Insurance Program

2007-2008 Insurance Summary
Wisconsin Youth Soccer Association
10201 W Lincoln Ave, Suite 207
West Allis, Wisconsin 53227
Web site: www.bollingersoccer.com

Requests for certificates of insurance must be submitted to the Wisconsin Youth Soccer State Office. Regarding naming sponsors as additional insured, we need to have the sponsor's name, mailing address, contact person and fax number. Copies are then sent to the named contact of the additional insured and the president of the soccer club. Turn around time is approximately 24 hours.

Click Here for the Wisconsin Youth Soccer Insurance Claim Form

General Information on the Liability and Accident Insurance Program:

Who is covered? All registered members and players of teams and leagues of the Wisconsin Youth Soccer Association.

When are they covered? The Insurance plan provides coverage to insured persons while participating in the following activities:

1. Scheduled games, team practices, or sponsored activities, provided they are under the direct supervision of a team official; or sanctioned local, regional or national tournaments, as a member of a contestant team.
2. Group travel directly to or from such scheduled practices, games or sponsored activities is covered under the accident policy. The liability policy provides non-owned and hired automobile liability only while on the official business of the Wisconsin Youth Soccer Association.

Plan Administrator
If you have any questions regarding this insurance plan, contact the Wisconsin Youth Soccer Association State Office, or the Insurance Plan Administrator:
Bollinger, Inc.
John T. Spiotta, Senior Vice President
830 Morris Turnpike
Short Hills, New Jersey 07078
Telephone: 800.526.1379 Fax: 973.467.0759
Web site: www.bollingersoccer.com

Accident Policy Benefits:

*This is a Full Excess policy.  This insurance is payable in excess of any other valid and collectible Health Plan or insurance in force at the time of the accident which causes the loss.  A deductible of $250 will apply to each covered accident.  Eligible accident medical expenses will be paid if incurred within one year from the date of the covered accident, including a dental benefit for whole or sound natural teeth.

What is covered? Medical care including treatment by a legally qualified physician, surgeon, dentist, registered nurse, or hospital service. The first medical treatment for the injured must commence within 60 days of injury. Claims will be paid on a Usual and Customary basis, meaning that fees and services which do no exceed those generally charged for similar care in your local area will be covered.

What is not Covered? Some of the losses that are not covered by Accident Insurance are: self-inflicted injuries; suicide; war; illness; travel in any aircraft, except as a fare-paying passenger on a commercial aircraft; being under the influence of drugs or narcotics; being intoxicated; hernia, and pre-existing conditions.

Also, the following medical and dental expenses are not covered: diathermy, light, or other heat treatment; repair/replacement of dentures; fillings or crowns; replacement/repair of eyeglasses, contacts or prescriptions therefore; masseur; braces; services/treatment by a physician retained or employed be the insured; injuries covered by workers compensation and pre-existing conditions.

How to file an Accident Claim
Submit an Accident Claim form to the State Association office by clicking here. In the event of an injury requiring medical treatment, you should:

1) Complete the Claims Form and include copies of all itemized bills.

2) NOTE: This is an Excess Policy. If you are covered by any other Health Plan or insurance, you must submit your bills to your other insurance carrier first. After your other insurance carrier has paid their share of the claim, you may then submit any remaining balances due under this plan. Be sure to send copies of all invoices and the Explanation of Benefits from your other insurance carrier with this claim form.

3) After you have completed the claim form, the bottom portion marked "Verification from a Team Manager or Team Representative" must be filled out and authorized by the state association.

4) Send the claim form and all relevant materials to:

Wisconsin Youth Soccer Association
Attn: Executive Director
10201 W Lincoln Ave, Suite 207
West Allis, Wisconsin 53227

The State Association will then forward the completed claim onto Bollinger, Inc. for processing and payment.

Liability Limits
The liability policy provides the following coverages:

Exclusions
The standard ISO 1996 Commercial General Liability exclusions apply.

Underwriting Insurance Company
The accident and liability policies are issued by:

For a full description of the policy coverage, conditions and exclusions, please refer to the actual policies.

Updated October 24, 2007