Secondary Medical Insurance

Process:

The online medical claim is required to be filled out by the injured player parent/guardian and then submitted by a Club Administrator who was present at the time of the accident. No other person(s) are authorized to initiate a claim form. If someone other than the Club Administrator submits the claim, it will be denied. *Club Administrator is defined as Coach, BOD or Registrar

Contact Keli Bitow at  with any additional questions.  

**Please note that there is a $500 deductible.

Regardless of when the accident occurred, the parent will be required to provide the following information on the Claim Form:

Step 1:
Athlete’s parent or legal guardian must fill out and sign the Participant Accident Claim Form and email to Club Administrator.

Step 3:
Club Administrator emails the claim form to .

Step 4:
Once approved, the parent will receive an email from AG Administrators on how to proceed with their claim. Parents communicate directly with AG Administrators and all itemized medical provider bills, and explanation of benefits (EOB) are provided to AG Administrators.

 

  • Injured player’s first and last name
  • Date of injury
  • Injured player’s address
  • Detailed explanation of sustained injury
  • Injured player’s date of birth
  • Club/team name
  • Type of injury (concussion, muscular, etc.)
  • Event type
  • Parent’s first and last name
  • Name of facility/field
  • Parent’s contact information (phone & email)
  • Location of facility/field

IF THE ACCIDENT OCCURRED ON OR AFTER 9/1/19: 

Step 1:
Athlete’s parent or legal guardian must fill out and sign the Participant Accident Claim Form and email to Club Administrator, along with itemized medical provider bills and an explanation of benefits (EOB) from their primary insurance carrier.

Step 2:
Club Administrator signs the claim form as the Special Risk Organization.

Step 3:
Club Administrator emails the claim form, itemized medical provider bills, and explanation of benefits (EOB) to .

Step 4:
Once approved, the parent will receive an email from A-G Administrators on how to proceed with their claim.

Parents can communicate with A-G Administrators directly once the claim is submitted and approved.

A-G Administrators, Inc.
Claims Department
P.O. Box 979
Valley Forge, PA 19482

(Phone)
(Toll-Free)