In the past, accident medical coverage for adult soccer teams and leagues was either too costly, too limited, or not available at all. Individuals were either forced to pay extremely high insurance premiums or to run teams without proper insurance protection, therefore running the risk of personal exposure to lawsuits or a participant or staff member's injury claim.

However, now a comprehensive program has been developed by USSSA Soccer to specifically cover the inherent risks involved for today's leagues and teams. This Accident Medical Insurance Program is designed to help eliminate the financial and emotional burden one can incur as a result of injury in today's soccer arena.

Who Is Covered
All named participants, volunteer workers and staff members of the Policyholder’s soccer team/league are covered while participating in sponsored and supervised Covered Activities and while traveling, directly and without interruption, to and from any Policyholder sponsored and supervised Covered Activity and their homes or places of residence.

Accidental Death, Dismemberment, Paralysis and Brain Death Benefit
If a Covered Accident results in any of the Covered Losses specified below within one year of the date of the Covered Accident, the Company will pay the applicable amount.

• Double Principal Sum for quadriplegia
• Full Principal Sum for loss of life
• Full Principal Sum for paraplegia
• Full Principal Sum for hemiplegia
• Full Principal Sum for loss of both hands or both feet
• Full Principal Sum for loss of use of both hands or both feet
• Full Principal Sum for loss of entire sight of both eyes
• Full Principal Sum for loss of one hand and one foot
• Full Principal Sum for loss of one hand and entire sight of one eye
• Full Principal Sum for loss of one foot and entire sight of one eye
• Full Principal Sum for loss of speech and hearing in both ears
• 50% of the Principal Sum for uniplegia
• 50% of the Principal Sum for coma
• 50% of the Principal Sum for brain death
• 50% of the Principal Sum for loss of one hand
• 50% of the Principal Sum for loss of one foot
• 50% of the Principal Sum for loss of sight of one eye 
• 50% of the Principal Sum for loss of speech
• 50% of the Principal Sum for loss of hearing in both ears
• 50% of the Principal Sum for  severance and reattachment of one hand or foot
• 25% of the Principal Sum for loss of index finger and thumb of same hand 
• 25% of the Principal Sum for loss of all four fingers of the same hand
• 20% of the Principal Sum for loss of all toes of the same foot
• 10% of the Principal Sum for loss of thumb

Except for the payment of benefits for Quadraplegia, if the Covered Person sustains more than one Covered Loss as a result of the same Covered Accident, the total of Benefits the Company will pay will not exceed the Principal Sum.  If a Covered Accident causes the Covered Person’s death, the total of all Benefits the Company will pay for Accidental Death and any other Covered Losses will not exceed the largest Benefit payable for a Covered Loss.

Loss of a Hand or Foot means complete Severance through or above the wrist or ankle joint.  Loss of Use of a Hand or Foot means total loss of all ability to move the hand or foot, that occurs within 60 days of a Covered Accident, continues for 12 months and is expected to continue for the remainder of the Covered Person’s lifetime.  Loss of Sight means the total, permanent loss of all vision in one eye which is irrecoverable by natural, surgical or artificial means.  Loss of Speech means total and permanent loss of audible communication which is irrecoverable by natural, surgical or artificial means.  Loss of Hearing means total and permanent loss of ability to hear any sound in both ears which is irrecoverable by natural, surgical or artificial means.  Loss of a Thumb and Index Finger of the Same Hand or Four Fingers of the Same Hand means complete Severance through or above the metacarpophalangeal joints of the same hand (the joints between the fingers and the hand).  Loss of Toes means complete Severance through the metatarsalphalangeal joint.  Quadriplegia means total Paralysis of both upper and both lower limbs.  Paraplegia means total Paralysis of both lower limbs or both upper limbs.  Hemiplegia means total Paralysis of the upper and lower limbs on one side of the body.  Uniplegia means total Paralysis of one upper or one lower limb.  Coma means a profound state of unconsciousness which resulted directly and independently from all other causes from a Covered Accident, and from which the Covered Person is not likely to be aroused through powerful stimulation.  This condition must be diagnosed and treated regularly by a Physician.  Coma does not mean any state of unconsciousness intentionally induced during the course of treatment of a Covered Injury unless the state of unconsciousness results from the administration of anesthesia in preparation for surgical treatment of that Covered Accident.

Maximum Medical Expense Benefit
If a Covered Person incurs Covered Expenses for treatment of an injury that resulted from a Covered Accident, within 52 weeks of the Covered Accident, the Company will pay the applicable amounts, not to exceed the Maximum Accident Medical Expense Benefit.  The first such Covered Expense must be incurred within 90 days after the date of the Covered Accident.

