Insurance information: Liability, Medical and Certificates of Insurance

About USGAA Insurance

All registered USGAA Members and affiliated Units are covered by a Group Liability Policy, which includes Directors and Officers Liability. If you require a Certificate of Insurance, please fill out the Webform on the right-side of this page — please ensure that you correctly spell the Official GAA Email address of your unit, as this is the address the COI will be sent to.

All registered Playing Members are covered by a Group Accident Medical Expenses Policy. Forms are located on the left-side of this page, and instructions to file a claim are included on Page 3 of the RPS Bollinger Form. Divisional Insurance Point of Contact and Divisional Secretary can assist with any questions.

Player Injury Insurance

Those registered with USGAA as Playing Members, receive coverage under an Excess Basis Policy.

Accident medical expenses are covered under this policy on an Excess Basis, and benefits will be paid under this plan after your own personal or group insurance (including Health Maintenance Organizations) has paid out its benefits.

Below are forms that are required as part of the injury insurance claim process. If you need to make a claim, please download and complete the forms provided, submitting them as outlined on Page 3 of the RPS Bollinger Claim Form. Your Divisional Secretary or Divisional Board Point of Contact can assist with any issues.

Medicare MMSEA Form 2022

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 2022

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

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 Liaison.

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.
  • The COI will be issued for the 2023 calendar year. If the facility owner requires a specific date to be listed in the COI, please insert here. If the facility owner requires multiple dates to be listed in the COI, please use the "Other Information" field below.
    Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.