Member Driven Value.
Get Access to Member Forms, Benefits
Group Insurance Certificates and more...
Click on the link below to download Claim Forms:Check Your Member Guide to Determine the Insurance Carrier that Provides Coverage for Your Membership Plan Benefits.
TERM LIFE CLAIM
& BENEFICIARY FORMS
Note: There are no claim forms to complete
when you visit a VSP participating doctor.
Click on the Plan Below to View Group Insurance Certificates(The Group Insurance Certificates below are for plans purchased on or after September 7, 2017. If you purchased a membership plan prior to September 7, 2017, fill out the request to receive the Group Insurance Certificates for your specific membership plan.)
Did you purchase a Gap Plan PRIOR to 9-7-17? If you purchased your plan prior to 9-7-17, the group certificates may be different than the plans listed above. Please select the Older Plan Certificates button below for access to your correct Group Insurance Certificates for your plan.
UBA Membership Benefit Forms
Use the following forms to enroll or order the following benefits and services of the United Business Association.
Click on Image Below to view Billing Forms:
Use these forms to update your bank draft account or credit card account or expiration date. Make sure to send it back securely. Don't send back through regular email. Use the Secure Email Upload Link located in the Send information to UBA Securely Tab. You can also fax back the information to 817.335.1270. Do you have a general billing question? Use the Billing Question link below to ask our billing department. Make sure to not include account information on this form. This form is for general questions only.
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.
Click on the Image Below to View Benefit Providers
Click on the Company Name Below to View Corporate Website.
^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.
United Business Association Proudly Supports the Following Charities.
You can too! Click on the Image Below to Donate Today!
Click on the Calendars Below to View Past Editions of UBA Matters Newsletters, exclusively for UBA Members.
(Password=BIN# on your Retail RX Discount ID Card. Can't locate your card, call us at 866.438.4274)