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Mail with $30 Registration Fee and COPY of Birth Certificate.

Last year’s participants need not provide COPY of Birth Certificate.

Mail to:  Roland Bechtel, Secretary

  1573 Treasure Lake

DuBois, PA  15801

       Phone:  814-375-4340

Insurance Coverage:

As a registered participant in the DuBois Area All-American Soap Box Derby, you

are provided with certain insurance benefits at local and National Derby Events.  You

have the following benefits which are highlighted below, as follows:

I.  Participant Accident Medical Policy

 

a.  Standard Member Participant Limits

·        $5,000 Accidental Death and Dismemberment

·        $15,000 Excess* Medical Benefits

·        $250 Maximum Dental Limit

 

b.  Standard Member Volunteer Worker Limits

·        $5,000 Accidental Death and Dismemberment

·        $15,000 Excess* Medical Benefits

·        $250 maximum Dental Limit

 

*Excess over any other insurance or

self-insurance, federal, state or other

governmental plan or law.

II.  Brief Summary

 

In the event a Derby member, participant, sponsor or volunteer (as

defined in the policies) is accidentally injured at a covered Event, the

previously described coverage would be in effect for eligible medical

expenses. Any other medical coverage available to a participant,

sponsor or volunteer applies up to the limits of that policy or plan.

 

The Accident policy is an ‘Excess’ Policy, which means that coverage

is not available until all other insurance, self-insurance, or governmental

plans available are exhausted.

 

Coverage pays Reasonable Expenses for Medical or Dental care if:

 

a)   the first expense is incurred within 26 weeks

      after the accident; and

b)      the expense is incurred within 2 years after

the accident.

 

Reasonable Expenses means expenses which do not exceed those

generally charged for similar Medical or Dental Care in the local area

where treatment is rendered.

 

Medical or Dental Care means the necessary medical, dental or

surgical treatment, services or supplies, hospital, nursing and ambulance

services. All Medical or Dental Care must be provided by a legally

qualified physician or dentist for the sole purpose of treating the injury,

and all coverage is subject to specific limitations and exclusions.

 

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