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UNITED HOCKEY UNION
A division of National Adult Sports Network, Inc.
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Adult League Player Registration

To Apply For United Hockey Union Adult Player Insurance:

Player Info

Desired Format: Aug 15, 1988

Rink

(this rink only)

Player Benefits

There is "NO" coverage if a player is involved in a fight which leads to injury or claims filed.

ACCIDENT MEDICAL EXPENSE BENEFITS

Any benefit limits and Benefit Percentages for Accident Medical Expense Benefits apply, unless otherwise specified, on a per-Covered Person per-Covered Accident basis. Any applicable Deductibles must be satisfied within the time periods specified before benefits are payable.

Scope of Coverage Applicable to Accident Medical Benefits 

Full Excess Medical Expense

Other Health Plan

Reduction: 50%

Medical Expense Benefits

  • Total Maximum for all Accident Medical Expense Benefits: $25,000
  • First Covered Expenses must be Incurred within: 180 days after a Covered Accident
  • Benefit Period: 2 years
  • Deductible: $500 - ( applies to each Covered Accident does not Include Covered Expenses paid under another Health Care Plan )

Covered Expenses

In-Patient Hospital Services

  • Daily ICU or CCU Benefit: 100% Policy Limit
  • Daily In-Hospital Benefit: 100% of the average Semi-private room
  • Miscellaneous Services: 100% Policy Limit
  • Ambulatory Medical Center: 100%  Policy Limit
  • Emergency Room Treatment: 100%  Policy Limit

Physician Services

  • Surgery Benefit: 100%  Policy Limit
  • Assistant Surgeon: 100%  Policy Limit
  • Physician's Surgical Facilities: 100%  Policy Limit
  • Second Opinion or Consultation: 100%  Policy Limit
  • Physician's Assistant: 100%  Policy Limit
  • Anesthesia Benefit: 100%  Policy Limit
  • Inpatient Visits: 100%  Policy Limit
  • Office Visits: 100% Policy Limit
  • Outpatient X-ray, CT Scan: 100%  Policy Limit
  • Outpatient Physiotherapy: 100%  Policy Limit
  • Nursing Services: 100%  Policy Limit
  • Ambulance Services: 100%  Policy Limit
  • Medical Equipment Rental:  100%  Policy Limit
  • Medical Services and Supplies: 100%  Policy Limit
  • Dental Services: 100%  Policy Limit
  • Prescription Drug Benefit: 100%  Policy Limit

Waiver

National Adult Sports Network, Inc.

Dba: United Hockey Union

Liability Waiver

In Consideration of the mutual promises and agreements of the PARTIES hereto and other good and valuable consideration, the undersigned individually and their heirs, executors and administrators, does hereby waive and release any and all claims or rights for damages which he, she may have or will have against National Adult Sports Network, Inc. Dba: United Hockey Union

 (hereafter referred to as UHU),  instructors, agents and assigns, from any and all injuries or damages suffered by himself, herself before, during or after any activities sponsored or involving UHU or its agents.

The undersigned acknowledges that the activities engaged in by the undersigned has certain risks involved in the activity.  Not withstanding these assumed risks, the undersigned agrees to engage in said activities at their sole risk, undertaking and expenses.  UHU and its agents and assignees shall not, in any event, be liable for any resulting injuries or claims which may be asserted by the undersigned.  The undersigned further agrees to reimburse UHU for any and all costs of litigation and attorney’s fees in the event a claim is asserted against UHU or one of its agents, affiliates, officers and directors.

clear

By signing player agrees to terms of waiver.

Payment

Please make sure to add the player name and rink under the order detail section on PayPal.

$54.00

$2.00

Payment

USD

Thank you for your submission. 

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