Trip Insurance Reporting Form

Submit this form at least 24 hours prior to leaving campus for your trip.

NOTE - If this is for a student organization and you need to rent a vehicle from transportation services for this trip, you must complete a student organization transportation request at least 2 weeks in advance.

Student Organization Transportation Request

WHO MAY BE COVERED?  Any OSU student, faculty, or staff member who is taking a trip sponsored by a University department or recognized student organization.

WHAT IS THE COST?  $.40 per person, per calendar day (not 24 hour period).  Your account will be charged via a Campus Vendor Invoice (CVI)

GENERAL INSTRUCTIONS:

  1. THE TRIP INSURANCE REPORTING FORM MUST BE SUBMITTED 24 HOURS BEFORE THE TRIP BEGINS
  2. Only one trip may be reported on each form.  All individuals making any one trip must be reported on the same form.
  3. The first and last names of all individuals to be covered must be given.  Any changes must be reported before the trip begins.
  4. The name and phone number of a contact person must be provided on the “Submitted by” line. This person will not be covered unless they are listed as making the trip.

REQUIREMENTS FOR COVERAGE:

  1. The trip must be under the sponsorship of a University department or recognized student organization.
  2. The destination must be outside the corporate limits of Stillwater but within the United States, Canada, or Mexico.
  3. Coverage begins at the point of departure.

EXCLUSIONS:  The following will not be covered:

  1. Snow skiing, water sports, and activities as well as intercollegiate athletic competition of any kind, including competition between groups or organizations.
  2. Individuals who are not enrolled students, or faculty, or staff.
  3. Trips taken in private airplanes.
  4. Personal trips or vacations.
  5. Partial coverage cannot be extended, wherein the trip would be covered but the activities excluded.

WHAT MEANS OF TRANSPORTATION IS REQUIRED?  Coverage may be taken on any trip taken in a University, private, or commercial vehicle as long as the trip meets the requirements and exclusions listed above.

LIMITS OF COVERAGE:

  • Accidental Death $5,000
  • Loss of both hands or both feet or entire sight of both eyes; loss of one hand or one foot and entire sight of one eye $5,000
  • Loss of one arm or one leg $2,500
  • Loss of one hand or one foot or entire sight of one eye $2,500 ($1,250)
  • Physician, surgeon, hospital, and nurse $1,000*

*There is a $25.00 deductible clause on all claims made on this policy.

Contact the Department of Leadership and Campus Life with any questions at 405-744-0379