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American Youth Soccer Organization Providing world class youth soccer programs that enrich children's lives.

Elmwood Park Soccer

Insurance

Insurance


Whenever a player or youth volunteer has suffered a concussion or an injury or illness that required the care of a physician or a visit to an emergency care facility, the AYSO Participation Release Form must be given to the parents or guardians. The participation release form must be completed in full and signed by the child's parents or guardians before the player or youth volunteer will be allowed to participate further in the program.

This form protects not only AYSO, but more importantly, the participants. Too often participants are out playing again before they are physically ready. Players should not participate until they are ready to play again. This form should also be used in cases of major illness.

 

Soccer Accident Insurance-updated benefit information effective July 1, 2015.

AYSO purchases Soccer Accident Insurance ("SAI"), which pays excess medical costs up to $50,000 maximum per accident to an insured person for accidental bodily injuries incurred as a direct result of participation in a covered activity subject to the policy terms, conditions and exclusions. Eligibility for benefits is 52 weeks from the policy effective date or the date of a covered accident. Download the SAI Brochure for more detailed explanation of the plan. Accident Medical Expense Benefits are only payable:

  • 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 $1000 Deductible; and 20% Coinsurance;
  • 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.

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Elmwood Park Soccer

PO BOX 350047 
Elmwood Park, Illinois 60707

Email Us: [email protected]
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