The US Lacrosse Accident Plans provide coverage for Accidental Injuries to members as a result of their participation in a covered lacrosse activity. The Accident Plans are comprised of two policies: the Basic Accident Insurance policy and the Catastrophic Accident policy.
These coverages are a benefit of membership and are intended to provide supplemental insurance coverage to help defray medical, dental and hospital expenses that members may incur while participating in lacrosse activities. This is not a healthcare plan and is not intended to cover 100% of expenses for which a member may be responsible. In addition, please note that these plans do not cover sickness, bodily illness or disease. It is strongly recommended that all lacrosse participants have their own primary healthcare or medical insurance in place.
The two policies combine to provide $1 million in Accident Medical coverage to US Lacrosse members. The first policy, Basic Accident Insurance, provides coverage up to a $100,000 Medical Expense Limit. The second policy, Catastrophic Accident, covers claims that exceed $100,000 within 2 years from the date of injury and provides coverage from that point up to a $1 million limit.
Who is Covered?
The Accident policy protects the following while participating in covered activities: all currently registered member players, coaches and officials; and those insured as non-members under the programs insured individually under the US Lacrosse Event Insurance plan.
Basic Accident Coverage Description
The Basic Accident Insurance policy pays the reasonable and customary charges for a covered accidental injury to an insured member, if that injury requires treatment by a legally qualified physician, dentist or graduate nurse; confinement in a hospital; ambulance service from the site of the injury to the initial treatment facility; and services and supplies ordered by a physician.
Accidental Injury is defined as "a sudden, unexpected and unintended event which is identifiable and caused solely by an external physical force resulting in injury to the insured person." This policy does not cover claims arising out of sickness, bodily illness or disease, such as cardiac arrest, asthma or stroke. However, the Accidental Death Benefit has been extended by US Lacrosse to provide coverage for members who suffer a fatal Cardiac or Circulatory (Stroke) event during a lacrosse activity.
To be eligible for coverage under the Basic Accident policy, the first medical or dental expense must be incurred within 60 days of the date of injury; and any further expense must be incurred within two years of the date of injury. Claims are paid on a "reasonable and customary basis" by geographic area (by zip code) where treatment is rendered.
All Accident claims must be filed within 90 days of injury to be eligible for payment. For claims covered by your primary insurance company, you must also file the claim with Bollinger as soon as it practicable (i.e once payment has been made by your primary insurance company).
Base Accident Policy Limits:
Medical Expense Limit - $100,000
Accidental Death Benefit - $20,000 (includes cardiac/circulatory coverage*)
Accidental Dismemberment Benefit - $20,000
Deductible for Adult Male Players - $3,000 per claim
Deductible for All Other Participants - $1,000 per claim (youth, HS, adult women, coaches, & officials)
Physical Therapy/Chiropractic limit - $2,000 (subject to $50 max per visit)
Durable Medical Equipment Limit - $2,500
Benefit Period - 104 weeks from date of injury
Game Fee Reimbursement (for officials only) - up to $200 per game, subject to $5,000 maximum per policy term
*Cardiac/Circulatory Coverage: If a member dies within 48 hours of a Cardiac or Circulatory (Stroke) incident during a covered activity, this policy's Accidental Death Benefit will be paid to the member's family. This policy does not provide any other coverage for sickness or illness. Therefore, no benefits for any medical expenses incurred as a result of the cardiac or circulatory incident are payable by the US Lacrosse Accident plan.
Full Excess Coverage means that the policy will pay for covered expenses as a result of an accidental injury, after any other applicable insurance policy or any other health care or employee benefit plan has paid out its benefits.
If the claimant has no health or medical coverage, or if the claimant is covered by Medicare or Medicaid, the Basic Accident policy will pay benefits on a primary basis, after the deductible has been taken.
Deductible: The deductible under this policy applies to each claim regardless of payments made or deductibles taken by other (primary) insurance.
Officials’ Game Fee Reimbursement: In addition to the Accident Policy benefits, officials are covered for Game Fee Reimbursement, to cover lost fees if they are prevented from officiating due to injury while officiating. Only fees for missed lacrosse games are payable by the policy and the official must have been injured while officiating lacrosse in order for coverage to apply.
|Game Fee Benefit:||Up to $200 per missed game|
|Waiting Period (Deductible):||7 days from date of injury (no benefits are payable for games missed during the Waiting Period)|
|Benefit Period:||26 Weeks|
|Maximum Benefit Payable:||$5,000 per policy term|
When submitting a claim for the Game Fee Reimbursement Benefit, in addition to the information required to file a claim, member officials must include the following: a schedule of the games they were assigned to officiate, and written confirmation of their fee (compensation) from their assignor(s). Claims for Game Fee benefits can not be paid without this written information from the assignor.
Basic Accident and Catastrophic Accident Policy Exclusions
The Accident policies cover only those medical/dental expenses arising out of Accidental Injuries that occur during covered activities. The policies do not provide coverage for claims arising out of sickness, illness or bodily conditions.
In addition, these policies do not cover any loss, fatal or non-fatal, incurred or resulting from the following:
- Suicide, or intentionally self-inflicted injury;
- Infections except pyogenic or bacterial infections caused wholly by a covered injury;
- Injury or sickness resulting from any declared or undeclared war;
- Loss resulting from air travel, except as a fare-paying passenger on a commercial airline;
- Expenses for treatment on or to the teeth, except for treatment resulting from injury to natural teeth;
- Eyeglasses, hearing aids, and examination for the prescription or fitting therof;
- Injury or sickness covered by any workers' compensation or occupational disease law;
- Hernia, unless it results from a covered injury;
- Injury resulting from the insured being intoxicated or under the influence of any narcotic unless administered on the advice of a physician.
How to File an Accident Claim
If you are injured during a covered lacrosse activity, you may obtain a claim form and instructions on filing the claim by clicking here: How to File a Claim
All claims are handled and paid by RPS Bollinger, insurance administrator for US Lacrosse.
This summary is a brief description only of the coverages, conditions and exclusions of the policy, and in no way affects or alters the scope of coverage provided. For the full details of terms and limitations, please refer to the actual policy. which is made available for review at the US Lacrosse National Office in Baltimore, Md.