As part of your player registration fee, players are entitled to excess medical insurance coverage if injured in the course and scope of participating in soccer with Edison United Soccer Association. All claims are processed thru New Jersey Youth Soccer, not EUSA.
Please note a copy of the current player pass for travel, and a copy of your insurance card must be sent along with the claim form.
There is a $1000.00 deductible associated with this policy.
You cannot use previous forms as they are obsolete and your claim will be returned to you. You will need the Acrobat reader to display the form.
You can also obtain an Accident/Medical claim from the NJYS Office.
Send the completed form to the NJYS office within 90 days of the injury. Do not wait for bills from your medical service providers or payments made by your insurance carrier.
Please include a copy of the referee report for the match the injury occurred if available.
IMMEDIATELY submit a claim for all medical expenses to the Company that administers your own personal or group insurance or healthcare plan (including Major Medical coverage). If you have coverage through an HMO or similar facility, you must use that facility first or the claim will not be covered under this policy.
After your other insurance or healthcare plan has paid the medical expenses up to the policy limits, attach any unpaid bills and copies of payments made by your insurance company (Explanation of Benefits) and mail to K & K Insurance Group Inc. at the address shown below.
All subsequent bills should be sent to K&K Insurance Group, Inc as you receive them. Please write the claimant's name and date of accident on all subsequent bills. A new claim form is not necessary. Bills that are sent to the NJYS office will only delay payment to your service provider. Once the claim has been filed with NJYS, any bills should be submitted directly to:
K&K Insurance Group Inc.
PO Box 2338
Fort Wayne, Indiana 46801-2338