Arkansas Soccer Association

SECOND TOP LOGO (THE ONE ON THE RIGHT)

YOUTH Player Insurance

What to do when an injury occurs:

  1. Fill out and mail/fax/email the Accident Medical Claim Form to the state office within 30 days of the injury. Please provide the referee report (long form) if possible.
  2. The state office will verify that you are a registered player participating in a sanctioned event. Players electing to participate in non-sanctioned events are not covered by this policy.
  3. If approved the state office will send the claim form to the insurance company for processing.
  4. The injured player is then responsible for providing the insurance company with bills and requested information. The state office does not handle any bills or payments.

Arkansas Soccer Association’s insurance provider is AMSIS.

DO NOT SEND FORM TO INSURANCE COMPANY – IT WILL ONLY DELAY YOUR CLAIM.  

 Explanation of coverage

Email form to: Jim Henke

Mail:  ASA, 9871 Brockington Road, Suite 10, Sherwood, AR 72120

ADULT Player Insurance

What to do when an injury occurs:

  1. ALL Adult claims MUST be filed via the USASA ONLINE form. PAPER forms will NO LONGER BE ACCEPTED. Here is the link to file a claim online: https://agadmin.retool.com/embedded/public/2431b24b-f945-4475-ba7d-338ce14904b2
  2. Additional information, including Claim Filing Instructions and Frequently Asked Questions, regarding Adult claims can be found on the USASA website: https://www.usadultsoccer.com/page/show/949935-insurance
  3. The state office will verify that you are a registered player participating in a sanctioned event. Players electing to participate in non-sanctioned events are not covered by this policy.
  4. Once ASA has verified that you are a registered player, USASA will submit the claim to the carrier and you should receive an email notification and a letter in the mail from the handling insurance adjuster regarding claim details. If you have not received this within 4-8 weeks, please reach out to ASA so ASA can follow up with USASA and their insurance carrier.

Explanation of Insurance – English and Spanish

Release of Liability Agreement 

Click Here to Visit USASA’s Website for More Information and Forms 

For additional questions, email:  Jim Henke

Mail:  ASA, 9871 Brockington Road, Suite 10, Sherwood, AR 72120

CERTIFICATES OF INSURANCE

Clubs can request Certificates of Insurance Here