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Youth Insurance Claim Form (redirect to Bollinger website - TSSA insurance carrier)

Youth Request for Certificate of Insurance


Insurance Coverage Information:

As a benefit of membership, soccer players, coaches, officials and other registered members receive the protection of Bollinger's Soccer Insurance Program for their soccer activities.

Who is covered?
Under the General Liability policy, the following are covered as Named Insureds: the Association and its member teams and leagues; all registered players and players participating in try-outs ; all member coaches and officials; volunteers of the team or league and other participants affiliated with the Association.

The Accident Policy covers: all registered players and players participating in try-outs ; member coaches and officials; volunteers and other participants directly affiliated with the Association.
Covered Activities
Registered members and volunteers are covered when participating in the following covered activities:

  • Scheduled games, team practice sessions and sponsored activities, provided that they are under the direct supervision of a team official; or tournaments sanctioned by the Association, as a member of a contestant team.
  • Group travel directly to or from such scheduled practices, games or sponsored activities is covered under the Accident policy. The Liability policy provides Hired/Non-owned auto liability only for the official business of the Association.
  • No coverage is provided under the Liability policy for parents, coaches or volunteers using any automobile to transport team members or volunteers to any practice, game, or activity.

 

 

 

Accident Insurance Coverage Description :

This policy provides coverage for accidental injuries incurred by Insured Persons, while participating in Covered Activities of the soccer association.
Underwriting Carrier: Nationwide Life Insurance Company

Policy Limits

Accident Medical/Dental Maximum

$100,000

Accidental Death & Dismemberment

$5,000

Deductible per claim

$500

Physical Therapy/Chiropractic benefit

$2,000/$50 maximum limit per visit

Co-Insurance

80/20

Benefit Period

104 weeks from date of injury


Full Excess Coverage *
*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 causing injury. The deductible will apply to each covered accident. To be eligible for coverage, medical and/or dental expenses must be incurred within the Benefit Period.
What is not covered?
Some of the types of losses or expenses not covered by this plan are: Dental expense, except for treatment resulting from injury to natural teeth; suicide or self-inflicted injury; eyeglasses or hearing aids; injury due to participation in a riot; injury resulting from declared or undeclared war; cosmetic surgery, except for reconstructive surgery as a result of the accidental injury; infection, except pyogenic or bacterial infection as a result of the accidental injury; travel in any aircraft except as a fare-paying passenger on a commercial aircraft; injury that is eligible for coverage under workers compensation; being intoxicated or under the influence of drugs or narcotics; and claims occurring while hang-gliding or parachuting.
This is only a summary of the policy benefits, terms and conditions, and does not alter, broaden or limit coverage in any way.

 

 

 

Liability Insurance Description:

Who is covered?
The Soccer Association, its member teams, leagues and clubs, and its member players, coaches and officials are all Named Insureds under this policy with respect to operations and sponsored activities of the Soccer Association.
Underwriting Carrier: National Casualty Company

2015 - 2016

Limit of Liability - per occurrence

$1,000,000

Limit of Liability - policy aggregate per location

None

Participants Legal Liability

$1,000,000

Products/Completed Operations aggregate

$1,000,000

Personal Injury/Advertising Injury limit

$1,000,000

Sexual Abuse Liability limit - per occurrence

$1,000,000

Sexual Abuse Liability limit - aggregate

$2,000,000

Hired/Non-owned Auto Liability (official business of Association only)

$1,000,000

Fire Legal Liability

$300,000

Medical Expense (to non-participants)

$5,000

Deductible

$0

This is a summary of the policy benefits, terms and conditions, and does not alter, broaden or limit coverage in any way.


What is covered?

  1. All operations of the Named Insured Soccer Association
  2. Claims for liability or negligence for bodily injury or property damage arising out of sponsored activities, premises or operations of the association, its member teams and leagues and participants.
  3. Liability for Personal or Advertising Injury, including false arrest, detention or malicious prosecution, or violation of right to privacy.
  4. Hired/Non-owned auto liability is provided only for the official business of the Association.
  5. No coverage is provided for parents, coaches or volunteers using any automobile to transport team members or volunteers to any practice, game or activity. Teams and leagues can purchase Excess Hired/Non-owned Auto Liability for their activities. Please click on "Purchase Insurance" for details.

    Certificates of Insurance
    Liability certificates of insurance will be issued on behalf of member teams and leagues to facility and field owners who need proof of coverage. Requests should be sent to the association office who will process your request in conjunction with Bollinger.

    Liability Exclusions: The usual Standard Commercial General Liability policy exclusions apply, such as Worker's Compensation, Nuclear Energy, Pollution and Lead; also, use of trampolines and fireworks is excluded.

 

 

 
 
 
Tennessee State Soccer Association | 100 Country Club Drive Suite 100 | Hendersonville, TN 37075
 
usyouthsoccer.org