GapPlusPlan.com for UBA Members

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

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Get Insured for Emergencies

Gap ER Plan

Member Driven Value.

Plan Costs

$20 per month - Individuals
$40 per month - Family 

Get Treatment for the Unexpected

Summary of Plan

Why Gap ER Plan

The Healthcare World is Changing

Did You Know...

1 in 5 Americans Report Visiting an Emergency Room at least once in the past year?1

Gap ER Plan is the first product introduced to address this changing health care environment.
  • It is more difficult to obtain a timely Dr Office Visit.2
  • Urgent Care Centers & Free Standing ERs are popping up on every street corner.
    (They are the fastest growing medical facilities being built).3
  • Majority of health plans make Urgent Care & ER Visits subject to the deductible or copays.


1Stats taken from:
http://www.cdc.gov/media/releases/2013/p0530-emergency-room.html.2https://www.forbes.com/sites/brucejapsen/2014-01-29/doctor-wait-times-rise-as-obamacare-rolls-out/#15fcd8d05a2.The Fiscal Times: http://www.thefiscaltimes.com/2017/03/21/Need-See-New-Doctor-Get-Ready-Record-Wait.Merritt Hawkins 2014 Survey of Physician Appointment Wait Times & Medicaid / Medicare Acceptance Rates:https://www.merritthwakins.com/uploadedFiles/Merritt-Hawkings/Surveys/mha2014waitsurvPDF.pdf. 3http://www.usatoday.com/story/money/business/2013/07/11/stand-alone-emergency-rooms-popping-up/2510779/. Future of Urgent Care: http://aaucm.org/about/future/default.aspx.
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

^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)

Group Accidental Death & Dismemberment Insurance

$1,000 Maximum Benefit^

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.

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

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State Availability

Group Accidental Death & Dismemberment & Emergency Treatment Benefit

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.

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.
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Get Insured For Emergencies with Gap ER Plan.

Disclosures & Claims

Important Information To Know

Coverage is available to paid Members after the effective date listed in your welcome letter following the receipt of the Membership application and the payment of the first month's dues by 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 within 365 days of the Covered Accident.



For Claims Assistance

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 ER Emergency Treatment Claim Form

Benefit payment is subject to the terms, conditions, limitations, exclusions, and other provisions within the Certificate. For more information and complete details of terms, conditions, limitations, and exclusions of coverage, please refer to the Certificate and Emergency Treatment Rider. Coverage may vary and may not be available in all states. A copy of the Certificate and Emergency Treatment Benefit Rider are available from the Association upon request.

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



Disclaimers

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. The intent of Emergency Room Treatment Facility will also include Free-Standing Emergency Rooms as well as Urgent Care Centers. 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.

30 Day Money Back Guarantee

Treatment In-Hospital Emergency Rooms are Covered
Treatment in Free-Standing Emergency Rooms are Covered
Treatment in Urgent Care Centers are Covered
Be Prepared for an Emergency - Get Covered with Gap ER