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Delaware Youth Soccer Association

Delaware Youth Soccer Association

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HomeAboutAbout UsInsuranceHow to File a Claim

How to File a Claim

HOW TO FILE A CLAIM

To File a Claim: Parents have up to 15 months from the date of the injury to submit claim form. For claims to be eligible for coverage, you must seek medical attention within 90 days of injury.

1. Parents need to complete a claim form from the Insurance link below

2. After you complete the form, please email it to Laura Sturdivant, Executive Director at Executivedirector@dysa.org

3. DYSA will validate the claim and forward to K & K Insurance/Specialty Benefits. K & K Insurance will send you a coverage letter and your claim number. Advise your Doctors/Hospital so they can file claims directly to your primary insurance first, and K & K Insurance/Speciality Benefits second.

4. Itemized bills are required: You or your providers must submit itemized bills with your primary insurance explanation of benefits (if applicable); balance due or notices do not provide the information needed to process your claim. Payments will be made to you if itemized bills indicate that they have been paid. Otherwise, payments will be made directly to the doctor, hospital or other service provider.

5. Parents will hear directly from the insurance company and not DYSA if there are any questions or problems with your claim

CLAIM FORM

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