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Adult Insurance

This memo should be used to advise all league members (coaches, officials, players, parents) of the procedure that needs to be followed to ensure that all medical insurance claims are processed properly.

Georgia Soccer-Adult maintains medical injury insurance for the registered members that have chosen to accept this added benefit. Claims are sent to US Adult Soccer Association (USASA) and then processed through the insurance company. If the steps listed below are met, medical insurance claims can be processed timely and accurately. 

We offer secondary insurance coverage with USASA Insurance. You should file with your primary insurance company first. You will file a claim, with our insurance company, for any remaining balances and/or out-of-pocket costs incurred. 

The deductible per claim is $400.00. This is in addition to any deductible that the primary insurance company already has. The deductible can be paid or it can be met through out of pocket expenses and/or any additional charges that have been incurred. 

The claim should be filed within 90 days from the date of injury. If it seems that the medical treatment is going to continue over a significant period of time, we do not recommend that you wait until all services are complete to file. The claim with our insurance company can be filed immediately and verified by our office. It is much easier to add additional charges to an already active claim than it is to initially get the claim started.

Procedures for Filing Medical Insurance Claims

  1.  Complete the USASA Special Risk Accident Claim Form: English | Espanol. Submit by email to susan@georgiasoccer.org. Do not submit to USASA.
  2. Once the accident claim form is received, Georgia Soccer will verify registration and forward it to USASA.
  3. USASA will complete additional verification and forward the form to the Insurance provider.
  4. The injured person will then receive a claims acknowledgment letter directly from the Insurance provider. This letter will verify that the claim form has been received and also provide a claim number, which can be given to providers and hospitals as needed or requested.

Depending on the circumstances, some exceptions are made to the above-listed procedures.

If you have a particular circumstance or questions about our coverage, or if further assistance is needed, please contact Laura Halfpenny, Georgia Soccer Executive Director here.

Submitting a USASA Special Risk Accident Claim Form

  • The claim form should be completed in its entirety and sent to Georgia Soccer within 90 days from the date of injury.
  • Part B- Question 8, Line A must be signed by a coach, team manager, referee, or league official. Part B- Question 8, Line B will be signed by a Georgia Soccer official.
  • Please be sure to sign page 3, Authorization.
  • If you have other insurance, submit your itemized bills to the other carrier first. You will receive a payment Explanation of Benefit worksheet (EOB) from your carrier.
  • You may attach itemized bills and your other carrier’s EOBs that are ready at the time of submitting this Claim Form. “Balance due” statements are not acceptable.
  • Upon receipt of the claim from USASA, the Insurance provider will provide an acknowledgment letter advising you of your claim. All future correspondence concerning your claim should be directed to K&K Insurance.
  • The claim form may be sent to Laura Halfpenny via email  or mail.
  • Claims will NOT be processed unless they are submitted through Georgia Soccer.

For further assistance, please contact:

State Association Contact
Georgia Soccer
2323 Perimeter Park Drive NE
Atlanta, GA 30341
ATTN: Laura Halfpenny
(678) 993-2100
 

 

Need to request a new Certificate of Liability Insurance?

Use this form to request a new Certificate of Liability Insurance. Facility names and owner names can often be different. Ask the facility owner for the specific name for the certificate holder (i.e. Parks and Recreation or Board of County Commissioners), you can often find this information on the facility owner rental request form and policies.
 
 

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