Claims

1. Submit a claim form. The claimant, or a parent/guardian if the injured person is a minor, is to complete the applicable section of the US Club Soccer Accident Medical-Dental Insurance Claim Form (Youth) (English / Español) and email it to insurance@usclubsoccer.org. Please do not send bills, Explanations of Benefits (EOBs), or other information to US Club Soccer.

1. Internal US Club Soccer verification. After you submit this form, US Club Soccer will review claim eligibility and verify the accident with the claimant’s club/member organization.
   
   
2. Post-verification claim status update. You will receive an email with the claim status when the verification is complete. If approved, US Club Soccer will then submit the claim to A-G Administrators, the claims processor.
   
   
3. Communication and instructions from A-G Administrators. You will then receive communication from A-G Administrators with instructions for you/your providers to submit documentation (bills, EOBs, etc.) directly to:

A-G Administrators
PO Box 21013
Eagan, MN 55121

Email: claims@agadm.com
Phone: (610) 933-0800
Fax: (610) 933-4122

• Treatment(s) must be medically necessary.
  
  
• Excess coverage: Applicable expenses are covered under this policy on an excess basis. Please read the information on the Accident Medical-Dental Insurance Claim Form (Youth) for more details.
  
  
• Claim eligibility timing: For claims to be eligible for coverage, this form must be submitted no later than 90 days after the date of injury, and medical attention must be received no later than 60 days after the date of injury.
  
  
• Benefit period: This policy is subject to a 52-week benefit period from date of injury. Medical or dental expenses that are incurred within 52 weeks of the date of injury are eligible for coverage under this policy. Any expenses or treatments that are rendered after the 52-week benefit period will not be covered by this policy.

• Prior to submission or US Club Soccer approval of your claim, please contact insurance@usclubsoccer.org.
  
  
• After US Club Soccer approval of a youth membership claim for an injury, contact A-G Administrators at claims@agadm.com or (610) 933-0800.