Injury Insurance Forms

 Pays medical bills on behalf of injured participants on an excess basis after family health insurance, if any, has first responded. If there is no existing family health insurance, benefits are paid on a primary basis.Covered persons include tackle and flag football players, cheerleaders, coaches, managers, officials, employees, volunteers, staff members, independent contractors, team workers, media personnel, and VIPs of the participating organization or plan sponsor.Covered activities are scheduled, approved, and adult supervised team or association activities including but not limited to tryouts, practice, play, tournaments, clinics, fundraisers, award banquets, team outings, and parades including travel to and from the place of such covered activity. Coverage is included for set-up, tear-down, and management of each event.Accident Medical Expense Benefits (full excess):Maximum benefit amount: $100,000Deductible (per injury): choice of $0 Accidental Death & Specific Losses: $10,000 

Injury Claim form (pdf)

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