- 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 90 days of covered accident;
- all claims must be filed within 90 days;
- each claim is subject to a $500 Deductible; and
- social security numbers, visa or green card are REQUIRED on SAI claim.
- Claims will require:
- Copies of primary Explanation of Benefits (EOB)
- Copies of itemized insurance billing forms - UB04 or CMS1500
- No 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 maximum excess medical costs
- $15,000 for Accidental Death & Dismemberment
- $10,000 for Dental Benefit
- $10,000 for Orthopedic Benefit
- $1,000 Physical Therapy; $100 per day up to 10 days
All AYSO currently registered* members (players, coaches, referees and other volunteers) 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.
- Group travel of five or more participants directly, without interruption to or from such practice sessions, games, tournaments, or sponsored 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
SAI Claim Form 1-25-24
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
2021 – 2022 Claim Form