or care of overnight resident patients under the care of a defective. Physician. It must have a Registered Nurse (R.N.) always on duty or call. Confinement in the special wing Usual and Customary Expense means an Expense which of a Hospital used primarily as a nursing, rest, (a) is charged for treatment, supplies or medical services convalescent or extended care facility is not Medically Necessary to treat the Insured Person's confinement in a Hospital, unless such confinement is condition; and (b) does not exceed the usual level of because of a lack of space in the Hospital's full service charges made for similar treatment, supplies or medical wing. services in the locality where the Expense is incurred. Hospital Confinement means a stay in a Hospital for 18 We, Us or Our means Markel Insurance Company.