#MEMBER DRIVEN VALUE
Follow us on FacebookFollow us on TwitterFollow us on Google Plus
Member Driven Value. www.gapplusplan.com
United Business Association - Member Driven Value.

MEMBERS

Member Driven Value.

866.438.4274

Unlock the Value of Your Membership.

Get access to Member Forms, Membership Benefits, Group Insurance Certificates and more.

Select from the quick links below to skip to sections.

Skip to Download Claim Forms by clicking here
DOWNLOAD
CLAIM FORMS 
Skip to Member Guide & ID Card section by clicking here
MEMBER GUIDE
& ID CARD 
Skip to Insurance Certificates section by clicking here
INSURANCE
CERTIFICATES 
Skip to UBA Benefit Enrollment section by clicking here
UBA BENEFIT
ENROLLMENT 
Skip to Change Request & Billing Forms Section by clicking here
CHANGE REQUEST
& BILLING FORMS 
Skip to Provier Lookup Section by clicking here
PROVIDER
LOOKUP 
Skip to Insurance Carriers section by clicking here
INSURANCE
CARRIERS 
Skip to Misc. Member Information by clicking here
MISC. MEMBER
INFORMATION 
Download Claim Forms - make sure to check your member guide to determine the correct insurance carrier that provides the insured benefit.
DOWNLOAD
CLAIM FORMS   

ACCIDENT CLAIM FORMS

For plans purchased on or after 04.05.18 and for all plans that include United States Fire Insurance Company Group Accident Insurance starting 06/01/18 and later.

Crum & Forster Claim Form

For business written BEFORE 04.05.18 and ONLY for covered Accident claims that occur PRIOR to 06.01.18.

Catlin Group Accident Claim Form

GTL Group Accident Claim Forms

Assurant Accident Claim Form
(CO only)

er claim forms

For plans purchased on or after 04.05.18 and for all plans that include United States Fire Insurance Company Hospital Fixed Indemnity & ER Insurance starting 06.01.18 and later.

Crum & Forster ER Claim Form

For business written BEFORE 04.05.18 and ONLY for covered ER claims that occur PRIOR to 06.01.18.

Catlin ER Claim Form

Critical Illness Claims

Windsor Critical Illness Claim Form

Catlin Critical Illness Claim Form

Gap HCI Claim FOrm

HCI Plan Claim Form

Dental Claim Form

Dental Claim Form

VISION Claim Form

Vision Claim Form

(Note: There are no claim forms to complete when visiting a VSP participating doctor.)

Term Life Claim Forms

IHL Term Life Claim Form

IHL Beneficiary Change Form

Member Guide & ID Card -you can reorder the Member Guide and ID card for your membership and additional gap plans
MEMBER GUIDE
& ID CARD 

RE-ORDER MATERIALS

Re-order Member Guide

Re-order Member ID Card

VIEW SAMPLE GUIDES

(For plans purchased on or after 04.05.18 - also includes all plan sample guides (except Gap HCI) listed on your new ID card starting on  06/01/18.)

UBA Membership Sample Guide

STM Plan Sample Guide

Gap Dental Sample Guide

Gap Vision Sample Guide

Gap AME Sample Guide

Gap CI Sample Guide

Gap ER Sample Guide

Gap HCI Sample Guide

Gap Plus Sample Guide

Gap Max Sample Guide

Super Gap Sample Guide

For plans purchased prior to 04/05/18 that show Gap Plus Legacy on your new Gap ID Card for 06/01/18 and later.

Gap Plus Legacy Sample Guide

For plans purchased prior to 04/05/18 that show Gap CI 10K on your new Gap ID Card for 06/01/18 and later.

Gap CI 10K Sample Guide

For Gap HCI Plans purchased PRIOR to 04/05/18, view the Sample Guide below.

Gap HCI Sample Guide

Download Group Insurance Certificates here - pick your plan and then choose your state to view certificate
INSURANCE
CERTIFICATES 

Select Image to View

(For plans sold on or after 04.05.18)

STM PLAN

STM Plan Group Insurance Certificates - view to learn more about your state specific group insurance

Gap Dental Plan

Gap Dental Plan Group Insurance Certificates - view to learn more about your state specific group insurance

Gap Vision Plan

Gap Vision Plan Group Insurance Certificates - view to learn more about your state specific group insurance

GAP AME PLAN

Gap AME Plan Group Insurance Certificates - view to learn more about your state specific group insurance

Gap CI Plan

Gap CI Plan Group Insurance Certificates - view to learn more about your state specific group insurance

GAP ER PLAN

Gap ER Plan Group Insurance Certificates - view to learn more about your state specific group insurance

gap hci plan

Gap HCI Plan Group Insurance Certificates - view to learn more about your state specific group insurance

gap plus plan

Gap Plus Plan Group Insurance Certificates - view to learn more about your state specific group insurance

Gap Max Plan

Gap Max Plan Group Insurance Certificates - view to learn more about your state specific group insurance

Super Gap Plan

Super Gap Plan Group Insurance Certificates - view to learn more about your state specific group insurance

For plans purchased prior to 04/05/18 that show Gap Plus Legacy on your new Gap ID Card for 06/01/18 and later.

