Section 2 -- GENERAL INFORMATION SECTION

Today's Field Hockey teams and leagues need the protection of a comprehensive program of insurance. The US Field Hockey Association has made a
number of improvements to the coverages provided to all members.

Changes to the USFHA Insurance Program (2006)

U.S. Field Hockey is pleased to announce an important insurance program
enhancement beginning in 2006. All members are now covered for approved USA Field Hockey activities under the Accident Medical program. In the past, this was not
available to all members

Who is Covered?

The following are covered as named insureds under the General Liability policy: US Field Hockey Association; all currently registered member players, coaches, officials and trainers; Futures Program trainers; and the directors and officers of US Field Hockey Association.

The Accident policy extends to all currently registered member players, coaches, officials and trainers and Futures Program trainers.

Covered Activities

The Accident and Liability policies provide coverage to insured persons (as defined above) while participating in the following Covered Activities:

1) Games, team practice sessions, camps, clinics, tournaments or sponsored activities, provided they are approved by U.S. Field Hockey Association.

2) Other sponsored and supervised activities are covered, such as team or league meetings, banquets and usual, non-hazardous fundraisers by both the accident and liability policies. No coverage is provided for any event that includes fireworks.

Important note: No liability coverage is provided to parents, coaches, trainers or volunteers while using any automobile to transport players, USFHA members or volunteers to any practice, game or activity. Therefore, the US Field Hockey Association strongly advises you to verify that anyone who is designated to drive players or other members to Field Hockey activities is properly licensed and insured.

Insurance Policy Information

The policies described in this web site are issued to and purchased by the US Field Hockey Association. Coverage is extended under these policies to USFHA members as an important benefit of membership in the US Field Hockey Association.

This insurance web site only provides a brief description of the coverages, conditions and exclusions of the policies. It in no way affects or alters the scope of the coverages provided.

For more information on details of the insurance policies, please contact the Agent:

Ronda Ashley, CPCU

Vice President - Sports

Bollinger, Inc.

Phone: 719-488-3549

Section 3. GENERAL LIABILITY

Who Is Covered?

The following are covered as named insureds under the General Liability policy: US Field Hockey Association, Inc.; all currently registered member players, coaches, trainers and officials; Futures Program trainers; and the directors and officers of US Field Hockey Association.

Member teams and clubs are defined as those associations where 100% of the participants are members of US Field Hockey Association for activities approved by U.S. Field Hockey. General liability extends to the team or club as an entity when all participants are members of USFHA. As such, the team or club may obtain certificates of insurance as required by facilities and field owners where they hold their events.

Covered Activities

Covered activities are defined as the following for Member Players, Coaches, Trainers , Futures Program trainers and Officials:

1) Approved games, team practice sessions, camps, clinics, tournaments or sponsored activities, provided they are under the direct supervision of a team official.

2) Other sponsored and supervised activities, such as team or league meetings, banquets and usual, non-hazardous fundraisers are also covered. Examples of non-hazardous fundraisers are bake sales, car washes and other similar events. No coverage is provided for any event that includes fireworks.

3) Regarding automobile exposures, no liability coverage is provided to parents, coaches or volunteers while using any automobile to transport players, USFHA members or volunteers to any practice, game or activity. Therefore, the U.S. Field Hockey Association strongly advises you to verify that anyone who is designated to drive players or other members to Field Hockey activities is properly licensed and insured.

Coverages Provided by the General Liability Policy

Coverage is provided for suits or claims arising out of:

· Participant injury

· Spectator injury

· Volunteer injury

· Property damage to third parties

· Activities necessary and incidental to the conduct of games or practices

· Sponsored functions, such as meetings, banquets and fundraisers

· Advertising and Personal Injury liability

· Products and Completed Operations liability, as respects the functions incidental to a Field Hockey team or league

· Alleged or actual sexual abuse or molestation

Coverage Description

Policy Limits:

General Aggregate Limit per Location:	$5,000,000
Per Occurrence Limit:	$1,000,000
Participants Legal Liability Personal Injury/Advertising Injury Limit:	Included in above limits $1,000,000
Products & Completed Operations Aggregate:	$1,000,000
Fire Legal Liability Limit:	$100,000
Medical Payments (to non-participants only):	$5,000
Deductible:	$0

Notable Liability Policy Exclusions In addition to the standard exclusions found under the Commercial General Liability policy (such as Pollution, Asbestos, Nuclear Energy), the following exclusions apply: Medical payments to participants, Employment practices liability, Punitive Damages, Designated products, Lead and Trampolines.

