Soccer Accident Insurance

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 180 days;
• Each claim is subject to a $500 Deductible; and 20% member Coinsurance

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.

Claim Submission and Required Documentation

The claim submission process depends on the date of injury. Follow the instructions below for the applicable injury date.

Incident Reports

All accidents require a completed AYSO Incident Report, signed by the Regional Commissioner or Safety Director and submitted to riskmanagement@ayso.org.

The Incident Report and insurance claim are separate submissions. For injuries occurring on or after July 1, 2026, families may begin the online insurance claim while arranging for the Region to submit the signed Incident Report.

Missing or incomplete documentation may delay claim review or payment. It does not prevent families from beginning the online claim submission. Provide requested documentation as soon as it becomes available, and observe the applicable policy deadlines.

For Injuries Occurring on or After July 1, 2026

Soccer Accident Insurance claims for injuries occurring on or after July 1, 2026, are administered by A-G Specialty Insurance. These claims are submitted online; a two-page paper Accident Insurance Claim Form is not required.

1. Submit Your Insurance Claim Online

Complete the AYSO online injury claim form.

Separately, ensure the signed AYSO Incident Report is submitted to riskmanagement@ayso.org by the Regional Commissioner or Safety Director.

2. Receive Your Claim Number

After AYSO reviews and approves the submission and A-G generates a claim number, the parent or guardian will automatically receive an email from A-G containing the claim number and billing instructions.

Save this email and follow its instructions for submitting supporting documentation.

3. Share Your Claim Number with Medical Providers

Give your A-G claim number to all hospitals, doctors, urgent care facilities, and medical billing departments involved in treatment. Ask providers to include it when submitting bills to A-G so their bills can be matched to the correct claim.

Include the claim number on supporting documentation and correspondence.

Submit Medical Bills and Supporting Documents

Supporting documentation includes:

• Itemized medical bills, commonly CMS-1500 or UB-04 forms, showing services and charges.
• Explanation of Benefits (EOB) statements from the claimant’s primary health insurance, if applicable.
• Receipts for eligible medical expenses paid directly by the claimant.
• Any additional information requested by A-G.

If the claimant has primary health insurance, submit charges to that insurer first. A-G reviews eligible remaining expenses as the secondary/excess payer, subject to the policy’s terms, conditions, and exclusions.

If the claimant has no primary health insurance, the claim may still be submitted. Eligible expenses will be reviewed under the applicable policy provisions.

A-G Specialty Insurance – Claims Support

For help submitting documentation, checking claim status, or answering claim questions:

• Email: affinity@agadm.com
• Phone: 484-320-7286
• Fax: 610-933-4122
• EDI Payer ID: 11370

Have your claim number available when contacting A-G.

For injuries occurring July 1, 2025–June 30, 2026, follow the MY2025 claim form and submission instructions below.

For injuries occurring between JULY 1, 2025 and June 30, 2026 only:

   Download Soccer Accident Insurance Claim Form - MY25

   Download Soccer Accident Brochure - MY25

   Download (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: 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

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 for MY25), 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 or (888) 293-9229.