WHO IS COVERED?
All registered players, managers or coaches while participating in state sanctioned or approved activities.
WHAT IS COVERED?
Accidental bodily injury caused during a sanctioned activity that causes a covered participant to incur medical expense for care and treatment within 90 days of the accident.
WHAT IS A SANCTIONED EVENT?
Team Activities:
- Scheduled Games, team practice sessions and team formation events, provided they are under direct supervision of an team official and the activity is either at a facility (outdoor or indoor) in which a certificate of insurance has been issued or is approved by Nebraska State Soccer; or sanctioned local or national tournaments as a member of a contestant team. Indoor games at a non-affiliated (e.g. private for profit & etc.) facility will not be covered.
- Any friendly game in which both team are registered members of Nebraska State Soccer or the United States Soccer Federation or games against college teams in which the Affiliate Member has approved play in advance.
Sponsored Activities:
- Any clinic sponsored by a member organization, free or fees are paid directly to member organization or member coach within the same club. Clinic will be defined as any activity in which no more than three (3) age groups are represented. Players can be registered or non-registered players. Coaches can be from member club or brought in by the member organization.
- Any camp sponsored by a member organization, free or fees are paid directly to member organization. Camps will be defined as any activity in which more than three (3) groups are represented. Players can be registered or non-registered players. Coaches can be from member club or brought in by the member organization. Any camp that is ran by member staff and not sponsored by the member organization. Any camp that is ran by member staff and not sponsored by the member organization or camps where fees are paid directly to staff will not be covered.
WHAT ARE THE BENEFITS?
Excess Accident Medical Expense reimburses you up to $100,000 for excess accident medical expense if accidental bodily injury causes you to incur medical expense for care and treatment within 90 days of the accident. The benefit amount is payable only for medical expenses incurred within 104 weeks after the date of the accident. This benefit is payable on an excess basis; the insurance company and claims adjuster will determine the reasonable and customary charge for the covered medical expense. They will then reduce that amount by amounts already paid or payable by any other plan. They will pay the resulting amount, less the deductible for excess accident medical expense.
WHAT IS NOT COVERED?
This coverage does not apply to an injury occurring while fighting, except in self defense, or for injury caused by repetitive motion or cumulative trauma, and not as the result of an accidental bodily injury, for treatment that is educational, experimental, or investigational in nature, for which an Insured Person has no obligation to pay for treatment by a person employed or retained by the policyholder, for any injury where workers' compensation benefits or occupational injury benefits are payable. All expenses should be submitted for payment within 90 days of when the service was received.
This coverage does not apply to loss caused or resulting from:
- Loss occurring while the insured is in, entering or exiting any aircraft that is owned, leased or operated by his or her employer on behalf of the employer. This exclusion does not apply to aircraft chartered with a pilot or crew on a one time charter basis.
- Loss occurring while the insured is in any aircraft while acting or training as a pilot or crew member. This does not apply to passengers who temporarily perform pilot or crew functions in a life threatening emergency.
- Loss caused by or resulting from the insured's emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection or bodily malfunctions. This does not apply to loss resulting from bacterial infection caused by an Accident or from Accidental consumption of a substance contaminated by bacteria.
- Loss resulting from suicide, attempted suicide or loss that is intentionally self-inflicted.
- Loss occurring while an insured is participating in military action in the Armed Forces of any country or established international authority. However, active military service for sixty (60) consecutive days or less shall not constitute service in the Armed Forces.
- Loss caused by or resulting from an insured being intoxicated or under the influence of any narcotic, unless taken on the advice of a physician and used in accordance with the prescription.
- Loss caused by or resulting from declared or undeclared war, but war does not include acts of terrorism.
Excess Accident Medical
Maximum Benefit Amount (per injury) $100,000
Deductible Amount (per claimant) $500 with primary insurance / $1,000 without
Accidental Death and Dismemberment Coverage
Maximum Benefit Amount $10,000
-Includes coverage for accidental loss of life, limb, hearing, speech and sight.
HELPFUL DEFINITIONS
- Excess Coverage: all benefits are payable on an EXCESS BASIS. This means that any other insurance to include a personal policy, an employee group policy, a parent’s policy under which a participant is insured MUST pay the charges on each bill before this insurance will apply. Proof of these payments or EOB’s (Explanation of Benefits) must be submitted with the claim.
- Deductible: the amount of medical expenses that the injured participant will be responsible for paying for each injury before coverage is applicable. The insurance company will determine the reasonable and customary charge for the covered medical expense and then will then reduce that amount by amounts already paid or payable by any other coverage. The participant accident plan will pay the resulting amount, less the deductible.
- Covered Medical Services: medically necessary treatment by a physician or dentist, hospital room and board, use of an ambulance, dental work to sound natural teeth, prescription drugs, diagnostic tests and x-rays, rental of durable medical equipment like wheel chairs or hospital beds, prosthetic appliances, orthopedic appliances or braces.
How do I file a Claim?
The policy is triggered by a claim being brought against the named insured of the policy. In the event of a claim, notification should be given immediately to American Specialty Insurance Services 142 North Main Street, Roanoke, IN 46783, telephone 800-245-2744. The online claim form can be accessed through the following link:
QUESTIONS?
Contact Donna Rudicel – American Specialty Claims Department
Phone – 800-566-7941 Ext. 306
Email - Drudicel@amerspec.com
This is only a general summary of coverage and is not intended to attempt to describe all of the plan provisions, limitations and exclusions. Actual coverages are detailed in the policy and are subject to the conditions contained therein. |
