2012-13 Group Accident Insurance Program
USA Track & Field, in an effort to promote the sport of Track & Field, Long Distance Running and Race Walking has purchased an Excess Accidental Medical Expense and Accidental Death and Dismemberment Insurance policy for its athlete members and registered officials. This insurance coverage is secondary to other insurance such as health coverage, disability or similar, governmental plan or program; or coverage provided or required by any law or statute and Workers’ Compensation. Covered persons must first submit their claim to all other insurance companies before claims on this policy will be processed.
Coverage is provided for excess accidental medical expense incurred (and accidental death and dismemberment) as the result of an accidental bodily injury occurring while you are participating in sanctioned events and registered practices scheduled by USATF member Clubs. Practices must be under the supervision of your Club's coaches or managers. Coverage includes travel directly to and from such sanctioned events and practices. Coverage is also provided while you are competing as a member of an approved international competition, while training at USOC training centers, and while participating in USATF Committee activities.
Schedule of Benefits
Excess Accidental Medical Expense Benefit
If you suffer an accidental bodily injury covered by the terms of this plan, which requires medical care and treatment this plan will pay up to a maximum benefit amount of $10,000:
The plan deductible of $200 will be deducted from the amount paid. The deductible applies separately to each person and each accident. In addition, the Excess Accidental Medical Expense Benefit is payable on an excess basis. The insurance company will determine the reasonable and customary charge for the covered medical expense, and then reduce that amount by amounts already paid or payable by any other plan. Other plan means any other insurance or other payment source for medical services including but not limited to health coverage; disability or similar; governmental plan or program; or coverage provided or required by any law or statute, including automobile “fault” and “no-fault” coverage and Workers’ Compensation.
Benefits are payable for expenses incurred within 52 weeks of the date of the accident up to the Maximum Benefit of $10,000. The first medical expense for a covered injury must be incurred within 30 days from the date of the accident, otherwise no benefits are payable. All claims must be filed within 90 days of the injury or as soon as reasonably possible.
Other Medical Provisions
Medical services are the costs for the medically necessary services of medical care and treatment by a physician or a dentist; hospital room and board and hospital care, both inpatient and outpatient; drugs and medicines required and prescribed by a Physician or a dentist; diagnostic tests and x-rays prescribed by a Physician or a dentist; transporting in an emergency transportation vehicle from the location where the person becomes injured to the nearest hospital where appropriate medical treatment can be obtained; dental care and treatment due to injury; treatment performed by a licensed medical professional when prescribed by a physician, if hospitalization would have been otherwise required; rental of durable medical equipment designed primarily for use, and used primarily, by people who are injured, such as a wheelchair or a hospital bed; artificial limbs and other prosthetic appliances.
No payment will be made for treatment of services rendered at a facility provided by USA Track & Field or by its staff members, employees and designated sports medicine volunteers (doctors, trainers, chiropractors, etc.). No payment will be made for physical therapy or chiropractic services.
The dental benefit is $250 per tooth, payable for expenses incurred for the necessary care and treatment of sound natural teeth resulting from injury due to an accident. Such care and treatment must be recommended and given by a licensed dentist and incurred within 52 weeks of the date of the accident.
Accidental Death and Dismemberment
If an accidental bodily injury results in a loss specified below within one year after the date of the accident, the policy provides the following benefits:
|For Loss of Life||$10,000|
|Both Hands or Both Feet of Sight of Both Eyes||$10,000|
|For Loss of One Hand and One Foot||$10,000|
|Either Hand or Foot and Sight in One Eye||$10,000|
|Either Hand or Foot||$5,000|
|Sight of One Eye||$5,000|
|Thumb and Index Finger of Same Hand||$2,500|
Loss of Speech means the permanent and irrecoverable total loss of the capability of speech without the aid of mechanical devices. Loss of Hearing means the permanent and irrecoverable loss of hearing in both ears. Loss of Hand means complete severance through or above the knuckle joints of at least 4 fingers on the same hand or at least 3 fingers and the thumb on the same hand. Loss of Foot means complete severance through or above the ankle joint. Loss of Sight means the permanent loss of vision in the eye. Remaining vision must be no better than 20/200 using a corrective aid or device. Loss of Thumb and Index Finger means complete severance through or above the knuckle joints of the thumb and index finger of the same hand.
Benefits will not be paid for any loss:
Eligible expenses resulting from re-injury or aggravation or an Injury that occurred prior to the effective date of the Covered Person's coverage are not covered.
Effective Date of Coverage
The effective date of your coverage will be from the date of your membership until the expiration date shown on your membership card, or the date the policy ends or the date you are no longer a member of USA Track & Field, whichever is earlier.
You may elect a beneficiary to whom any death benefits shall be payable by submitting written notification to the Plan Administrators on a form approved by the insurance company. The Plan Administrators will provide these forms on request. If you have not elected a beneficiary the proceeds will be paid in the following descending order: your spouse, your surviving children in equal shares, your parents in equal shares, your siblings in equal shares, or your estate.
To File A Claim
If you suffer an accident while covered by the terms of this policy, you must send all related medical bills to your employer's (or yours parent's/guardian's) insurance company for payment, if you have coverage. Claim forms for USATF Group Accident Insurance can be downloaded here.
Completed claim forms and other information must be sent to: American Specialty Insurance, PO Box 459, Roanoke, IN 46783. Do not send claim forms, medical bills or related insurance claim information to USA Track & Field or your local Association.
This program is underwritten by:
Federal Insurance Company
This program has been arranged
Entertainment & Sports Insurance eXperts (ESIX)
5660 New Northside Drive, Suite 640
Atlanta, GA 30328
678-324-3300 - Phone
Federal Insurance Company is a member insurer of the Chubb Group of Insurance Companies. The coverage and services described are descriptive only. Actual coverage is subject to the language of the policy as issued under Policy number 9906-20-44