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GOVERNOR MIFFLIN ACCIDENT INSURANCE

Interscholastic Sports Insurance Update for the Governor Mifflin School District

The Governor Mifflin School District provides accident insurance coverage for any student athletes who are injured in the course of participating in all PIAA sports. This coverage includes all Junior High and Senior High sport activities, Band and Cheerleading activities, the Middle School Water Polo program, and all swim lesson age groups sponsored by the school district. This coverage serves as a secondary insurance reimbursement to the parents primary insurance plan. The coverage will reimburse the first $100 of a submitted injury claim, then will reimburse any deductibles, copays, or coinsurance charges under the parents primary insurance up to the limits of the policy for treatment of that injury.

The sports accident insurance works as follows:

  • The parents/guardians’ insurance is used at time of service; applicable co-pay/deductible/coinsurance is paid to provider or facility.
  • Any remaining charges from the service are billed to the parent/guardian, which they pay.
  • The parent/guardian should contact Kyle Koncar, Administrative Assistant, to fill out a claim form with Pat Tulley, Athletic Director, or applicable athletic trainer (signature needed).
  • The Districts’ sports accident insurance plan will pay the remainder of what the parent’s plan does not pay at 100% of Usual, Reasonable & Customary Charges (URC) up to the limitations of the attached benefit schedule.

MCA Administrators will process all claims upon accurate submission of the following documents:

  • Claim Form (signed)
  • All itemized bills from physician with diagnosis codes
  • All Explanation of Benefit (EOB) statements from Primary insurance carrier

Parents should mail all documents to:

MCA Administrators
PO Box 6540
Harrisburg, PA 17112
(800) 427-9308

Parents can also scan all necessary forms, bills, receipts and statements and e-mail them to the claim department at student-insurance@mcoa.com

Plan benefit schedule and claim form is attached. Parents can also download claim form here: http://www.amastudentplans.com/downloads/MCA_PA_Claim_Form_Rev8-14-12.pdf

National Athletic Trainers' Association

Contact the Sports Medicine Staff
J.A. Greene, MS, LAT, ATC, Head Athletic Trainer
Tara Davis, ATC, Assistant Athletic Trainer
Phone: 610-775-9456 (ext. 1041)

Athletic training room/office:
10 S. Waverly Street, Shillington, PA 19607
Auxiliary gym entrance – enter through doors 20 or 21.


Partner Physician:
Berkshire Orthopedics/
Team Sports Medicine
2201 Ridgewood Road, Suite 250, Wyomissing, PA 19610
Office: 610-375-4949
Dr. Stephen Soffer, M.D.

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