Sports Accident Program (New York)

• Eligibility
• Who is Covered?
• When Are They Covered?
• Description of Coverages
• General Exclusions and Limitations
• Optional Features Available
• Underwriting
• General Remarks
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Eligibility

Any organization engaged principally in the play or practice of sports, with participants up to age 18, is eligible for coverage under this program. Contact your reporting office for details. This program is not intended for Sports Camps. Please refer to the Special Risk Accident program for this type of camp.

Who is Covered?

All players, managers and coaches are covered under the policy and must be included when determining the policy premium.

When Are They Covered?

The policy covers all insured persons against specified losses resulting, directly and independently of all other causes, from accidental bodily injury sustained while participating as a member of the team in a scheduled game, official tournament game or practice session; or, while traveling directly to or from such game or practice session.

Description of Coverages

Accidental Death and Dismemberment ($15,000 maximum) - Pays the maximum benefit selected if an injury resulting from a covered accident results in loss of life; both hands or both feet or sight of both eyes; one hand and one foot; or hand or foot and sight of one eye. Pays one-half the maximum benefit for loss of one hand; one foot; or sight of one eye. Loss must occur within 180 days of the accident. If more than one loss is sustained, only one of the amounts, the largest applicable, will be payable.

Loss of hand or foot means severance through or above wrist or ankle joint. Loss of sight means entire and irrecoverable loss of sight.

Accident Medical Expense ($100,000 maximum) - Pays for the reasonable expenses* incurred as the result of injuries sustained in a covered accident, up to the maximum benefit selected and subject to the deductible chosen, if any. Covers necessary medical or surgical treatment, services or supplies which are prescribed by the insured person's attending physician.

The first expense must be incurred within 26 weeks of the accident and the last expense within one year of the accident (2 years if the maximum accident medical expense benefit selected is greater than $5,000).

We will not pay more than the Maximum Benefit for all expenses incurred for all Medical Care and dental treatment, services and supplies as the result of any one accident.

Other benefit limits and deductibles are available. For further details, please contact your reporting office.

*"Reasonable expenses" means fees and prices which do not exceed those generally charged for similar Medical Care in the local area where received by the Insured Person.

General Exclusions and Limitations

The policy does not apply to (a) intentionally self-inflicted injuries, suicide or attempted suicide; (b) medical services performed by any person retained or employed by the Team or Policyholder provided no charge is made by such persons in the absence of insurance; (c) injury sustained while in or on any aircraft except as an airline passenger on an aircraft operated by a passenger airline on a regularly scheduled trip over its established route; (d) expenses incurred for the repair or replacement of existing dentures, partial dentures, braces, fixed or removable bridges, or other artificial dental restoration; (e) expenses incurred for the repair, replacement, examination for prescription or fitting of eyeglasses or contact lenses; (f) expenses incurred for the repair or replacement of artificial limbs or orthopedic braces.

Optional Features Available

• Coverage is available for bat boys, equipment managers, ball boys, scorekeepers, trainers, and volunteer workers on a team or league basis.
• Coverage is available for umpires and referees if all teams in a league are insured.
• Coverage is available for members of the policyholder participating in team sponsored and supervised activities (other than a scheduled game or tournament game or practice session) and while traveling to and from such activities.
• Excess Coverage - Lower rates are available if the accident medical coverage is purchased on an excess basis over and above other group, blanket, or franchise health insurance coverage; other group hospital or medical service plans, and prepayment coverage; any coverage under labor-management trustee plans, union welfare plans, employer organization plans, or employee benefit organization plans; coverage under any governmental program or coverage required or provided by any statute, except Medicaid; and coverage provided by any mandatory no-fault automobile insurance. Excess coverage is not available for policies issued on a contributory basis. In addition, it may only be used for Student Accident only coverage or Youth Organization Accident only coverage.

Please note that any amounts paid by another "Plan" as defined above cannot be used to satisfy any deductible under our policy.

Please Contact Your Reporting Office For Full Details On These Optional Features.

Underwriting

Complete the request form contained in this site, taking into consideration the following:

1. All sports rates are set forth on an individual basis according to the age group. This will afford greater flexibility in all quotations. The individual rate is the sum of the rate for the Accident Medical Expense Benefit and the rate for the Accidental Death and Dismemberment Benefit.
2. In most cases, team rates will be requested. To obtain team rates for any age group, simply multiply the number of members on the final team by the individual rates for the coverage desired. Tryouts will be automatically covered - see exceptions in (g). No additional or return premium will be applicable for additions or deletions to the team.
3. When more than one age group is involved, a composite premium may be determined by using the following formula: Composite Premium = AX + BY + CZ A, B and C = the number of participants in each age group. X,Y and Z = the corresponding rates applicable to each age group.
4. For the purpose of rating, all members of a high school team will be deemed to be in the age group 16-18.
5. It is not permissible to insure only certain members of a team or squad. All team or squad members (including managers and coaches) must be included.
6. The "per participant" rate will be charged for each manager and coach. When more than one age group is involved, use the rate of the age group with the largest number of participants.
7. Coverage for tryout periods is automatically included in the rates for all sports (except high school tackle football) and regardless of the number of persons participating in the tryout period. The final number of team members should be used to compute the team premium. (For high school tackle football, a separate premium is applicable for the tryout period.)
8. If coverage was previously provided by another carrier, premium and incurred loss information for the past 3 years must accompany the request form. A copy of the previous carrier's policy, certificate or brochure must also be included.
9. Coverage will commence on the desired effective date or on the date the request for insurance is approved by the Company, whichever is later.
10. Coverage may be provided for all the teams of a school district, recreation program or town. Each sport must be rated separately and listed on the request.
11. It is not the purpose of the Sports Blanket Accident program to cover heavily concentrated air travel exposure. However, the rates shown in this section do include air travel as long as the aggregate limit of the group does not exceed $500,000 on any one aircraft. To determine the aggregate limit for the group, multiply the selected death benefit by the number of group members traveling together on a single aircraft. If the aggregate limit is over $500,000, contact your reporting office.
12. Any team playing a split season will be charged the normal season rate for each of its seasons.

General Remarks

The minimum premium for each policy written is $250.

Coverage for non-scheduled events such as All-Star games, single games and tournaments is also available under the Sports Blanket Accident Policy - contact your reporting office for complete details.

The policy provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Insurance Department.

IMPORTANT NOTICE - THE POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS.