GapPlusPlan.com for UBA Members

409 W VICKERY BLVD, FORT WORTH, TX 76104 | 866.438.4274

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Get Insured for an Accident or Emergencies

Gap AME Plan

Member Driven Value.

Plan Costs:

$30 per month - Individuals
$60 per month - Family 

Summary of Plan

Why Gap AME Plan

Accidents Happen. Be Prepared for the Unexpected.



Did You Know
Accidents Happen - Accident Statistics

    Accident Statistics

    1 in 15 people in the U.S. experienced an unintentional injury in the home in 2015 serious enough to consult with a medical professional.1

    Non-Fatal injuries affect millions of Americans. In 2015, 40.6 million people - about 1 in 8 - sought medical attention.1
Emergency Statistics

    Emergency Statistics

    1 in 5 Americans report visiting an Emergency Room at least once in the past year.2

Stats Taken From:
1National Safety Council (2017). Injury Facts. 2017 Edition. Itasca, IL: Author.Library of Congress Catalog Card Number:99-74142. Statistics taken from Page 2 and 144. http://www.ncs.org/injuryfacts. 2http://www.cdc.gov/media/releases/2013/p0530-emergency-room.html.
Group Accident Medical Expense Insurance

MAXIMUM BENEFITS^

 Member Principal Sum  $10,000
 Spouse Principal Sum*  $10,000
 Dependent Child(ren) Principal Sum*  $10,000

$100 Deductible per Covered Accident Per Covered Member

^Coverage is available to all active members of the United Business Association. Coverage is provided by and underwritten by Catlin Insurance Company, Inc., 3340 Peachtree Rd, NE Suite 2950, Atlanta, GA 30326. XL Catlin is the global brand used by XL Group Ltd's insurance subsidiaries, including Catlin Insurance Company, Inc.

Any covered loss must occur with 365 days of the Covered Accident. Please refer to the Certificate and Accident Medical Expense Benefit Rider for maximum age of dependents. Note: The first treatment of service must occur within 90 days of the Covered Accident and all subsequent treatments must be incurred within 52 weeks of the Covered Accident. For full definitions, limitations, exclusions, and terms please refer to the Certificate and Accident Medical Expense Benefit Rider. Pre-Existing Conditions are excluded from this coverage. Benefit payment is subject to the definitions, limitations, exclusions and other provisions within the Certificate. Coverage may vary and may not be available in all states. A copy of the Certificate and Accident Medical Expense Benefit Rider are available from the Association upon request.

*Spouse and Dependents are eligible if listed on the Membership Enrollment Application or later added, recorded, and acknowledged by the Association and meet the age requirements listed in the Policy Certificate. The Group Accident Medical Expense Insurance Maximum Benefit ends at age 70 for the Eligible Covered Spouse. Check the Policy Certificate and Accident Medical Expense Rider for the age limits on dependent children.

Policy Form Series AHAG 051 (In LA, AHAG AS050) | Rider form Series AHAG 401 0412 (California Certificate of Authority #08666 NAIC #19518)

Group Accidental Death & Dismemberment Insurance

$5,000 Maximum Benefit Amount^

Percentage of Maximum Benefit

  Loss of Life 100%
  Loss of two or more Hands or Feet 100%
  Loss of Speech & Loss of Hearing (Both Ears) 100%
  Loss of Sight (Both Eyes) 100%
  Loss of one Hand or Foot   50%
  Loss of Speech   50%
  Loss of Hearing (Both Ears)   50%
  Loss of Sight (One Eye)   50%
  Severance & Reattachment of One Hand or Foot   50%
  Loss of all the Toes on the Same Foot   20%
  Loss of all Four Fingers of Same Hand   25%
  Loss of Thumb & Index Finger (Same Hand)   25%


^Coverage is available to all active members of the United Business Association. Coverage is provided by and underwritten by Catlin Insurance Company, Inc., 3340 Peachtree Rd, NE Suite 2950, Atlanta, GA 30326. XL Catlin is the global brand used by XL Group Ltd's insurance subsidiaries, including Catlin Insurance Company, Inc.

*Spouse and Dependents are eligible if listed on the Membership Enrollment Application or later added, recorded, and acknowledged by the Association and meet the age requirements listed in the Policy Certificate. The Group Accidental Death & Dismemberment Insurance Maximum Benefit ends at age 70 for the Eligible Covered Spouse. Check the Policy Certificate and Accident Medical Expense Rider for the age limits on dependent children.

Policy Form Series AHAG 051 (In LA, AHAG AS050) | Rider form Series AHAG 401 0412 (California Certificate of Authority #08666 NAIC #19518)

Emergency Treatment Benefit

Maximum Benefits^

 Member Principal Sum  $1,000 per visit
 Spouse Principal Sum*  $1,000 per visit
 Dependent Child(ren) Principal Sum*  $1,000 per visit

5 Maximum Number of Visits per Year

In-Hospital Emergency Room Treatment Free Standing Emergency Room Treatment Urgent Care Emergency Treatment

^We will pay the benefit amount shown above if a Covered Person requires Emergency Room Treatment by a Physician in a Hospital Emergency Room subject to the Maximum Number of Visits listed above and in the schedule of benefits. Any benefits payable under these Additional Accident Benefits shown above are paid in addition to any other Accidental Death & Dismemberment benefits payable. Emergency Treatment Benefit Rider is provided by and underwritten by Catlin Insurance Company, Inc. The intent of Emergency Room Treatment Facility will also include free standing Emergency Rooms as well as Urgent Care Centers.

*Spouse and Dependents are eligible if listed on the Membership Enrollment Application or later added, recorded, and acknowledged by the Association and meet the age requirements listed in the Policy Certificate.