Excess Coverage:  The Company will pay Covered Expenses after the Covered Person has satisfied any applicable Deductible, and only when they are in excess of amounts payable by any Other Health Care Plan available to the Covered Person whether or not claim has been made for benefits it provides.

Pre-existing Injury Benefit
The policy will include coverage for Covered Expenses resulting from re-aggravation of an injury that occurred prior to the effective date of this policy.  In order to be eligible for this coverage, the Covered Person must:  Have received a written medical clearance from a Doctor to participate in the Policyholder’s Covered Activity; and be participating in the Policyholder’s Covered Activity when the re-aggravation occurs.

Heart or Circulatory Conditions Benefit
The policy will include coverage for Covered Expenses incurred by a Covered Person as a result of heart or circulatory conditions that: Occur and manifest themselves while participating in a Covered Activity (or within 24 hours after participation); and The Covered Person has neither received nor been advised to have any medical treatment for the condition. If the Covered Person suffers loss of life resulting from the heart or circulatory condition within 90 days from the date of participation in the Covered Activity, the benefit amount for Loss of Life, as shown under the Accidental Death & Dismemberment Benefit, will be payable.

Exclusions and Limitations
This Plan does not cover any loss to or resulting from:

• Sickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or surgical treatment thereof, except for any bacterial infection resulting from an accidental external cut or wound or accidental ingestion of contaminated food.
• Use of drugs or narcotics, unless administered under the advice of a Physician.
• War or any act of war, whether or not declared.
• Participation in any riot or insurrection.
• Air travel or the use of any device or equipment for aerial navigation, except as a fare-paying passenger on a regularly scheduled commercial airline.
• Suicide or self-inflicted injury, or any attempt thereat.
• Medical service provided by any person or facility employed or retained by the Policyholder.
• Medical service provided by any member of the Covered Person’s household.
• Dental treatment, except as the result of a Covered Accident.
• The repair or replacement of any artificial dental restoration.
• Expenses payable under any Workers’ Compensation Law or similar legislation.
• Injury sustained while riding in or on any off-road motorized vehicle.

$25,000.00 Accidental Death, Dismemberment, Paralysis and Brain Death Benefit
$10,000.00 Maximum Medical Expense Benefit
$10,000.00 Pre-existing Injury Benefit
$25,000.00 Heart or Circulatory Conditions Benefit
52 Week Benefit Period
Excess Coverage

With a $500.00 Deductible Amount:             $24.50 Per Participant
With a $750.00 Deductible Amount:             $17.50 Per Participant
With a $1,000.00 Deductible Amount:          $12.00 Per Participant
With a $1,500.00 Deductible Amount:          $9.00 Per Participant

A roster list of named participants is required prior to coverage effective date.
All premiums must be paid in advance to coverage effective date.
Minimum policy premium is $100.00

Coverage is afforded by StarNet Insurance Company, a W.R. Berkley Company rated “A+” by A.M. Best Company.

Policy Term
Annual Policy Term

Claim Service
Francis L. Dean & Associates realizes the first and foremost reason a Policyholder purchases insurance is that in the event a claim should arise, that claim is processed in a swift and professional matter.  With this understanding, all claims are processed through a partnership with The Loomis Company of Wyomissing Pennsylvania.

Claim forms are supplied at no additional charge.  All claim forms have filing instructions and a toll free (800) number for claim inquiries or filing help.  Copies of all EOB’s (explanation of benefits) and denial letters will be sent to the appropriate Policyholder official or agent.  Monthly claim detail reports for each Policyholder will also be mailed. 

Average claim processing time is approximately five to ten days.  No pre-certification will be necessary for claimants that must undergo surgery or other similar treatments.  If a claimant or physician needs to verify benefits before treatment, that claimant or physician can contact the claims office, the appropriate agent or the plan underwriter.

The claims office is a participating member of multiple preferred provider networks including 10 national networks, 85 individual PPO’s, 3,000 hospitals and 500,000 physicians.  A claimant is not required to seek treatment from physicians or hospitals that also participate with one of these organizations.  A claimant is encouraged to seek treatment at the most convenient location of his or her choice.  However, when a claimant visits a physician who is a participating member, it results in a 10% - 30% reduction of the medical bills.  Most hospitals and major physician offices are members of one of these preferred provider organizations.   When filing a claim there are no special requirements or procedures, everything is processed by the claims personnel.

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