Indiana Dancers Association
Insurance for Square Dancers
The Indiana Dancers Association is participating U.S.D.A. in the National Insurance Program.
Larry & Rose Hakes
1007 Chestnut Blvd, Chesterton, IN 46304-3215
Tele: (219) 921-1196 E-mail:email@example.com
Square Dancers of
Fee and Insurance
Flat Rate Per Member - $4. 75
** Please make all checks payable to Indiana Dancers Association **
your club to participate in an insurance program
designed especially for you as a
(Requires 100% participation of a club's membership at time of application.)
Reminder to all IDA Clubs;
forward the insurance forms for additional members and new classes to Larry
Hakes, Insurance Coordinator, as soon as they join the club. The fee is due on
new members at the time of becoming a member.
firstname.lastname@example.org to save postage.
To quickly find answers to these questions, click on the question:
PART I - LIABILITY INSURANCE
PART II - ACCIDENT MEDICAL INSURANCE
Forms - (Word Format)
Additional Enrollments - (New members after initial Enrollment)
Other Members - (Club members covered by other clubs)
TWO AREAS OF INSURANCE PROTECTION ARE
ACCIDENT MEDICAL COVERAGE
As closely as safety rules are followed, accidents will happen. Accident Medical insurance helps protect club members from financial loss due to a covered accidental bodily injury. Liability insurance protects the club and it's members and association officials from financial loss due to unforeseen incidents which may develop into litigation against members and dance organizations.
PART I - LIABILITY INSURANCE
Combined Single Limit of liability for bodily injury and
property damage each occurrence (subject to a $100 property
damage deductible per claim) while participating in scheduled and sponsored
dancing activities. $100,000 limit for
Damage To Premises Rented to you. Nonowned/liired Car Liability Coverage is available-contact U.S.D.A. National Insurance
Coordinator for application.
WHO IS COVERED:
club and its members while participating in club or organization
sponsored and supervised dancing activities. Liability coverage
applies in the
Notify the Affiliate Insurance Chairman regarding any third party claims presented to the Club/Association. Chairman shall call U.S.D.A. National Insurance Coordinator with full description of incident.
PART II - ACCIDENT MEDICAL
-- Usual and Customary Accident Medical
Accidental. Death Benefit
Dismemberment Benefit (loss of both
both feet, sight of both eyes, or any combination thereof)
— Accidental Dismemberment Benefit (loss of one hand, one foot, sight
of one eye)
Death and Dismemberment Benefits Limitations We will not pay for a Loss
caused in any way by:
or mental infirmity or illness;
except pyogenic or bacterial infection in a cut or wound caused by an
3. medical or surgical treatment; except for surgery which results from an accident;
travel, other than as a fare-paying passenger on a scheduled commercial
.war or act of war;
part in a riot or felony; this shall not include being a victim of a
attempted suicide or intentional self-inflicted injury.
*Accident Medical Coverage is excess to any other valid and
collectible medical insurance covering the same accident Coverage
provided for covered medical expenses incurred within
52 weeks of the accident up to $10,000 for all eligible expenses as
stated in the Policy.
**If more than one of specified losses results from the same accident, only one amount, the largest, will be paid.
members will be insured while participating in any regularly
scheduled and sponsored dancing activity worldwide, including
group travel (10 or more dub members) in a vehicle commercially
licensed for transportation of passengers and operated by a person holding a valid operator's license for such
vehicle, while being transported to or from a covered dancing activity
Accidental bodily injury sustained by an insured person while participating in dancing activities sponsored and supervised by a recognized club or organization.
for treatment on or to the teeth, except for treatment resulting from
injury to natural teeth;
hearing aids, and examination for the prescription or fitting thereof;
attempted suicide or intentionally self-inflicted injury; -Injury due to
participation M a riot
resulting from air travel, except as a fare-paying passenger on a
or sickness resulting from declared or undeclared war; -injury or sickness while
in the armed. forces of any country;
or sickness covered by any workers' compensation or occupational disease
provided in a governmental hospital unless the insured is legally
obligated to pay such charges;
except pyogenic or bacterial infections caused wholly by a covered
unless it results from a covered injury;
insured's being intoxicated or
under the influence of any narcotic
unless administered on the advice of a physician; -Pre-existing
occurring while dancing at private residences; -Services
normally provided without charge by you or your employees;
occurring while parachuting or hang-gliding; or injury sustained
while traveling in or on any two or three-wheeled motor
vehicle operated by a person who does not hold a valid operator's
the event of a covered accident, immediately notify the Club Representative
or a responsible officer of the Club. A Proof of Loss
form (available from the Club Representative) must be completed. The front is to
be filled in and signed by the Club official
and the claimant; the back is to be completed by the attending
physician. Notice of injury is to be forwarded to the U.S.D.A.
National Insurance Coordinator within twenty (20) days, or as soon thereafter as reasonably possible to
policy term is January 1 through December 31. Coverage becomes
effective for individual clubs under the policy on the day the application and
premium for insurance is received by the U.S.DA. National Insurance
$4.75 Flat Rate Per Member per policy term or any part thereof. Liability totes would be substantially higher if the Accident Medical portion were not to be included in this program.
THIS IS A SUMMARY OF COVERAGE- NOT A CONTRACT
complete provisions, policy coverages, terms, conditions & exclusions,
please refer to the Policy at www.usda.org/insuranc.htm. If there any conflict
between the provisions of this brochure and those of
the Policy, the
provisions of the Policy will govern.
Roster of club members is
required at time of premium payment.
If a club member
belongs to more than one club, they pay only one enrollment fee.
club members leave the club and fail to join another participating club within
30 days, their insurance coverage ceases.
Students (taking lessons for the
first time or coming back after an extended absence) in beginning dance classes
sponsored by an insured club are covered by insurance at no additional cost to
the club. A club must submit a roster with a beginning and ending date for the
class. Students will only be covered while attending classes for nine (9)
minimum fee for a club is $45.00; a club must have at least eight (8) members
listed on their roster to register for insurance
The policy does not cover the
caller/cuer and his or her equipment when he or she is calling.
An honorary member or caller/cuer
member of a club is covered by this policy when attending a dance as a dancer
and an enrollment fee has been paid for each dancer.
street address, city, state and zip code of each facility anticipated to be used
during the year will be required when effecting coverage.
Approximately 45 days lead-time is
required to obtain a certificate of insurance for a particular facility not on
the original policy.
$100,000 limit for damage to premises rented to you and caused by an insured
outs, snow trips and other non-dancing activities are not covered by this
insurance. Special, one-event accident
medical insurance must be separately arranged.
Claims must be filed, whenever
possible, within 20 days from the date of the accident with medical bills
Mail claims to the
Federation/Association insurance chairman.
death and dismemberment benefit applies regardless of any other insurance the
member may have. Death must result from a covered accident at a bonafide
club or organization dancing activity or an accident during the course of group
travel (see definition of group travel).
excluded while dancing at private residence.
Why and How
information form within 48 hours.
addition to the club roster after the initial enrollment for the current year
will require an enrollment fee per dancer.
of event form is necessary if a club dances at a facility which is not their
regular dance location.
certificate of insurance is not issued for a facility, there is no liability
coverage for the
facility being used.
A new insurance certificate is only needed if requested
by the new facility.
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