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USA Roller Sports

USAROLLER SPORTS

ACCIDENT INSURANCE INFORMATION

Insurance Questions: Lindsey Rose lmessman@usarollersports.org

Please see "Forms" section under Resources for Insurance forms.

Effective Date

The effective date for the USA Roller Sports excess accident/medical expense benefit program is the time the athlete signs and dates this application and remits full payment to a USARS representative, initiating the individual into the master policy and confirming membership in USA Roller Sports. This application and full payment must be received at USARS Headquarters, 4730 South Street, Lincoln, NE 68506, within 10 days of the date on the application in order for the insurance to remain valid. Giving payment to a coach or club president could compromise your insurance coverage if the preceding timeline is not followed.

Who and What is Covered

Competitors/Coaches-Registered member skaters/coaches of USA Roller Sports are provided with excess (secondary) accident/medical expense benefits in the amount of $25,000 for injuries occurring ON SKATES limited to organized and supervised practice sessions held within USA Roller Sports chartered club facilities, or during USA Roller Sports sanctioned competitions and/or USA Roller Sports training sessions sanctioned by national headquarters specified to occur outside of club facilities. The event must be supervised by a club officer (or an official USA Roller Sports coach) or the USA Roller Sports designated leader of an USA Roller Sports sponsored event. The individual will be required to certify the validity of the claim being submitted. No coverage is extended to a skater injured while on skates, but who is not in training for USA Roller Sports competitions.

Non-Competitive Card Holders/USA Roller Sports Officials-Coverage is limited to accidents occurring both on or off skates while actually participating in a competition that is progress.

What is Not Covered

Training off skates or training outside of chartered club facilities, unless specified by a USA Roller Sports sanction, or any injury occurring while on skates but while not training for USA Roller Sports competitions is not covered. Sickness is not covered. Pre-existing conditions are notcovered and shall mean any condition for which treatment has been provided within (6) months prior to such injury. Re-injury is considered a pre-existing condition.

Benefits Summary

A deductible is applied per accident before any benefits are payable. Secondary accident medical reimbursement will pay 100% of the excess over payment by your primary plan. Please note there are different deductible amounts depending on whether the USARS member has primary insurance or not.   Deductibles are subject to the current policy in place; therefore, you will need to contact USARS to get the current deductible amount.

If you have any questions of what the deductible amount is, for the sport you compete in, please contact Lindsey Rose at 402-483-7551 ext. 24.

For benefit information please refer to the USA Roller Sports website (www.usarollersports.org).

Excess Coverage-All benefits are payable on an EXCESS BASIS. This means that your primary policy must pay the charge on each bill (that are payable under that policy's contract) before this insurance will pay. Proof of these payments must be submitted to the claims payer.

Accident Medical Expense-If, as a result of an injury, an insured incurs covered expenses starting within 30 days of the date of the accident, up to $25,000 will be paid for covered expenses incurred within 26 weeks of the initial injury.

Deductible-Is met by personal payments totaling the deductible amount for the injury for which you are submitting the claim. If you have no other insurance coverage, you will be responsible for the deductible amount in medical and /or dental expenses. Meeting the annual deductible for your group or any other insurance does not satisfy this requirement.

Basis For Payment-"Usual and Customary" or "Reasonable and Customary" rates. Your doctor's billing clerk will understand these terms. You will be responsible for any amount that exceeds total payable benefit.

Accident Report & Claims Forms - An accident report must be filed with USA Roller Sports by the injured individual and signed by a club officer within 14 days of the date of injury. Claim forms will be emailed by USA Roller Sports to the injured party after receipt of a completed and signed accident report form and all insurance criteria are met. The club president must verify the rink circumstances and when the injury occurred. To initiate the claims process, contact USA Roller Sports (402) 483-7551 ext. 24, within 14 days of the accident.