As a benefit of USSA membership the following membership categories include excess participant sport accident insurance:

Coaches (all disciplines)

All USSA members are required to have valid and sufficient medical/accident insurance coverage and accept full
responsibility for provision of coverage as a condition of becoming a USSA member and participating in official
USSA training and competition. Primary medical/accident insurance must be in effect for the entire term of
the membership year. Athletes must carry proof of insurance and this must be available at each event so that
prompt medical/hospital care can be authorized, if ever needed.

Excess participant accident insurance is a benefit included with the above USSA memberships. This insurance is
excess ONLY over all other insurance. This coverage would be for those charges not covered by any other
insurance. There is a $1,500 deductible and a co-payment of 20% of the first $5,000 of unpaid charges per
accident. Maximum benefit per accident is $25,000, incurred within 52 weeks from the date of an accident.

WHEN IS COVERAGE IN EFFECT?
The coverage under this policy is in effect while properly registered USSA members are participating in a USSA
sanctioned or registered event, including official training at such event. The coverage is also in place during training
supervised or directed by a USSA Certified Member Club and/or USSA Certified Professional Coach.
All USSA members are required to sign a Waiver and Release of Liability upon application for membership. An
original signature is required for the participant to be properly registered and for the excess participant accident
insurance coverage to be in effect. Participants under 18 years of age (21 in certain states) must have a
parent/guardian permission signature.

HOW TO FILE A CLAIM
If a properly registered USSA member is injured during a USSA sanctioned or registered event, training, or
supervised practice, the injured member must first file a claim with their own personal primary insurance carrier. A
First Report of Accident form must be filed with our insurance carrier as soon as possible but under no
circumstances later than 1 year after the accident. A claim can then be filed with this policy for those charges not
covered by any other insurance. Claim forms must be filled out completely, with all required signatures, and
submitted to insurance company named below before any claims can be processed. To obtain a claim form contact
Laurie Hamble at 435.647.2695 or lhamble@ussa.org.

ALL CLAIM FORMS, INVOICES AND INQUIRES SHOULD BE DIRECTED TO:
American Specialty Insurance Services, Inc.
Attn: Claims Department
142 North Main Street, PO Box 459
Roanoke, IN 46783-0309
Phone (800) 566-7941 Fax (219) 672-8835
Revised 10/24/07