Underwriting Company

The Liability Policy is underwritten by Markel Insurance Company, Glen Allen, VA. Markel is rated “A” by A.M. Best’s rating service.

How to File a Liability Claim

If you receive legal notice of claim:

If you are involved in an incident which may give rise to a liability claim (for example, a claim arising out of Bodily Injury or Property Damage), or if you receive a legal summons or a letter from an attorney as a result of such an incident, please report this information immediately to Summit America Insurance Services, the insurance agent for the USFHA. In your report, please describe the incident and include copies of all legal documents you may have received, or a police report or incident report, if available.

If you are involved in a serious incident which may give rise to a claim:

For any serious injuries or incidents of serious property damage, please complete a USFHA Incident Report Form as soon as practical after the incident in order to provide
a full description of the incident. In these cases, if a claim should evolve from the incident in the future, USFHA and Summit America would have complete details of the occurrence in order to better manage the claim.

Please send all liability claims information or Incident Reports to:

Ronda Ashley, CPCU

Vice President - Sports

Bollinger, Inc.

15330 Copperfield Dr.

Colorado Springs, CO 80921

Phone: 719-488-3549

Email: ronda.ashley@Bollingerinsurance.com

USFHA Incident Report Form .pdf | .doc (Word Document)

Section 4. ACCIDENT INSURANCE

Accident Coverage for ALL USFHA Members!

Who is Covered?

The Accident policy covers: all currently registered member players, coaches, trainers, Futures Program trainers and officials while participating in a Covered Activity. Proof of coverage for the activity will be determined by a certificate of insurance evidencing USFHA approval of the activity.

Covered Activities

Covered Activities are defined as the following for Players, Coaches, Trainers, Futures Program Trainers and Officials:

1) Approved games, team practice sessions, camps, clinics, tournaments or sponsored activities, provided they are under the direct supervision of a team official.

2) Group Travel as a Team directly to or from such scheduled practices, games or sponsored activities.

3) Other sponsored and supervised activities, such as team or league meetings, banquets and usual, non-hazardous fundraisers are also covered by both the accident and liability policies. No coverage is provided for any event that includes fireworks.

Coverage Description

The Accident Medical Insurance Plan pays the reasonable and customary charges for a covered injury to an insured if that injury requires treatment by a legally qualified physician, dentist or graduate nurse; confinement in a hospital; ambulance service from the site of the injury to the initial treatment facility; and services and supplies ordered by a physician.

The first expense must be incurred within 90 days of the date of injury; and any further expense must be incurred within 52 weeks of the date of injury. All Accident Claims must be filed within 90 days of injury to be eligible for payment. For claims covered by your primary insurance company, you must file the claim with Bollinger, the insurance administrator, as soon as is practicable (i.e., once payment has been made by your primary insurance company).

Limits of coverage:

Medical Expense Limit	$25,000
Dental Expense Limit	Included in Medical limit
Accidental Death Benefit	$5,000
Accidental Dismemberment Benefit	$5,000
Aggregate limit per policy term (all claims)	$2,000,000
Deductible per claim	$500 per claim
Full Excess Coverage
Policy Benefit Period	104 weeks from date of injury

This policy is written on a full excess basis meaning that the policy will pay for covered expenses as a result of an accidental injury, which are not recoverable from any other insurance policy or any other health care or employee benefit plan. If there is no other insurance available to the participant, the accident policy will pay benefits on a primary basis.

The deductible per claim is a ‘disappearing deductible.’ If benefits are paid by the claimant’s primary insurance carrier, those amounts will be applied toward the deductible of this policy.

Accident Policy Exclusions

This policy does not cover any loss, fatal or non-fatal, incurred or resulting from the following:

1. Suicide or self destruction or any attempt thereat;

2. Infections, except pyogenic infections caused wholly by a covered injury;

3. War or any act of war, or accident while the insured person is in the military, naval or air service of any country;

4. Accident incurred while the insured person is operating, or learning to operate, or performing duties as a member of a crew of any aircraft;

5. Dental treatment, except as a result of injury to natural teeth;

6. Replacement of eyeglasses or eye examinations for the correction of vision or fitting of glasses unless the injury causes impairment of sight;

7. Injury for which the insured person is entitled to benefits under any Worker’s Compensation Act or Law or any similar legislation;

8. Hernia of any kind;

9. The insured’s being intoxicated or under the influence of any narcotic unless administered by a physician

Underwriting Company

The Accident Insurance Program is underwritten by Markel Insurance Company of Glen Allen, VA. Markel is rated “A” by A.M. Best’s rating service.

