SL]FFIELD ACADEMY - Suffield Academy

SUFFIELD ACADEMY
Suffield, Connecticut 06078 . (860) 668-7315 . Fax (860) 668-2966
Medical Insurance for Suffield Academy Students
20tt-2012
Sufflreld Academy requires that alt enrolled students have insurance to cover emergency and
other medical services which may be needed while they are at school. Suffield Academy offers a twooption
insurance package through the Student Insurance Division of the Mega Insurance Companies. This
coverage is used by many independent schools, as well as colleges and universities. Plan I is designed for
students who do not have existing coverage; Plan II is available to supplement existing medical insurance
coverage, particularly network plans (HMO) based in the child's home area which may not cover expenses
incurred away from home. A brief description of the coverages may be found on the back of this sheet. Your
child will receive an identification card and full description of benefits if you enroll in the program for the
20Il-20I2 school year. Our Health Center coordinates the interaction between health care providers and the
insurance company.
The premium cost for Plan I is $1,640 and it covers the twelve-month period from August 15,201I,
through August 14,2012. The premium cost for Plan II is $660 for full-year coverage (August 15,20II,
through August I4,20I2) or $550 for a ten-month option (August 15,2011, through June 14, 2012).
Please return this form to Suffteld Academy a.s soon as possible.
If you have any questions, you may call the Business Office at860-668-7315, or e-mail
pbooth @ suffieldacademy.org.
If you already have medical insurance coverage that will cover your child's expenses while at Suffield
Academy, and you have provided written documentation of that coverage (attached a copy of your insurance
card to the Permission for Medical or Surgical Treatmentform), please check Box A, sign and return the
attached Waiver/Enrollment form. If you cannot provide such documentation, you will be required to purchase
Plan I coverage. In order to enroll your child in the insurance program at Suffield, please check Box B on the
attached Waiver/Enrollment form, select the appropriate plan, sign the form and return it with your check (in
U.S, dollars),