Georgia Soccer-Adult maintains medical injury insurance for the registered members. Claims are submitted to US Adult Soccer Association (USASA) and then processed through the insurance company. If the steps listed below are met, medical insurance claims can be processed timely and accurately.
We offer secondary insurance coverage with USASA Insurance. You should file with your primary insurance company first. You will file a claim, with our insurance company, for any remaining balances and/or out-of-pocket costs incurred.
The deductible per claim is $400.00. This is in addition to any deductible that the primary insurance company already has. The deductible can be paid or it can be met through out of pocket expenses and/or any additional charges that have been incurred.
The claim should be filed within 90 days from the date of injury. If it seems that the medical treatment is going to continue over a significant period of time, we do not recommend that you wait until all services are complete to file. The claim with our insurance company can be filed immediately and verified by our office. It is much easier to add additional charges to an already active claim than it is to initially get the claim started.
Procedures for Filing Medical Insurance Claims
- Complete the USASA Injury Claim Form: [LINK]
- USASA will complete additional verification and forward the form to the Insurance provider.
- The injured person will then receive a claims acknowledgment letter directly from the Insurance provider.
- The email addresses you will receive communication from are: cdxnotify@agadministrators.com and affinity@agadm.com
- This letter will verify that the claim form has been received and also provide a claim number, which can be given to providers and hospitals as needed or requested.
Need to request a new Certificate of Liability Insurance?
Use this form to request a new Certificate of Liability Insurance. Facility names and owner names can often be different. Ask the facility owner for the specific name for the certificate holder (i.e. Parks and Recreation or Board of County Commissioners), you can often find this information on the facility owner rental request form and policies.
Form: https://bit.ly/3i3rQJx