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. Download the SAI Brochure below for more detailed explanation of the plan. 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;
- First medical or dental expense must be incurred within 60 days of covered accident;
- Proof of loss must be filed within 90 days;
- Each claim is subject to a $500 Deductible; and 20% member Coinsurance;
Claims will require:
- Copies of primary Explanation of Benefits (EOB)
- Copies of itemized insurance billing forms – UB04 or CMS1500
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.
- $1,000 Physical Therapy; $100 per day up to 10 days.
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 July 1, 2023, and after:
Download 2023-2024 Soccer Accident Insurance Overview
Download 2023-2024 Soccer Accident Insurance Claim Form
Download 2023-2024 Soccer Accident Insurance Overview - Spanish
Download 2023-2024 Soccer Accident Insurance Claim Form - Spanish
For injuries occurring on June 30, 2023, or prior:
Download 2022-2023 Soccer Accident Insurance Overview
Download 2022-2023 Soccer Accident Insurance Claim Form
Where to Send Soccer Accident Insurance Claim Form
Please forward completed claims forms (after July 1, 2023) to Players Health assistance on claims at [[1]].
After costs have been incurred within 90 days of the injury, the claimant (or guardian) should complete Part A of the Accident Claim Form (You must include the policy number on line two of the claim form: Policy US2065201), and received the required signatures from the Regional Commissioner or Safety Director for your Region, claim forms and supporting documentation should be sent to:
AYSOclaims@playershealth.com
We would recommend you make copies of all documents and mail the claim form including itemized medical bills and copies of the EOB’s (explanation of benefits from primary insurance).
Incident Reports
All accidents require an AYSO Incident Report be completed and filed with the Office.
