Accident Participant Medical Claim

The Accident Participant Medical policy provides supplemental accident medical insurance for all registered team players, coaches, managers, referees, officials, and volunteers while participating in sanctioned and approved activities of the state soccer association.   Coverage is provided on a secondary / excess basis over any other insurance available to the claimant.  A summary of the coverage van be found here (link to coverage outline page)

The accident medical claim form for each state soccer association is below.  Please select the state association you are a member of and follow the submission instructions.

Accident Participant Medical Claim FAQ

Q: Does the participant accident medical policy have a deductible?

A: Yes, all policies have a deductible.   Please consult the coverage outline for your state association regarding the deductible amount.

Q: Is the accident medical coverage secondary or primary coverage?

A: The participant accident medical coverage procured by your state association is secondary / excess coverage over any other insurance coverage available to the claimant.  All charges must first be submitted to your primary health insurance plan.

Q: What items are needed by the claims examiner in order to pay my claim?

A: The claims examiner needs the properly completed claim form, itemized medical provider bills, and the Explanation of Benefits (EOB) from you primary insurance company, if applicable.

Q: What is an itemized medical provider bill?

A: An itemized medical provider bill (HCFA, UB92/UB04) shows diagnosis and procedure codes for services rendered and is used by medical providers to bill insurance companies.  The HCFA is utilized by physician and outpatient offices while the UB92/UB04 is exclusively used by hospitals and outpatient surgical facilities.

Q: Can “balance due” statements sent to me by the medical provider be used instead of itemized provider bills?

A: No, simple “balance due” statements do not include all of the necessary information regarding the services rendered.  It is the claimant’s responsibility to request itemized bills from the medical providers.

Q: What is an EOB?

A: EOB stands for Explanation of Benefits. This is a document produced by your primary medical insurance carrier that explains their response and action (whether it be payment, denial, or pending) to a medical claim processed on your behalf.   EOBs from your primary health carrier are needed in order for the claims examiner to process your claim under the soccer association’s secondary / excess insurance program.

Q: Are payments made payable to the medical provider (physician / hospital) or to the claimant?

A: All benefits will be made payable to the medical provider unless paid receipts are provided showing the claimant already paid the medical provider.

Claims Inquiry

If you have any questions regarding the medical claim procedure or need claims status information, please call us at (817) 738-6100 or use the claims inquiry contact form.