William S. Hart Union High School District

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School-Related Injuries Notice

Dear Parent/Guardian:

The WM. S. HART UNION HIGH SCHOOL DISTRICT ASSUMES NO LIABILITY FOR STUDENTS INJURED AT SCHOOL OR IN ACTIVITIES RELATED TO SCHOOL. The District does not carry medical or dental insurance for students injured on school premises, while under school jurisdiction, or through school sponsored activities. For this reason, the District is offering parents/guardians a low-cost, medical/dental insurance plan for their consideration.

This insurance is available to each student through a voluntary purchase plan. The coverage for this school year will be with Myers-Stevens & Company. The Myers-Stevens program is an established program that is offered in over 500 school districts throughout the State, but parents/guardians need to be keenly aware that many medical costs will not be fully paid because of the very modest premium.

There are three accident/medical plans available; each plan provides a different level of benefits. All of the plans may be purchased on either a “School-Time” or “24-hour” basis. The “Dental Accident” plan may be added to the other coverages or purchased by itself.

IMPORTANT INFORMATION: State law requires students to have adequate medical insurance prior to being allowed to participate in interscholastic sports.

TACKLE FOOTBALL PLAN: The accident insurance plans described above cover all athletics except tackle football. Coverage for tackle football is also offered at additional cost through separate coverage. You may purchase tackle football coverage as indicated on the application form.

Providing insurance coverage for your child should ease your concerns in the event of injury. You can obtain information on coverage when using the online registration or obtain a brochure from your school site and complete the application, follow the instructions in the brochure, enclose your check or money order and mail the application directly to Myers-Stevens. The District accepts no responsibility for coverage for any applications submitted to the school. Please retain the brochure attached to the application for plan descriptions and claim procedures. Following receipt of your application, an individual I.D. card will be mailed to you to assist in obtaining medical treatment.

If you have any questions, please contact the plan administrator, Myers-Stevens & Company, at
(800) 827-4695 or Sonia Pishehvar, District Risk Manager at (661) 259-0033 Ext. 253.

Sincerely,
Ralph Peschek
Chief Financial Officer