2022-23 Ohio Student Accident Insurance Program

  • Pickerington Schools has made arrangements with the Student Protective Agency to provide optional student accident insurance for those wishing to purchase coverage this year.

    Please note that this is a strictly voluntary student accident insurance coverage that the district makes available to parents as a courtesy.  The full cost of the premium is paid by the parent/guardian. If there is a claim during the student day, the claim must be certified by a school official. If the claim happens during a non-school 24-hour period or over the summer, the parent completes the claim.

    Read the 2022-23 Ohio Student Accident Insurance Program brochure for details. To apply for coverage, please complete the 2022-23 enrollment form. In case of an accident, please complete and submit an accident medical claim form. Please note the coverage shown on the application.

  • Senior high football coverage requires an additional premium. All other school supervised sports are covered under the plan. This is an excess coverage policy for which benefits are payable only for that part of the loss not covered by other collectible insurance. If a person has no other insurance, the company will pay the covered medical expenses incurred within one year, up to the specified limits of the policy.

If you are having trouble viewing the document, you may download the document.

  • 2022-23 Student Accident Insurance Plans Application

    Complete the application and check the boxes for coverage desired. Tear off and keep the rest of the application, as it shows not only the coverage but the exclusions and limitations of the policy.

    Mail the applications directly to Student Protective Agency, 300 Coshocton Avenue, Mount Vernon, OH 43050 along with a money order of check payable to Student Protective Agency. The school will be notified as to who takes out coverage. You can call the Student Protective Agency at 800-278-2544 for more information.

    Comments (-1)
  • 2022-23 Student Accident Insurance Claims Form

    In case of an accident, the student or parent should immediately go to the building principal who will sign and provide the claim form if only school time coverage is taken out. 24-hour coverage needs no signature. The policy number shall be provided by the school for the claim or you can call 800-278-2544. You may give that policy number to the doctor or hospital but the bills should be sent to the parent or guardian who attach them to the claim form. Once completed, mail to the claims office at Guarantee Trust Life Insurance, PO Box 1148, Glenview, IL 60025.

    If you have any further questions regarding a claim, please call 1-800-622-1993. It is the responsibility of the parent or guardian to file the claim.

    Comments (-1)