United Business Association
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NEED A CLAIM FORM FOR ACCIDENT OR OTHER GROUP INSURANCE?
WE CAN HELP YOU FIND WHAT YOU ARE LOOKING FOR.

LOGIN TO THE MEMBER PORTAL TO

DOWNLOAD CLAIM FORMS
FOR UBA PRODUCTS



Do you need to file an insurance claim?

If you purchased an optional supplemental UBA Gap Membership Product that included group insurance programs, you can find more information about how to access the insurance claim forms here. Did you have an accident, emergency room visit, doctor visit, first diagnosis critical illness (invasive cancer, heart attack or stroke), dental, vision, term life or short term medical claim? You can also locate the phone number to the claim's administrator(s) on the back of the ID card.

There are multiple ways that you can access your product specific claims forms for your state. The first and best way to access your specific product insurance claim form(s) is to log in to the Member Portal. Each type of group insurance that you have purchased in your UBA Gap Membership Product will be highlighted along with the correct claim forms. Instructions on how to access your Member Portal are below. We provided a screenshot of the login & register page of the Member Portal and instructions on what to do to get registered. Second, you can always Call us, and we will be happy to assist you getting the correct form for your product and state.






Accident Claims

ACCIDENT CLAIMS

You must fill out an accident claim form and send to the appropriate claim's administrator located on the form along with all other necessary documentation including itemized bills, explanation of benefits from all other insurance and anything else the claim's administrator requests. Learn More about how to file an accident claim.

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Critical Illness Claims

CRITICAL ILLNESS CLAIMS

You must fill out a critical illness claim form when you have a first diagnosis of a covered Critical Illness and send to the appropriate claim's administrator located on the form. The claim's administrator will confirm the first diagnosis & check for pre-existing conditions. Learn More about how to file a Critical Illness Claim.

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Term life Claims

TERM LIFE CLAIMS

You must fill out a term claim form upon death of a covered member and send to the appropriate claim's administrator located on the form. The claim's administrator pays claims to the beneficiary on file. Don't forget this insurance coverage ends when the covered member turns 65. Learn More about how to file a Term Life Claim.

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Hospital Fixed Indemnity Claims

HOSPITAL FIXED INDEMNITY CLAIMS

You must fill out an accident claim form (Hospital Fixed Indemnity uses the same claim form as the accident claim form) and send to the appropriate claim's administrator located on the form along with all other necessary documentation including itemized bills, explanation of benefits from all other insurance and all other claim's administrator requests. Learn More about how to file a hospital fixed indemnity claim (These Group Hospital Fixed Indemnity Claims can include: ER Visits / Physician Visit / Daily Hospital Confinement / Outpatient Labs & X-rays).

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Group Accident & Sickness Hospital Cash Indemnity Claims

HOSPITAL CASH INDEMNITY CLAIMS

This is for members that purchased the Gap HCI Product only. You must fill out the Gap HCI claim form for the Group Accident and Sickness Hospital Cash Indemnity Insurance underwritten by Federal Insurance Company and send to the appropriate claim's administrator located on the form along with all other necessary documentation including itemized bills, explanation of benefits and all other claim's administrator requests. Learn More about how to file a Group Accident & Sickness Hospital Cash Insurance claim for the Gap HCI Product.

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Short Term Medial Insurance Claims

SHORT TERM MEDICAL CLAIMS

This is only for members that purchased the individual Short Term Medical Insurance STM Plan underwritten by United States Fire Insurance Company. You must fill out the short term medical claim form and send it to the claim's administrator, Health Special Risk (HSR) - info is located on the form along with all other necessary documentation. For Short Term Medical Claims, the first time you see a provider, you must file a claim. Once the claim is established with the provider, you will not have to file a claim for that same provider again. Learn More about how to file a Short Term Medical Insurance claims.

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Dental Claims

DENTAL CLAIMS

If you are using a participating dental provider then a claim form does not need to be filed. Only if you are not using a participating provider do you need to send in the claim form to the dental claim's administrator. Learn More about how to file a Dental Claim.

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Vision Claims

VISION CLAIMS

If you are using a participating vision provider, VSP then a claim form does not need to be filed. Only if you are not using the participating provider VSP do you need to send in the claim form to the vision claim's administrator. Learn More about how to file a Vision Claim.

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Important: Healthy America and United Business Association (UBA) are not authorized to pay claims or be involved in the claim decision process. All claim decisions are made by the TPA claim's administrator and the insurance carrier.

If you need help, contact us at 866-438-4274, and we will be happy to try and assist you.





Sign in to Member Portal as returning user or Register if your first time at the member portal


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