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Claim Form Procedures

claim form procedures

Medical Claim Procedures

Any accident prior to September 1, 2021, please reach out to the State Office

Any accident or injury on or after September 1, 2021, please use the instructions below:

 

Player’s Health Insurance Claim Form Player's

               Health Insurance Claim Form Link

1.  Complete the online claim form found above

2.  When completing the insurance claim form, please refer to the notes below:
 

General Liability Cause: Operations and Premises

General Liability Description: Fall

Contact Insured:

First Name: Courtney

Last Name: Chinworth

Email Address: cchinworth@epysa.org

Phone Number: 610-238-9966

 

3.  Once the claim has been submitted, Player’s Health will reach out to you directly. Claim forms should be submitted as soon as possible (within 60 days from date of injury). Player’s Health will then collect itemized bills, explanation of benefits (EOB’s) from your primary carrier, any cancelled checks for bills you have paid relating to this injury, or any other necessary medical documentation. If you do not have primary insurance coverage, please make Player’s Health aware of this once they have contacted you.

Medical Insurance Coverage

Medical coverage for travel teams is paid through the Primary League they participate in. Recreational clubs are paid through the league they play in. Intramural leagues pay Eastern Pennsylvania Youth Soccer directly. If your club/league purchased the coverage, then there is a $500 deductible (this $500 is not applied towards your primary deductible, you will have $500 deducted from the amount you are requesting for a refund). You should check with your organization before completing the paperwork for a claim.

If you have any questions regarding the insurance process, please reach out to Courtney Chinworth at cchinworth@epysa.org.

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