Optional Student Insurance Forms

Dear Parent/Guardian:                                                                                                                         August 2017


We wish to emphasize that the Windom Area School District does not provide any type of health or accident insurance for injuries incurred by your child at school.  


Since children are particularly susceptible to injuries, we encourage you to review your present health and accident insurance program to determine if your coverage is adequate.  If you do not feel your insurance is adequate because of a deductible or co-insurance clause, or if you do not have insurance, we encourage you to review the student insurance program.  This plan will provide benefits for medical expenses incurred because of an accident.  An explanation of the cost and benefits is explained on the premium envelope.  


The program is underwritten by Security Life Insurance Company of America location in Minnetonka, Minnesota and administered by Student Assurance Services, Inc. of Stillwater, Minnesota.


In making application for this coverage, please read the envelope explaining the coverage carefully.  The following instructions apply:


  1. Print names, addresses and other information clearly.


2.  Please enclose a check or money order made payable to – STUDENT ASSURANCE SERVICES, INC. or

    complete the credit card payment form.


  1. Print Student’s name on the face of the check.


  1. Detach and retain the summary of coverage and send the envelope to:  Student Assurance Services, Inc., PO Box 196, Stillwater, MN  55082-0196.  Coverage will become effective at 12:01 a.m. following the date the envelope containing the enrollment form and premium is postmarked by the U.S. Post Office but not prior to August 1.  DO NOT SEND YOUR ENVELOPE BACK TO THE SCHOOL.


  1. All questions regarding the coverage should be directed to Student Assurance Services, Inc., Stillwater, Minnesota at 651-439-7098, or toll free 1-800-328-2739.  We also have a link on our website to the Student Assurance Services information and website – from our home page under “Families” click on “Optional Student Insurance Forms”

Student Assurance Services


Please sign and return the Student Insurance Letter with below if you already have adequate insurance.


Thank you,   Peggy Pfeffer, Finance Director/Business Manager