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HOW TO SUBMIT FOR SUPPLEMENTAL INSURANCE THROUGH INDIANA SOCCER

 

In the unfortunate circumstance your child gets injured while playing soccer (practice or game), the Indiana Soccer League has supplemental accident insurance to help cover the cost of your medical expenses.

 

1.  Accident Medical Policy Limits

For reasonable necessary medical expenses, youth accident medical policy pays up to $100,000 for injuries sustained in a covered accident. Dental injuries are treated like any other injury. Payment will not be made for any expenses incurred after 52 weeks from the date of injury. An expense is considered incurred on the date the medical care is rendered. A $1,000 Deductible and 80/20 Co-Insurance applies to each covered accident. A Physical Therapy/Chiropractic limit of $50 per visit/$2,000 maximum per injury also applies.

 

2.  Youth Soccer Accident Medical coverage is provided on an "excess" basis.  Therefore, all medical bills must be submitted to any other medical insurance carrier first. 

 

3.  Notice of claims must be filed within 90 days from date of injury.  The claim process can be started before personal insurance makes any payments.  It can take some time for personal health insurance to make payments and you do not want to miss the 90 day deadline.

 

4.  To submit a claim, print the claim form and instructions from the Indiana Soccer League website.  http://www.soccerindiana.org/services/insurance/

 

Indiana Soccer YOUTH or YOUTH COACH Medical Claim Form (PDF) -
Insurance Claim Instructions

 

Mail the fully completed Claim Form verified by a witness to:

Indiana Soccer League

19000 Grand Park Blvd., Suite J

Westfield, IN  46074

 

 

5.  Keep copies of all medical bills and corresponding Explanation of Benefits from the primary insurance carrier.  These will all need to be submitted to the claim adjuster for review and payment.

 

6.  Once the claim has been filed and an adjuster assigned, you will receive a letter with further instructions.  It is imperative that you read EVERY correspondence carefully! Each request will have a time frame to be completed.  If it is not completed within that time, the file may be closed.

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