K-12 Student Accident Insurance Forms

The QBE Insurance Company offers independent Accident Insurance for any student. Parents or guardians wishing to sign up will find links to Instructions, Applications, and Claim Forms listed below.

Please note that the QBE Insurance Company and Jefferson County Schools are not affiliated in any way. Any communication pertaining to the insurance policy coverage or benefits must be directed to the contact persons listed below.

If you have any questions please contact your local servicing agent - Mark Basile by email at: basileinsurance@aol.com or by calling Mark at:304-624-6438.

Doug Young, President
256 West Millbrook Road
Raleigh NC 27609
O: 919-846-9798
M: 919-606-0398
F: 919-846-1146

Insurance Application Instructions   Insurance Parent Application   Claim Form

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