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Insurance
[Claim
Form][Description
of Benefits]
USASA
Monthly Claims Report
Reports provided by USASA's Insurance Agent -
DesChamps & Gregory
As a registered member of your local NCASA
sanctioned league, you are entitled to accident
insurance coverage through USASA with K & K
Insurance Co. Your coverage is paid for as
part of your annual registration fee. It
is important to understand that the accidental
insurance coverage is secondary to your primary
health coverage with your employer, but it can
still offer assistance in many cases in the
event of a soccer related injury irregardless of
your primary plan coverage.
The
Accident and Health Plan under the USASA policy
provides a supplementary/excess combined maximum
benefit not to exceed $5,000 per incident after
the incident deductible of $400 has been
satisfied. Only allowable charges may be
applied to the deductible or paid in accordance
with policy limits. Medical charges for
injuries incurred only at the time of the
covered accident are eligible. The injured
participant must seek treatment for the claimed
accident within 60 days of the injury.
Services other than those with pre-established
maximums are subject to plan guidelines.
(This is a benefit description only, not a
guarantee of payment.) A more detailed
summary of benefits will be provided to the
participant upon request.
Claim
forms with incomplete information will require
additional information requests that delay
payment. Should you receive a request for
additional information, please respond
promptly.
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