Documents › Board of Education, 2026-07-16

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Also attached to this agenda item: 2026-2027 Pupil Benefits Plan

pupil Pupil Benefits Plan, Inc. benefits 101 Dutch Meadows Lane, Glenville, New York 12302 plan, — (518)377-5144* (800) 393-3301* fax (518)377-3291 insuring nts since EMAIL TO: Elaine@pupilbenefits.com Student Accident Coverage Request [ 2026-2027] please check box Rate Per Student COVERAGE R mI Usual & Customary [$9.90] No deductible [CROTON-HARMON] School District Assistans panes or OP Business Manager SP SYSESS Mae lel 2/2 bo Date Any person whe knowingly and with intent to defraud any insurance company or other person files an application for insurance or Statement of claim containing any materially false information, or conceals for the purpose of misleading, Information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty notto exceed five thousand dollars and the stated value of the clalm for each such violation. Cs x a Ky SIGNATURE Coverage effective July 1, [2026]- June 30, [ 2027 ]. Please complete this blanket coverage request and return to Pupil Benefits Plan before June 1, [2026]. Your total enrollment will be requested as of September ist. Form CovReq22-R