Insurance information: Liability, Medical and Certificates of Insurance

About USGAA Insurance

All divisions and clubs within the USGAA must carry liability insurance and submit proof of coverage to the USGAA prior to registration. The USGAA has purchased a group policy which all divisions and clubs may buy into at a reduced rate. For more information about getting your club into the group insurance policy, contact the USGAA Insurance Officer:

Player Injury Insurance

The USGAA provides an opportunity for player injury insurance. For more information about availability and how clubs and players can take advantage of this program, please contact your Divisional Secretary or Divisional Board Insurance point of contact. Below are forms that are required as part of the injury insurance claim process. If you are involved in the program and making a claim, please download and complete the forms provided, and return them directly to the Divisional Secretary or Divisional Board Insurance point of contact. They will be the first step in getting the claim properly processed.

Medicare MMSEA Form 2019

Federal law requires that liability insurers (including self-insurers), no-fault insurers, and workers’ compensation plans report specific information about Medicare beneficiaries who have other insurance coverage. This reporting is to assist the Centers for Medicare & Medicaid Services (CMS) and other insurance plans to properly coordinate payment of benefits among plans so that your claims are paid promptly and correctly.

USGAA Incident Report Form 2019

This form is required, and designed to provide specific details about the incident that is at the center of your injury claim. Please be sure to fully and accurately complete all sections of this form, and obtain the requested signatures from the parties listed on the form.

RPS Bollinger Claim Form 2019

This is the official claim form that is processed by RPS Bollinger – the insurance firm that provides coverage for the USGAA. It is important this form is completed fully and accurately. If you have any questions, please contact your Divisional Secretary or Divisional Insurance Officer.

Please contact your divisional secretary or designated insurance officer for information about submitting claims and the appropriate divisional email accounts to which you should send completed forms.

Liability Certificate of Insurance Request

Please use this form to request the issuance of a Certificate of Insurance (COI) for your event. COIs are issued to members in good standing and for sanctioned events only, such as trainings, matches, and fund raisers.

  • The name of the person from the member club/division making the COI request.
  • Please use Official GAA email address.
  • .
  • Please provide a descriptive name/title for your event - e.g., Annual Fundraiser, Division Tournament, etc.
  • If the event spans multiple dates, please specifically note the dates in the "Other Information" field below.
  • This field is for validation purposes and should be left unchanged.