The School Districts of Manatee County have purchased a Mandatory Compulsory Accident Insurance Plan which covers its students during school time hours.  The School Districts have arranged for you to have the opportunity to upgrade to a plan with higher benefits and/or 24 hour coverage. 

Student Information (Items in RED must be filled in)
School Name:
Student Name:
Mail Address:
City:
State:                       Zip Code:     
Phone: ###-###-####
Student E-mail:   Gender  
Date of Birth: MM/DD/YYYY                  Student ID#     
 
Billing Information (Items in RED must be filled in)
Name:
Street Address:
City:
State:                         Zip Code:   
Phone: ###-###-####
Your E-mail:
 
Credit Card Information
Credit Card: (No spaces or dashes)      EXP DT: (MM/YY)

We accept  VISA/Mastercard
Card ID #:

Choose the Appropriate Catastrophic plan option

Type

 Description / Price

Upgrade Base Student Plan

** The above rates include an administration fee.

Other Questions, Comments, or Requests: