Please forward completed claims forms to AG ADMINISTRATORS, mail to PO Box 979, Valley Forge, PA 19482 ; Fax: 610-933-4122. For assistance with coverage questions or the claim process, please contact aysoclaims@playershealth.com for assistance.
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:
2023-2024 SAI Brochure – Overview
2023-2024 SAI Brochure -Spanish
SAI Claim Form Spanish 1-25-24
For injuries occurring on June 30, 2023 and earlier:
2021-2022 SAI Brochure – Overview
