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Insurance Forms

All claims should be verified and signed by the league verification officer before sending to USASA.

All players registered with an MBSL team receive secondary accident insurance coverage for any injury resulting from participating in a game, practice, or tournament. This insurance is only secondary or excess and claims should only be filed if player(s) needs additional coverage after filing with a third party company (for players who have a primary insurance plan)

The Following is the schedule of benefits provided to players.

Online claim filing for the adult division is not available at this time.

To submit a claim visit our office or call us 831-394-0335 ext 19 to file a report.

 

ACCIDENT PLAN LIMITATIONS AND EXCLUSIONS
Current Plan Approved for 2015-2016 year

Accident Medical Expense Benefit
Dental Benefit (sound, natural teeth only)
Deductible Amount
Accidental Death Benefit
Accidental Dismemberment Benefit
Hospital Room & Board Expense (In-Patient)
Hospital Miscellaneous (In-Patient)
Hospital Miscellaneous Expense (Out-Patient
Hospital Emergency Care
Physician Expense (Non-surgical)
Surgeon Expense (In-or-Out-Patient)
Assistant Surgeon Expense
Anesthesiologist
Physical Therapy or Chiropractic Expense
X-rays (In-or-Out-Patient) including diagnostic
Imaging, MRI, CAT Scans, or similar procedures
Ambulance Expense
Orthopedic appliances or braces as a result of covered
Injury NOT for the prevention of injury