Student Accident Insurance

Policy Number US2067165
August 14, 2024 to August 14, 2025

Student Accident Insurance Plan             Student Accident Claim Form

Who is Insured?

This insurance Program provides coverage to all registered and enrolled students for covered Injuries sustained while the Insured Student is:

1. Participating in activities sponsored and supervised by the school except for play and/or practice of Intercollegiate Sports;
2. Traveling during such activities as a member of a group in transportation furnished or arranged by the school; or
3. Traveling directly to or from the Insured's home premises, i.e., RCC, and the site of such activities. (RCC is considered the "home premises.")

Accident Medical Expense Benefit Maximum: $25,000

How Benefits are Paid – Full Excess Coverage

Benefits are paid for covered expenses that are in excess of benefits paid by any other health care plan the insured has. This accident insurance is secondary to all other insurance policies. If no other insurance exists, benefits will be payable like primary coverage.

Exclusions & Limitations:  See Student Accident Insurance Plan

Filing a Claim

In the event of Injury, the student should:

1. Obtain a Student Accident claim form online within 30 days of the date of loss. Proof of loss must be furnished to the Insurance Company within 90 days from the date of the accident. Bills submitted after one year will not be considered for payment except in the absence of legal capacity.
2. Complete the Student Accident Claim form; attach all medical bills; attach primary carrier’s Explanation of Benefits (EOB) and mail to the Servicing Agent listed below. You must complete one claim form per Injury.

Randolph Community College Servicing Agent for Accident Claims

Important Notice:

This brochure is a summary of the important benefits and features of the North Carolina Community and Technical Colleges 2024-2025 Student Accident Insurance Plan purchased by the Policyholder and underwritten by United States Fire Insurance Company. The policy (Form BA-50000P-USF-NC) issued to and on file at the College contains all of the benefits, provisions, limitations, exclusions and qualifications of your insurance. The Policy will prevail in the event of any discrepancy between this brochure and the Policy.