How to File an Accident Claim

If you are injured during a covered Field Hockey activity, you may obtain a claim form and instructions on filing the claim by clicking here: How to File a Claim.

All claims are handled and paid by Bollinger, Inc., the insurance administrator for U.S. Field Hockey Association.

Accident Claim Form

Section 5: How to File a Claim

Filing an Accident Claim (for injuries to USFHA Members/Futures Trainers)

IMPORTANT ACCIDENT CLAIM INSTRUCTIONS for injuries

occurring after 12/1/03:

1. Accident medical expense coverage is provided by U.S. Field Hockey on an EXCESS BASIS, and benefits will only be paid under this plan AFTER YOUR OWN PERSONAL OR GROUP HEALTH PLAN (Employee of Government Welfare or Benefit Plans) HAS PAID OUT ITS BENEFITS. You must send copies of any and all payments (the Explanation of Benefits) made by your insurance plan with this claim form.

2. The Statement of Other Insurance section of this claim form must be fully completed. If you are employed but have no insurance, please include a statement of verification from your employer on their letterhead.

3. This accident insurance plan provides benefits on a limited basis. Therefore, this plan may not cover all medical bills in full.

4. You must attach Itemized Bills from your doctor, dentist or hospital. Statements or Billing notices are not acceptable. If information on bills is incomplete, we may have to request additional information which could delay payment.

5. In the event of hospitalization, we may request medical records from the hospital before processing the claim for payment.

6. Signatures: This claim form has three (3) required signatures and one (1) optional signature line.

Signature #1) “Verification of Covered Activity” is a required signature. See below for details.

Signature #2) “Authorization to release medical records” is a required signature by the claimant or claimant’s legal guardian (if a minor) to release information regarding the claim.

Signature #3) “Authorization to pay providers directly”-Optional (instead of having claim check sent to you).

Signature #4) “True Statement Certification”- Required - must be signed by claimant (or parent/guardian) to verify that claim information is true and correct.

7. “Verification of Covered Activity”- Make sure that an authorized official of your local Field Hockey team or league has signed the claim form under the “Verification of Covered Activity” (signature #1). The form may be signed by the coach, manager or referee who can verify that the injury took place during an approved field hockey activity. If this claim occurred during a camp, clinic or tournament, it must be signed by the director or by a coach or referee who can verify that the claim took place during the sponsored activity. DO NOT SEND THE CLAIM TO THE U.S. FIELD HOCKEY NATIONAL OFFICE FOR VERIFICATION.

9. Only one claim form is necessary for each accident. Subsequent bills can be sent in as you receive them. Please indicate Name, Social Security Number, and Date of Accident and the U.S. Field Hockey certificate of insurance # on all subsequent bills.

For Further Information Contact:

Sharon Davino

Sports Claims Department

Bollinger, Inc.

101 JFK Parkway, P.O. Box 390

Short Hills, NJ 07078-0390

Phone: 1-800-350-8005

Filing a Liability Claim

If you are involved in an incident that results or could result in a liability claim,
or if you are named in a lawsuit as a result of a covered activity under the U.S.
Field Hockey policy, please contact Ronda Ashley
at Summit America Insurance Services immediately.
Such claims typically involve court deadlines, therefore, please fax all legal
notices of claim immediately to:

Ronda Ashley, CPCU

Vice President - Sports

Bollinger, Inc.

15330 Copperfield Dr.

Colorado Springs, CO 80921

USA Field Hockey Incident Report Form .pdf | .doc (Word Document)

Section 6 -- Certificate of Insurance Application

Section 2 -- GENERAL INFORMATION SECTION

Changes to the USFHA Insurance Program (2006)

Who is Covered?

Section 3. GENERAL LIABILITY

Section 4. ACCIDENT INSURANCE

Accident Coverage for ALL USFHA Members!

Section 5: How to File a Claim

Filing a Liability Claim

Section 6 -- Certificate of Insurance Application

Section 7 -- Risk Management Information