THE DETAILS BELOW ARE APPLICABLE TO COVERAGE FROM 8/1/2018-8/1/2019
What is covered?
Accidental injury that occurs at USA Rugby sanctioned activities.
Who is covered?
All registered members of USA Rugby, including athletes, coaches, officials and referees who sustain an injury during a sanctioned rugby activity, and are participating on a compliant team, requirements are listed in the Membership Policies.
What is a sanctioned event?
A sanctioned event is a rugby game or practice where all participants are registered, including clubs, players, coaches, referees and volunteers. In addition, your team must be fully compliant with sufficient number of players and registered coach with all club and player fees paid in full. Tournaments must be sanctioned through USA Rugby’s tournament sanctioning process in order for insurance to be active.
What if I am injured at an activity and I am registered but others are not?
USA Rugby’s accident insurance will not cover any participant in any unsanctioned activity. Check with your coach or team administrator to verify all participants are registered prior to participating in any rugby activities.
Do I have to be registered to be eligible for the insurance?
Yes, you must be a member of USA Rugby PRIOR to any injury in order to be eligible for coverage. Your registration will be confirmed at the time your claim form is submitted to USA Rugby.
What is a deductible?
A deductible is the amount the registered member has to pay before the policy will pay a monetary benefit.
However, the $1,000 deductible for members with primary insurance coverage can be met by the costs associated with deductibles or co-payments made under the member’s primary medical insurance.
The $5,000 deductible for members who do not have primary coverage is the amount that must be paid ‘out of pocket’ by the member prior to the accident policy paying a monetary benefit.
If I have primary insurance coverage, should I file a claim?
If you have primary insurance, you MUST file a claim there first. This policy is an excess accident medical policy and is designed as a supplement to your medical insurance. After you receive the explanation of benefits form from your medical carrier, submit a copy of the explanation of benefits form to CHP to adjust the balance of the claim.
My primary insurance coverage said I’m responsible for $2,000 in medical expenses, which includes my deductible and other out-of-pocket medical expenses. How does this insurance respond?
The accident policy has a $1,000 deductible for members with primary insurance. Once the accident policy deductible is met, the policy will pay 70% of the remaining costs that primary insurance does not cover (up to the policy limit of $10,000). Therefore, in this example, the policy could pay up to $700 of the $2,000 that primary insurance did not cover.
A) USAR member with primary insurance dislocates their arm, the hospital bills total $30,000. Their primary insurance carrier is able to reduce the bill to $13,000 for in-network. Because of deductibles and coinsurance, the primary provider only pays $10,000 (leaving $3,000 to the Member). Then the member submits their Explanation of Benefits (EOB) to USAR claims team (CHP). The member is responsible for the $1,000 deductible and a 30% copay on the remaining $2,000. The USAR accident policy covers the remaining bill.
- Total Billed Amount – $30,000
- Primary Insurance Reduction – $17,000
- Primary Paid – $10,000
- Policy (CHP) Paid – $1,400
- Patient Paid – $1,600
[1600 = 1000 + (2000 * 0.3)]
If I do not have primary insurance, how will this insurance respond?
There is a $5,000 deductible for members without primary insurance. Once the accident policy deductible is met, the policy will pay 70% of the remaining costs, up to the policy limit of $10,000.
PLEASE NOTE: $10,000 is the maximum amount this policy will pay, there is no catastrophic coverage under this policy.
B)USAR member without primary insurance tears an ACL, the hospital bills total $70,000. They do not have primary insurance, therefore there is no Primary Insurance Reduction or Primary Paid. CHP is able to reduce the bill by $48,000, leaving $22,000 to be paid. The member has a $5,000 deductible, and a 30% copay, which requires them to pay $5,000 + (0.3 * $17,000) = $10,100. However, the policy limit is $10,000, therefore the member must also cover the additional $1,900. The claim payments would appear as follows:
- Total Billed Amount – $70,000
- Primary Insurance Reduction – $0
- Primary Paid – $0
- Other Reduction – $48,000
- Policy (CHP) Paid – $10,000
- Patient Paid – $12,000
[12000 = 5000 + (0.3 * 17000) + 1900]
Who is the insurance carrier?
The insurance carrier is AIG, an A+XV Best rated insurance company. CHP is a third party administrator, hired by AIG, to assist in claims handling.
Are there exclusions to this insurance coverage?
Yes, there are exclusions. Please refer to Summary of Coverage on the USA Rugby Insurance page for exclusions. Please note, this is not a comprehensive list of exclusions. Others may apply.
Is illness covered under this policy?
No, this is an Accident policy only. Only medical treatment as a result of a Rugby related activity accident at a sponsored or sanctioned event will be covered. Please do not try to substitute this insurance for a medical insurance policy that covers your total medical conditions. It will not provide this coverage.
What is accidental death and dismemberment coverage?
These are benefits in the event of death due to a covered occurrence (while at a sanctioned rugby practice or event). Additionally, there are scheduled benefits due to the loss of a hand(s), foot(s), eye(s), speech, hearing and quadriplegia, paraplegia or Hemiplegia. Please refer to the Summary of Coverage.
How do I file a claim?
To file a claim go to www.usa.rugby and click on the Membership tab on top of the page. Click on the Accident Insurance and Accident Claims tabs. Follow the detailed instructions on how to file the incident report and claims with the insurance company. Please email firstname.lastname@example.org if you have any questions.
How do I follow up on my claim?
You will be provided with instructions on how to follow up on your claim once the incident report is approved in the USA Rugby National Office.