Soccer Accident Insurance- updated benefit information effective July 1, 2021.

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 policy effective date or the date of a covered accident . Download the SAI Brochure Overview 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 90 days of covered accident;
• all claims must be filed within 90 days;
• each claim is subject to a $1000 Deductible; and 20% member Coinsurance;
• Claims will require:
  • Copies of primary Explanation of Benefits (EOB)
  • Copies of itemized insurance billing forms – UB04 or CMS1500
• No 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 maximum excess medical costs
  $15,000 for Accidental Death & Dismemberment
  $10,000 for Dental Benefit for injuries to sound natural teeth
  $10,000 for Orthopedic Benefit
  $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, 2021 and after:

2021-2022 SAI Brochure – Overview

2021-2022 SAI Brochure

2021 – 2022 Claim Form – English

2021 – 2022 Claim Form – Spanish

If you have any questions or need assistance, please contact Darryl Levi, Region 42 Safety Director