Policy Form Series AHAG 051 (In LA, AHAG AS050) | Rider form Series AHAG 401 0412 (California Certificate of Authority #08666 NAIC #19518)

State Availability

Gap AME Plan is available in the following states:

AL, AR, AZ, CA, DC, DE, FL, GA, ID, IL, IA, IN, KS, KY, LA, MI, MO, MS, NC, ND, NE, NJ, NM, OH, OK, PA, RI, SC, TN, TX, VA, WV, WI & WY


Group Accidental Death & Dismemberment, Emergency Treatment Benefit &
Group Accident Medical Expense Insurance:

Underwriting Insurance Company

Catlin Insurance Company, Inc.
XL Catlin is the global brand used by XL Group Ltd's insurance subsidiaries, including Catlin Insurance Company, Inc.
Policy Form Series AHAG 051 (In LA, AHAG AS050) | Rider form Series AHAG 401 0412
(California Certificate of Authority #08666 NAIC #19518)

Catlin Insurance Company, Inc.'s accident insurance products are not available to Utah residents.
View Gap AME Sample Member Guide

Click on Link below to View Gap AME Sample Member Guide

Click here to download Gap AME Sample Member Guide

Group Insurance Certificates

Click on State Image to View Group Insurance Certificates.

Alabama Gap AME Group Insurance Certificates
Alabama

Arkansas Gap AME Group Insurance Certificates
Arkansas

Arizona Gap AME Group Insurance Certificates
Arizona

California Gap AME Group Insurance Certificates
California

District of Columbia Gap AME Group Insurance Certificates
DC

Delaware Gap AME Group Insurance Certificates
Delaware

Florida Gap AME Group Insurance Certificates
Florida

Georgia Gap AME Group Insurance Certificates
Georgia

Idaho Gap AME Group Insurance Certificates
Idaho

Illinois Gap AME Group Insurance Certificates
Illinois

Indiana Gap AME Group Insurance Certificates
Indiana

Iowa Gap AME Group Insurance Certificates
Iowa

Kansas Gap AME Group Insurance Certificates
Kansas

Kentucky Gap AME Group Insurance Certificates
Kentucky

Louisiana Gap AME Group Insurance Certificates
Louisiana

Michigan Gap AME Group Insurance Certificates
Michigan

Mississippi Gap AME Group Insurance Certificate
Mississippi

Missouri Gap AME Group Insurance Certificate
Missouri

Nebraska Gap AME Group Insurance Certificate
Nebraska

New Jersey Gap AME Group Insurance Certificate
New Jersey

New Mexico Gap AME Group Insurance Certificate
New Mexico

North Carolina Gap AME Group Insurance Certificate
North Carolina

North Dakota Gap AME Group Insurance Certificate
North Dakota

Ohio Gap AME Group Insurance Certificate
Ohio

Oklahoma Gap AME Group Insurance Certificate
Oklahoma

Pennsylvania Gap AME Group Insurance Certificate
Pennsylvania

Rhode Island Gap AME Group Insurance Certificate
Rhode Island

South Carolina Gap AME Group Insurance Certificate
South Carolina

Tennessee Gap AME Group Insurance Certificate
Tennessee

Texas Gap AME Group Insurance Certificate
Texas

Virginia Gap AME Group Insurance Certificate
Virginia

West Virginia Gap AME Group Insurance Certificate
West Virginia

Wisconsin Gap AME Group Insurance Certificate
Wisconsin

Wyoming Gap AME Group Insurance Certificate
Wyoming

Claim Information

For Claims Assistance:

  • Group Accidental Death & Dismemberment Insurance Claims
  • Group Accident Medical Expense Insurance Claims
  • Emergency Treatment Benefit

For Group Accidental Death & Dismemberment, Group Accident Medical Expense Insurance & Emergency Treatment Benefit Claims:

United Business Association Claims Unit
HSR, 4100 Medical Parkway, Carrollton, TX 75007
Phone: 1.866.523.3452
Fax: 1.972.512.5824


Click here to download Gap Plus Catlin Accident Claim Form Emergency Treatment Benefit Claim Form


Claims for benefits shall be administered based on the Policy and/or Rider. A copy of the Policy and/or Rider is available upon request. Benefits are subject to the definitions, limitations, exclusions and other provisions within the Policy and/or Rider. For more information and complete details of the terms, conditions, limitations, defintions of a covered critical illness and exclusions of coverage, please refer to the Policy and/or Rider. Product features and availability may vary by state.

For Catlin Insurance Company, Inc. Insurance Benefits:
Policy Form Series AHAG 051 (In LA, AHAG AS050) | Rider form Series AHAG 401 0412 (California Certificate of Authority #08666 NAIC #19518)
Terms & Disclosures

Disclosures

If insurance is included in any Gap Plan, it is not basic health insurance or major medical coverage and does not qualify as minimum essential coverage under the Affordable Care Act. You must be a member of the United Business Association (UBA) to access and enroll in any Gap Plan that provides an insured benefit. Various insurance companies, as described, have issued group limited benefit insurance policies to the United Business Association as the group master policyholder. You must purchase UBA Membership in order to purchase this additional plan.



UBA Refund / Cancellation Policy

If you are not completely satisfied with your UBA Gap Plan, please call your Personal Member Concierge at 866.438.4274. We will be happy to issue a complete refund of membership dues within the first thirty (30) days. We want you to be 100% satisfied with your UBA Gap benefits and services.

Note: This membership is separate from any other insurance or supplemental plan you have purchased. Please contact your agent for any plans other than the UBA Gap Membership Plan. If you are canceling, please make sure to cancel using our cancellation phone number at 866.438.4274 or our cancellation form located at gapplusplan.com/billing.html. Please do not cancel through your agent. Cancel directly with GAP to make sure your cancellation request is handled promptly and correctly.

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