As an affiliate of U.S. Youth Soccer, Louisiana Soccer Association (“LSA”) maintains insurance for its membership. Insurance coverage through LSA extends only to soccer-related events that are fully sanctioned by LSA.
Excess Soccer Accident Medical Benefit Plan
The LSA insurance plan is an excess/secondary insurance policy. This means that all charges must be submitted to your primary insurance carrier first and that LSA benefits are provided only after all other insurance benefits are exhausted in full. Medical or dental expenses incurred on behalf of a “covered person” must be submitted to your primary insurance carrier and an “Explanation of Benefits” from your primary insurance carrier must be provided to Pullen Insurance Services, LSA’s insurance carrier.
CLAIM PROCEDURES The Claim Procedures are outlined on the Pullen Insurance Services website.
- The Injured Person their parent or guardian should complete the online Claim Form. A confirmation email will be sent to you upon completion. 1
- The information pertaining to your Claim will be sent to LSA for approval or denial. Once approved, you will receive an email with the Claim Form as an attachment. You will need to send the Claim Form to the claims payor, Chartis, with the itemized medical provider bills and explanation of benefits (EOB) from your primary carrier. If your claim is denied by LSA, you will receive an email indicating the reason for the denial.
- Additional bills and EOBs can be submitted at a later date after the initial submission of your claim.
1 If your injuries occurred prior to September 1, 2011, you must use the paper Claim Form provided on the Pullen website.
LIMITED COVERAGE When a member has a primary insurance carrier and elects to seek treatment from a facility that is either not covered or only partially covered by that insurance carrier, LSA will not cover any additional cost over and above what would have been paid had that member stayed within his or her primary insurance plan. It will be the member's responsibility to provide the documentation proving the coverage amount of his/her insurance carrier.
COVERED PERSONS All affiliated players, coaches, assistant coaches and other adult volunteers of participating youth soccer organizations are covered by this program if:
a. Their names are listed on a registration report for that organization, and the registration report has been provided to LSA; and
b. The organization has paid the required fee to LSA for all affiliated persons; and
c. The organization has affiliated all participating players and adults, whether the individuals involved are participating in an adult, competitive or recreational program.
COVERED ACTIVITIES Covered persons are eligible for excess benefits for injuries that result, directly and independently of all other causes, from an accident that occurs while participating in any of the following covered activities:
a. Scheduled games, team practice sessions or other soccer activities sponsored by the affiliated organization, provided they are under the direct supervision of a team official;
b. Sanctioned tournaments or games, provided these activities are sanctioned by LSA or another US Youth Soccer state soccer association; or
c. Traveling directly to or directly from such scheduled games, practices sessions, or sponsored activity.
THIS OUTLINE IS ONLY FOR GENERAL INFORMATION AND NONE OF THE ABOVE SHALL AMEND OR ALTER THE TERMS OF THE PLAN DOCUMENT. THE WORDING OF THE PLAN DOCUMENT CONTROLS