What to do when a Player has an insurance claim
PRESENTED BY: FLORIDA YOUTH SOCCER ASSOCIATION
and M.E. Wilson Co., Inc., PO Box 373, Tampa, FL 33601
(813) 229-8021
FAX: (813) 229-2795
Excess Accident coverage is automatically provided to registered members of the Florida Youth Soccer Association as part of the registration fee. The Accident policy provides coverage for registered players during sanctioned events, including regularly scheduled practices and games. This insurance is payable in excess of any other valid and collectible Health Plan or insurance in force at the time of the accident causing injury. In other words, this coverage is excess above the player’s own family health insurance.
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Policy Limits
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Accident Medical/Dental Maximum
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$50,000
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Accidental Death & Dismemberment
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$10,000
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Deductible per claim
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$2,000
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Physical Therapy/Chiropractic benefit
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$2,000/$50 maximum limit per visit
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Co-Insurance
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80/20
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Benefit Period
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104 weeks from date of injury
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The deductible will apply to each covered accident. To be eligible for coverage, medical and/or dental expenses must be incurred within the Benefit Period.
Complete the Youth Soccer Accident Proof of Loss (claim form), . The form must be signed by the Coach, the Agent of Record from your club, and parent or legal guardian. More information about FYSA insurance can be found here at the Bollinger website.
The fully completed, signed claim form must be returned for processing to:
M. E. Wilson Company, Inc.
P O Box 373
Tampa, FL 33601
Be sure to include any itemized doctor bills as well as all Explanation of Benefits that you receive from your primary insurance carrier.
What keeps the Insurance Company from paying your claim?
· Incomplete or unsigned claim forms
· "Balance forward statements" from the Healthcare providers rather than Itemized Billings.
· Failure to provide your insurance company’s explanation of benefits.
If you have any questions about reported claims or completing the claim form, feel free to call the FYSA Claims Department at M. E. Wilson Company, Inc.
1-888-229-8021
Underwriting Carrier: Markel Insurance Company
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