Indiana Quarter Horse Racing
Shelbyville Indiana


Indiana Grand Race Course




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~ QHRAI Benevolence
Health Program - Claim Form

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~ Workmans Comp Form~

QHRAI Benevolence Health Program for 2016

Eligibility Requirements –

1. Must be licensed by the IHRC for involvement in Quarter Horse Racing in Indiana.

2. Breeders, Stallion Owners and other horsemen that are directly involved with
Quarter Horse Racing, but not required to receive an IHRC license are eligible
with approval by QHRAI Board of Directors.

3. To be eligible, horsemen must have conducted no less than 50% of their Quarter
Horse Racing Business in Indiana, either in the current or past year. Example- Trainer,
Owner, Jockey must have at least half of their official starts in Indiana; Breeders, Sire
Owners must have had at least half of their “raced” foals race in Indiana.

4. Eligibility of horsemen not covered above can be approved by the QHRAI Board of Directors.

5. Only dependents in the immediate family and same household of an eligible
beneficiary are eligible for consideration for benefits.

6. To be eligible you must have participated in Quarter Horse racing in Indiana in the
current or immediate past year. Exceptions may be considered if approved by
the QHRAI Board of Directors.


1. Except in emergency situations approved by the QHRAI Board of Directors, the
total payment on ALL applications for aid shall NOT exceed the applicant’s annual
individual limits set forth below.

2. The QHRAI may increase these limits in emergency situations, and after
QHRAI Board approval.

3. These limits are subject to review at least semi-annually by the QHRAI Board of Directors.

4. These limits will be subject to change if substantial legislative changes occur,
an unanticipated number of claims are submitted or any other circumstance out
of the QHRAI’s control that would prohibit our ability to fund this program at the levels below.

Annual limits for the calendar year 2016

1. Individual Maximum - $1,500.00

2. Family Maximum - $2,500

Application Limit –

1. Each application for $500.00 or less – Pay Full Amount

2. Each application for more than $500.00 – Pay first $500 Plus 25% of remainder
of claim. Rounded up to the nearest dollar, not to exceed maximum annual limit.

3. Individual application for Eye Glasses – Not to exceed $500.00

4. Individual application for Dental - Not to exceed $1000.00

a. NOTE – Dental and Optical do apply to maximum annual limits.

Claim Applications to –

QHRAI Benevolence Administrator
P O Box 399
Shelbyville, IN 46176

** Or submit at a QHRAI Board of Directors meeting

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