How To File An Insurance Claim
The youth division accident medical policy provided by PA West Soccer is an excess/secondary policy. All charges must be submitted to your primary health insurance provider first.
The PA West Soccer plan is written as an excess policy. This means your primary medical insurance provider must process these claims first. You will receive an Explanation of Benefits worksheet from your other provider detailing what has and hasn't been covered by your primary plan. DO NOT wait until your other provider to process all your bills before filing a claim with PA West Soccer. To file a claim, please use the link below to file a claim online. Please note, the deductible for the PA West Soccer secondary medical policy is $500.00.
The online claims submission program is for accident dates on or after September 1, 2011.
If your accident date was before September 1, 2011, DO NOT PROCEED WITH THE ONLINE SUBMISSION; you must use the downloadable form (pdf) found below.
Click Here to download the Youth Accident Claim Form... (PDF File)
Click Here to download the USASA Adult Accident Claim Form (PDF File)
*To download PDF files, you will need the Adobe Acrobat software installed on your computer. If you have the software, the forms will open automatically in your browser. If you need to download the free software, click the Adobe Acrobat button below.