Paulamuesse at 16:12, 8 May 2026

2026-05-08T16:12:31Z

← Older revision		Revision as of 09:12, 8 May 2026
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	=== Where to Send Soccer Accident Insurance Claim Form===		=== Where to Send Soccer Accident Insurance Claim Form===
	After costs have been incurred, the claimant (or guardian) should complete Part A of the Accident Claim Form, and received the required signatures from the Regional Commissioner or Safety Director for your Region on the required Incident Report, claim forms and supporting documentation should be sent to:~~<blockquote>~~'''~~AYSOclaims~~@~~playershealth~~.~~com~~'''~~</blockquote>We would recommend you make copies of all documents and email the claim form including itemized medical bills and copies of the EOB’s (explanation of benefits from primary insurance).~~		After costs have been incurred, the claimant (or guardian) should complete Part A of the Accident Claim Form, and received the required signatures from the Regional Commissioner or Safety Director for your Region on the required Incident Report, claim forms and supporting documentation should be sent to: '''riskmanagement@ayso.org'''

			We would recommend you make copies of all documents and email the claim form including itemized medical bills and copies of the EOB’s (explanation of benefits from primary insurance).

	===What Happens Next===		===What Happens Next===

ayso>Tiffanysosa at 20:07, 12 December 2025

2025-12-12T20:07:39Z

New page

AYSO purchases Soccer Accident Insurance (“SAI”), which pays excess medical costs up to $50,000 maximum per accident to an insured person for accidental bodily injuries incurred as a direct result of participation in a covered activity subject to the policy terms, conditions and exclusions. Eligibility for benefits is 52 weeks from the date of a covered accident. See the Maximum Benefits Payable listed below for a more detailed explanation of the plan limits. Accident Medical Expense Benefits are only payable:

* For usual and customary charges incurred after the deductible has been met;
* For those medically necessary covered expenses that the covered person receives;
* If first medical or dental expense must be incurred within 60 days of covered accident;
* Proof of loss is filed within 90 days;
* Each claim is subject to a $500 Deductible; and 20% member Coinsurance;

'''Claims will not be processed if any of the following are missing or incomplete:'''

* A Completed Accident Insurance Claim Form (two pages)
** Both parts of the claim form must be completed including 'other insurance' portion of the form
** Page 2 requires the signature of the Regional Commissioner or Safety Director for the Region
* Copies of primary Explanation of Benefits (EOB) from the primary insurance carrier
* Copies of itemized expenses: insurance billing forms – UB04 or CMS1500 or detailed forms with itemized charges and diagnosis codes, these can be requested from the primary insurance carrier
* Copies of receipts for anything paid directly by the claimant
* AYSO Incident Report, filed with the Office.

'''Primary Insurance:''' If there is no other insurance available to the registered member, the medical benefit will be processed on a primary basis subject to Usual and Customary rates, and the policy terms, conditions and exclusions.

'''MAXIMUM BENEFITS PAYABLE:''' (subject to policy terms, conditions & limits)

* $50,000 Accident Medical Maximum per Injury including Dental and Orthopedic Benefit.
* $15,000 for Accidental Death & Dismemberment.

All AYSO currently registered* members (players, coaches, managers, team workers, referees, officials and volunteer workers) are “Covered Persons” for accidental bodily injury while participating in the following covered activities:

* Team practice sessions, scheduled games, tournaments, or other sponsored activities (meetings, banquets, fundraisers) provided they are under the direct supervision of an AYSO registered volunteer.
* Travel of covered members to and from a sponsored activity such as practice sessions, games, tournaments, or AYSO sanctioned activities, provided that players are traveling as a team and a licensed adult driver operates the vehicle.

Registration requirements will be verified before any benefits are paid.

=== For injuries occurring on/after July 1, 2024 only: ===

{{Download|Media:2024 AYSO-Claim Form Only V3-2-1.pdf|Soccer Accident Insurance Claim Form - MY24}}
{{Download|Media:2023_AYSO-Claims-Form-Spanish.pdf|(Spanish) Soccer Accident Insurance Claim Form - MY24}}

===For injuries occurring on/after July 1, 2025 only: ===

{{Download|Media:AYSO_Claim_Form_MY25.pdf|Soccer Accident Insurance Claim Form - MY25}}
{{Download|Media:AIG Brochure_MY25.pdf|Soccer Accident Brochure - MY25}}
{{Download|Media:Players Health Claim Form (Spanish).pdf|(Spanish) Soccer Accident Claim Form - MY25}}

=== Where to Send Soccer Accident Insurance Claim Form===
After costs have been incurred, the claimant (or guardian) should complete Part A of the Accident Claim Form, and received the required signatures from the Regional Commissioner or Safety Director for your Region on the required Incident Report, claim forms and supporting documentation should be sent to:<blockquote>'''AYSOclaims@playershealth.com'''</blockquote>We would recommend you make copies of all documents and email the claim form including itemized medical bills and copies of the EOB’s (explanation of benefits from primary insurance).

===What Happens Next===
Once the claim has been submitted to Player's Health, an email confirmation will be sent to confirm the submission of the claim to Administrative Concepts, Inc., AYSO's TPA (third party administrator), generally within 5 business days.

Once the processing agent has received the claim, a second email will be sent from Administrative Concepts, Inc., generally withing 10 business days (check your junk/spam folders). All correspondence regarding the claim should be sent to the claims Administrator from this point forward. Contact information for the TPA: '''aciclaims@acitpa.com (888) 293-9229.'''

==Incident Reports==
All accidents require an '''[[Fill Out an Incident Report|AYSO Incident Report]]''' be completed and filed with the Office. Failure to submit both the Incident Report and the Claim Form with supporting documentation will delay processing.
[[Category:Insurance And Safety]]
[[Category:Safety Director]]
[[Category:Regional Commissioner]]

Soccer Accident Insurance - Revision history

Paulamuesse at 16:12, 8 May 2026

ayso>Tiffanysosa at 20:07, 12 December 2025