Kaneohe AYSO

SOCCER ACCIDENT INSURANCE

All players and volunteers are covered for a specific membership year, as soon as they complete the player registration and / or volunteer application form and deliver that signed form to the appropriate registration staff volunteer. This typically happens during registration day events, but it can also take place via US mail. Please note that registration forms sent via mail are only effective upon receipt, and that no player may play or practice until the region has received a signed registration form.

All AYSO registered players, coaches, referees, and volunteers are covered for accidental bodily injury while participating in the following activities:

Scheduled games, tournaments, team practice sessions or other sponsored activities, provided they are under the direct supervision of a team official.

Group travel directly to or from such games, tournaments, practice sessions or sponsored activities, provided that players are traveling as a team and a licensed adult driver operates the vehicle.

If you or your parents are covered by any other health care plan, you must submit your bills to the other plan first. After your other plan has paid their share of the claim, you may then submit any remaining balances to the AYSO plan. Be sure to send copies of all itemized bills and the Explanation of Benefits Form outlining the benefits paid under your primary plan.

The membership year begins on August 1 and runs through July 31 of the following year. Registered players and volunteers are covered under the Soccer Accident Insurance (SAI) program during the current membership year in the region to which they belong.

Our new system allows a claims agent to use the eAYSO membership system to determine if the person named on each SAI claim form is actually registered in our database. This is why it's so important for you to be sure SAI claim forms are accurately and completely filled out, especially ensuring each form contains a valid AYSO ID number. A claims agent will use this AYSO ID number to validate registration status.

After comparing the AYSO ID number on the SAI claim form against the eAYSO database, one of two events may happen. First, the AYSO ID number may not be found in the system at all. Or, the AYSO ID number is found, but it may relate to a player or volunteer record from a prior membership year. When this happens, the claims agent will never summarily deny the claim! Instead, the agent will contact the NSTC for guidance on how to proceed. An NSTC staff member will then research the issue, and may even contact you for assistance. Often the problem is traced to a timing difference between when a region receives a signed player or volunteer form and when that form actually gets entered into the eAYSO membership database, or mailed to the NSTC. Under all circumstances, it is the NSTC staff and not the insurance company, who will determine the validity of SAI claims.

How to File an SAI Claim

The claimant must do the following:

• Obtain an AYSO “Incident Report form" from your Regional Safety Director or download one here.

• Obtain an AYSO “Soccer Accident Insurance” (SAI) Claim form from your Regional Safety Director or download one here.

• Complete the portions of the claim form marked “To be completed by claimant,” and “Statement of insurance.”

• “Eligibility verification”: Secure signatures from the two authorized AYSO officials: the Safety Director and the Regional Commissioner.

• Be sure the authorized AYSO officials have fully completed every section of PART A including the AYSO region number and a valid AYSO ID number before you mail the claim form. Claim forms without this information can not be processed.

• It is the responsibility of the claimant to make a copy for his own records and then mail the claim form to Dianna Taormina, American National Life Insurance Co. of Texas within 90 days of the date of injury.

• Send your claim form with all relevant documents to:

Dianna Taormina

American National Life Insurance Co. of Texas

AYSO Accident Claims

The Loomis Company

P.O. Box 13906

Reading, PA 19612

e-mail: DTaormina@Loomisco.com

(610) 374-4040 ext. 2253

(888) 585-7065