ACCIDENT / MEDICAL INSURANCE (Secondary Coverage Only)

The insurance policy is for major medical only and carries a $2000 deductible

You have 90 days from date of injury to submit claim form.
For claims to be eligible for coverage you must seek medical attention within 60 days from date of injury.
For claims to be eligible you must have your own primary coverage

To fill out a form online or to print a blank claim form then click this link

1.   Either fill in online or manually complete a blank claim form (see above link). Please note that filling in an online form does not allow you to submit the claim, it simply allows you to fill it out neatly as if it was typed. You still need to print the completed online form

2.   Submit the form to IYSA. DO NOT SUBMIT BILLS. we will verify the claim and that the player is IYSA registered and that the event at which the injury occurred is sanctioned by IYSA and US  Youth Soccer

3.    IYSA will submit the form to the insurance company

4.    The insurance company will contact you, at which time they will issue you a claim number and you can then submit the bills to the.