Gap Plus Legacy

Gap Plus Legacy Group insurance Certifiates

For plans purchased prior to 04/05/18 that show Gap CI 10K on your new Gap ID Card for 06/01/18 and later.

Gap CI 10K

Gap CI 10K Plan Group insurance Certificates

For Gap HCI Plans purchased PRIOR to 04/05/18, use the certificates link below.

Gap HCI Plan

Gap HCI Plans purchased PRIOR to 04/05/18 Group Insurance Certificates
UBA Benefit Enrollment - this is where you can order vitamins, get links for MeMD, MailMyPrescriptions, Theme Park Order Form, HSA Enrollment, Gateway Medicard and Scholarship Application
UBA BENEFIT
ENROLLMENT 

Member Forms/Links

(You must be an active member of UBA to access these benefits and services of your membership)

FREE VITAMIN ORDERS

Vitamin Online Order Form

Vitamin Order Form (pdf)

WHOLESALE PHARMACY

(Use code in guide to access Member-only promotions)

MailMyPrescriptions.com

telemedicine service

MeMD - Telemedicine 24/7

graduate scholarship

Scholarship Application (pdf)

Theme park benefit

Theme Park Form (pdf)

medical data card

Gateway Medicard Order (pdf)

hsa enrollment - hsa bank

HSA Account App - Individual

HSA Account App - Employer

Business Insurance

(The business insurance links are not guaranteed coverage, you must apply for these insurance policies and be approved to access)

Business Owner's Policy

Home Based Business Owners

Data Breach & Cyber Liablity

Lab Discounts

(Use code in the guide to access service - Not available in MA, MD, ND, NJ, NY, RI & SD)

Order / Schedule Labs

Back to Top of Members Page
Provider Lookup - look up dental, vision, rx, rx discount, pet rx discount providers
PROVIDER
LOOKUP 

Find Providers

Dental Provider Lookup

Vision Provider Lookup

Gap RX Provider Lookup

(this is for providers for the Gap RX plan sold 09.07.17-04.04.18)

RX Discount Providers

Retail RX Discount Providers

Retail Pet RX Discount Providers

Insurance Carriers who provide us coverage - view the insurance carriers who provide insured products to UBA as the Master Policy Holder
INSURANCE
CARRIERS 

Select Carrier to View

Crum & Forster - a registered trademark of United States Fire Insurance Company

Windsor Life Insurance Company,
reinsured by Optimum Re 

Federal Insurance Company,
a Chubb Company^
 

Investors Heritage Life Insurance Company

Renaissance Life & Health Insurance Company of America

Guarantee Trust Life Insurance Company

National General Accident & Health

PRAM Insurance Services, Inc.,
exclusive underwriter for Envision Insurance Company

Catlin Insurance Company, Inc.

Crum & Forster Logo: Plans are underwritten by the United States Fire Insurance Company, 5 Christopher Way, 3rd Floor, Eatontown, NJ 07724. C&F and Crum & Forster are registered trademarks of United States Fire Insurance Company. The Crum & Forster group of companies is rated A (Excellent) by AM Best Company 2015.

XL Catlin is the global brand used by XL Group Ltd's insurance subsidiaries, including Catlin Insurance Company, Inc. Windsor Life Insurance Company is re-insured by Optimum Re.

^Insurance benefits are underwritten by Federal Insurance Company. Chubb NA is the U.S.-based operating division of the Chubb Group of Companies, headed by Chubb Ltd. (NYSE:CB). Insurance products and services are provided by Chubb Insurance underwriting companies and not by the parent company itself.  

Miscellaneous Member Information - view member news, causes to support, video links and more
MISC. MEMBER
INFORMATION 

UBA Newsletters

Past Editions of UBA Matters

Causes to Support

We proudly Support Stand Up To Cancer - you can too - donate today at www.standup2cancer.orgSuport American Heart & American Stroke Association - donate today at www.heart.org/HEARTORG/

Gap Video Links

MailMyPrescriptions.com Video

MeMD - Telemedicine Video

Gap YouTube Channel

Back to top of Members Page