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Capac AYSO Region 1296

Insurance (SAI)


AYSO purchases Soccer Accident Insurance ("SAI"), which pays excess medical costs up to $50,000 maximum per accident to an insured person for accidental bodily injuries incurred as a direct result of participation in a covered activity subject to the policy terms, conditions and exclusions. Eligibility for benefits is 52 weeks from the policy effective date or the date of a covered accident.
Download the SAI Brochure for more detailed explanation of the plan. Accident Medical Expense Benefits are only payable:

    • for usual and customary charges incurred after the deductible has been met;
    • for those medically necessary covered expenses that the covered person receives;
    • first medical expense must be incurred within 90 days of covered accident;
    • all claims must be filed within 90 days;
    • each claim is subject to a $200 Deductible; and
    • social security numbers, visa or green card are REQUIRED on SAI claim.
    • Claims will require:
      • Copies of primary Explanation of Benefits (EOB)
      • Copies of itemized insurance billing forms - UB04 or CMS1500
    • No Primary Insurance: If there is no other insurance avail¬≠able to the registered member, the medical benefit will be processed on a primary basis subject to Usual and Customary rates, and the policy terms, conditions and exclusions.
    • MAXIMUM BENEFITS PAYABLE: (subject to policy terms, conditions & limits)
      • $50,000 maximum excess medical costs
      • $15,000 for Accidental Death & Dismemberment
      • $10,000 for Dental Benefit
      • $10,000 for Orthopedic Benefit
      • $1,000 Physical Therapy

All AYSO currently registered* members (players, coaches, referees and other volunteers) are "Covered Persons" for accidental bodily injury while participating in the following covered activities:

    • Team practice sessions, scheduled games, tournaments, or other sponsored activities (meetings, banquets, fundraisers) provided they are under the direct supervision of an AYSO registered volunteer.
    • Group travel of five or more participants directly, without interruption to or from such practice sessions, games, tournaments, or sponsored activities, provided that players are traveling as a team and a licensed adult driver operates the vehicle.

*Registration requirements will be verified before any benefits are paid.

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Capac AYSO Region 1296

P.O. Box 114 
Capac, Michigan 48014

Email Us: [email protected]
Phone : 586-337-5440
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