GapPlusPlan.com for UBA Members

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

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Get Insured for a Critical Illness, an Accident and emergencies

Gap Max Plan

Member Driven Value.

Plan Costs

$50 per month - Individual
$100 per month - Family 

Accidents Happen. Be Prepared with Gap Max Plan

Summary of Plan

Why Gap Max 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

Critical Illness Statistics

    Critical Illness Statistics

    Every year, about 735,000 Americans have a heart-attack. Of these 525,000 are a first heart-attack.3

    It is estimated there will be 1,688,780 new cancer cases in 2017.4

    Every year, about 795,000 Americans have a stroke. Of these 610,000 are a first or new stroke. Someone in the U.S. has a stroke every 40 seconds.5

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. 3http://www.cdc.gov. Stroke Facts & Heart Disease Facts & Statistics. Mozaffarian D Benjamin EJ Go AS, et al. Heart Disease & Stroke Statistics - 2015 updated: a report from the American Heart Association. Circulation 2015:131:e29-322. 4Cancer Facts and Figures 2017 by the American Cancer Society downloaded at https://www.cancer.org. 5Mozaffarian D. Benjamin EJ Go AS Arnet DK Blaha MJ Cushman M Et Al, on behalf of the American Heart Association Statistics Committee and Stroke Statistics Sub Committee. Heart Disease and Stroke Statistics - 2016 update:a report from the American Heart Association. Circulation 2016:133(4):e38-360.
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)

Group Critical Illness Insurance - Covered Critical Illnesses

Maximum Benefit Amount after the first 12 months from effective date^

 Member Principal Sum  $25,000
 Spouse Principal Sum*  $25,000
 1st Diagnosis in the first 12 months from Effective Date  $2,500

^Coverage is available to all active members of the United Business Association and their eligible spouses between the ages of 18-64. Coverage is provided by and underwritten by Windsor Life Insurance Company.

We pay this benefit only if the Critical Illness first occurs after the Effective Date of Coverage for that Covered Person and while the Covered Person's coverage under this Group Policy is in force. We pay a Covered Critical Illness benefit only one time, regardless of the subsequent occurrence of the same or different covered Critical Illness for that Covered Person. It is a lump sum benefit. Once the benefit is paid, coverage for that Covered Person under the Master Policy terminates. Claims for benefits shall be administered based on the Policy Certificate. To be considered first diagnosis of a covered critical illness, it must meet the full definition listed in your Policy Certificate. Please view the Policy Certificate to view full definitions, limitations, exclusions, and terms of the Policy Certificate.



Important Benefit Information:

Group Critical Illness Insurance

It is a Lump Sum Benefit.
Benefits end when Covered Person reaches age 65.



Covered Critical Illnesses

First Diagnosis of Life-Threatening Cancer First Diagnosis of Heart-Attack First Diagnosis of Stroke
CI Definitions

Covered Critical Illness Definitions

Life-Threatening Cancer:

Includes only those types of cancer manifested by the presence of a malignant tumor, characterized by the uncontrolled growth and spread of malignant cells that invade tissue, blood or the lymphatic system. As used herein, Leukemia and Hodgkin's Disease (except stage 1 Hodgkin's Disease) shall be considered Life-Threatening Cancer. Does not include
  • Premalignant tumors or polyps;
  • Cancer in situ;
  • Carcinoid of the appendix;
  • Stage 0 transitional carcinoma of urinary bladder; or
  • Any skin cancers other than malignant melanomas.

Heart-Attack (Myocardial Infarction):

An acute myocardial infarction resulting in the death of a portion of the heart muscle (myocardium) due to a blockage of one or more of the coronary arteries and resulting in the loss of normal function of the heart.

Stroke:

An acute cerebrovascular accident producing neurological impairment and resulting in paralysis or other measurable objective neurological deficit persisting for at least thirty (30) days. This definition of Stroke shall specifically exclude:
  • Transient ischemic attack (mini-stroke);
  • Head injury;
  • Chronic cerebrovascular insufficiency;
  • And reversible ischemic neurological deficits.
State Availability & Underwriting Company

Gap Max 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)


Group Critical Illness Insurance:

Underwriting Insurance Company

Windsor Life Insurance Company
Windsor Life Insurance Company is re-insured by Optimum Re.

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

Click on Link below to View Gap Max Plan Sample Member Guide

Click here to download and view Gap Max Plan Sample Member Guide

Group Insurance Certificates

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Claims Information

For Claims Assistance:

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

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


Group Critical Illness Insurance:

United Business Association Claims Unit
Windsor Life Insurance Company
1345 River Bend Dr Suite 100, Dallas, TX 75247
Phone: 1.877.368.3927
Fax: 1.214.528.2777


Click here to download Gap Plus Windsor Critical Illness 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 Group Critical Illness Insurance: Note - Always include the Covered and Primary Insured's Name, current address, and Certificate Number (which is your social) when addressing claims. All claims must be notified within 30 days after a covered loss occurs or starts, or as soon as possible.

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.

30 Day Money Back Guarantee
Covered Critical Illnesses - 1st Diagnosis of Life-Threatening Cancer
Covered Critical Illness - 1st Diagnosis of Heart-Attack
Covered Critical Illnesses - 1st Diagnosis of Stroke
Gap Max Plan