Class 1 – All enrolled students (grades PK-12, includes enrolled and registered early childhood infants to school age), including the graduating class trip, religious services or instructions and all interscholastic student athletes excluding senior high football are covered under the Policyholder program for whom premium has been paid.
Class 2 – All enrolled boarding students (grades PK-12) excluding senior high football are covered under the Policyholder program for whom premium has been paid.
Base Plan Options:
Please make selections below indicating the Desired Plan of Coverage.
Mutual of Omaha Insurance Company
3300 Mutual of Omaha Plaza
Omaha, NE 68175
||For questions regarding enrollment or plan coverage, please contact:
Janice M. Briggs
Senior Account Executive
mobile (913) 706-1363
direct (913) 815-1300
Term of Coverage
It is understood that the effective date of coverage under this program will be August 1, or the date this form and the premium are received and accepted by the Company, whichever is later. Coverage for this term will expire on August 1.