Table of Contents

• Introduction
  
• Obtaining Coverage
  
• Sponsoring Department Premium Payment (Camp Insurance)
  
• Insurance Claims
  
• Appendix
  
• Appendix 1 Camp Insurance Request Form
  
• Appendix 2 Parental Consent Form
  

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Introduction

Accident insurance is available for workshops, camps, institutes or seminars held on campus or at University sponsored activities, which involve students or non-students. Pre-existing conditions are excluded from coverage. Twenty-four (24) hour insurance protection coverage is obtainable for overnight events. This policy is "supplemental", meaning that if the participant has accidental coverage, the camp coverage pays medical costs not covered by his or her primary policy. If a participant does not have accidental coverage, then the camp policy is considered his or her primary coverage and will pay medical expenses up to $5,000 per occurrence. Medical expenses exceeding $5,000 must be borne by the participant's private insurance, their parents' insurance, or from other sources.

The associated cost depends on the type of activity and the required coverage period. Academic activities are considered lower risk with lower premiums, while sports and recreational activities are considered higher risk and therefore incur higher premiums.

Individuals who are enrolled in FSU Camp Programs and are age 65 or older are covered at the same rates as other campers. Any foreign students participating in Camp Programs who are part of the foreign exchange program will be covered; however, claims must be filed in the U.S. Any summer camp traveling out of the country, i.e., geological dig, will be covered; however, claims must be filed in the U.S. Adult chaperones who attend summer camps and are to be covered should be included with the camps' coverage. They would be covered as any camp participant.

If the participant to be covered by this insurance is a minor, parental consent for medical treatment must be obtained prior to commencement of the sponsored activity. Parental consent forms may be faxed by request or downloaded from Environmental Health and Safety's (EH&S) web site. All departments are responsible for maintaining consent forms on file up to three (3) years.

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Obtaining Coverage

As soon as it is known that coverage will be required, the sponsor must complete and submit an on-line EH&S Camp Insurance Request form, located on the EH&S website, to the Coordinator, Administrative Services, Department of Environmental Health and Safety. The form is also available in MS Word or Adobe Acrobat format from the website or may be sent via an email attachment to the sponsor. FSU faculty/staff members overseeing camps should not be included in the request for coverage; said persons are provided coverage under Worker's Compensation. A preliminary form must be submitted five (5) working days prior to the beginning date of the activity. If changes occur to the program, a revised form should be sent with all corrections upon conclusion of the activity.

All of the following information is required to obtain coverage:

• Sponsoring department
• Name of workshop, seminar or camp
• Number of campers
• Inclusive dates of activity
• Department contact name, phone number & email address
• Budget number for payment
• Names & ages of participants (indicate under 18 or 18+)
• Names of adult chaperones

A copy of the form must be sent to Thagard Student Health Center if that facility will be used for treatment.

This policy covers each insured person during the policy period while he or she is participating in, attending or preparing for the FSU sponsored camp activities while on the premises of, designated by and under the direct supervision of the Camp Program or traveling with a group in connection with such activities under the direct supervision of the Camps.

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Sponsoring Department Premium Payment (Camp Insurance)

The EH&S Senior Accountant audits the insurance provider's invoice for accuracy. Since the invoice covers multiple programs, it is paid from the EH&S Insurance Clearing Account. The Senior Accountant prepares reports for each department of the amounts due for each of their activities. Once departments confirm the reports agree with their records, a charge document (FSU Form GP-16) is prepared and submitted to the Controller's Payables Office to reimburse the Insurance Clearing Account. E&G funds should not to be used to cover charges incurred by Departments.

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Insurance Claims

All insurance claims questions or concerns should be directed to the Coordinator of Insurance and Risk in the Department of Environmental Health and Safety.

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Appendix

Appendix 1 Camp Insurance Request Form

Format			Form Number	Form Name
web	doc	pdf
			EHS 2-7	Camp Insurance Reqeust Form

Appendix 2 Parental Consent Form

Format			Form Number	Form Name
web	doc	pdf
			EHS 2-8	Parental Consent Form

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