Dear Parents and Guardians:

We wish to emphasize that the school district does not provide any type of health or accident insurance for injuries incurred by your child at school.

As a service to students and their families, our school is making available a student accident insurance plan for your child at a very nominal cost.

REASONS TO PURCHASE THIS COVERAGE:

1. Deductible and co-pays in your health plan. Many health plans have increased the amount of out-of-pocket expenses.
2. No insurance.

This plan will provide benefits for medical expenses incurred because of an accident. If you have other insurance, our benefits will be applied to your deductible or co-pay.

If you have no other insurance this will become your primary accident plan.

To purchase coverage:

1. Print the Form, which is located here:   Insurance Form
2. Print Student’s name on the face of the check.
3. Detach and retain the summary of coverage, and return the envelope to First Agency, Inc. Coverage does not become effective, until the premium is received by First Agency, Inc.
4. For coverage purchased for interscholastic football or other fall sports starting prior to the first day of school, the effective date will be the date the application and premium is received by First Agency, Inc.
5. All questions regarding this coverage should be directed to First Agency, Inc. @ (269) 381-6630, or toll free 1 (800) 243-6298.
   
   ♦ Please use one envelope for each child – do not combine applications for several children in one envelope.
   Purchase coverage on-line (with Visa or Mastercard) at www.1stagency.com/voluntaryaccidentcoveragehtm
   and then follow directions by choosing STATE and SCHOOL DISTRICT
   
   ♦ Be sure to retain the descriptive sheet for later reference.
   
   Thank you.