UBA'S MOST POPULAR SUPPLEMENTAL INSURANCE CATEGORY
INCLUDES OPTIONAL SUPPLEMENTAL GROUP INSURANCE
LIKE ACCIDENT, CRITICAL ILLNESS, ER VISITS AND MORE.

GAP 5000+

Gap to help offset
out-of-pocket medical expenses.

Blanket Group Accident Insurance

Blanket Group Accident Medical Expense Insurance

$5,000 Group Accident Medical Expense Insurance Annual Maximum Benefit.

$100 Deductible per accident.

Blanket Group Accidental Death & Dismemberment Insurance

$2,500 Group Accidental Death & Dismemberment Insurance Maximum Principal Sum.

Blanket Group Accident Insurance is underwritten by Sirius America Insurance Company.

Group Critical Illness Insurance

Critical Illness Insurance Benefit

$5,000 Critical Illness Benefit Lifetime Maximum Benefit Amount

Maximum Lifetime Benefit Amount is $1000 if first diagnosis of a Covered Critical Illness occurs within the first year from the effective date. Invasive Cancer benefit will not be paid if Proof of Loss occurs prior to 45 days from the effective date. Benefit ends at age 65 and Critical Illness Insurance Benefit is only available for Covered Member and their Eligible Spouse.

Group Critical Illness Insurance is underwritten by Sirius America Insurance Company.

ASSOCIATION BENEFITS
PROVIDED BY:

BLANKET GROUP ACCIDENT INSURANCE
& GROUP CRITICAL ILLNESS INSURANCE
UNDERWRITTEN BY:
Sirius America Insurance Company

BILLING, FULFILLMENT &
CUSTOMER SERVICE PROVIDED BY:

^{*Billing is administered through the Third Party Administrator
of H A Partners, Inc. or HealthyAmerica (depending on state).}

THE INSURANCE PORTIONS OF THIS MEMBERSHIP PRODUCT PROVIDE LIMITED COVERAGE. THEY DO NOT PROVIDE COMPREHENSIVE MAJOR MEDICAL INSURANCE. COVERAGE IS PROVIDED UNDER BLANKET ACCIDENT AND GROUP CRITICAL ILLNESS INSURANCE ONLY POLICIES.

The following monthly insurance rates apply to coverage underwritten by Sirius America Insurance Company¹. Your overall total association membership dues for the optional supplemental Gap 5000+ Plan also include these monthly insurance rates:

¹Blanket Group Accident Insurance:
$4.17 (Member), $8.37 (Member+1), $15.76 (Family)

¹Group Critical Illness Insurance:
$3.26 (Member) & $6.51 (Member+Spouse)


Read the Certificate(s) of Insurance carefully. This is a brief description of various group association insurance membership products and is not an insurance contract, nor part of the Certificate of Insurance and is subject to the terms, conditions, limitations, and exclusions of the Blanket Group Policy and Certificate(s) of Insurance. Coverage may vary or may not be available in all states. You’ll find complete coverage details in the Certificate(s) of Insurance. Blanket Accident Insurance and Group Critical Illness Insurance are underwritten by Sirius America Insurance Company, New York, NY. The insurance described in this document provides limited benefits. Limited benefit plans are insurance products with reduced benefits intended to help supplement comprehensive health insurance plans. The insurance coverage is not an alternative to comprehensive coverage. It does not provide major medical or comprehensive medical coverage and is not designed to replace major medical insurance. Further, the insurance coverage is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act. Covered Critical Illnesses are subject to the definitions, limitations and exclusions of the Group Policy. Coverage for Critical Illness is for Member and eligible Spouse between the ages of 18-64. Benefit for Group Critical Illness Insurance ends at age 65. Group Critical Illness Insurance Benefit Maximum is reduced if the first diagnosis occurs in the first year from the effective date. Membership Product cost for the Gap 5000+ Plan does not include the separate $10 UBA Membership dues. You must be a member of the United Business Association in order to purchase this plan.

United Business Association, Sirius America Insurance Company, and HealthyAmerica are separate legal entities and have sole financial responsibility for their own products.

HASA-1000 | HASA-BAM-1000

• CHOOSE STATE TO VIEW CERTIFICATE OF INSURANCE
  
  (Limitations & Exclusions)
  • Alabama
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Illinois
  • Indiana
  • Kansas
  • Kentucky
  • Louisiana
  • Michigan
  • Mississippi
  • Missouri
  • Nebraska
  • Nevada
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Rhode Island
  • Tennessee
  • Texas
  • Virginia
  • West Virginia
  • Wisconsin
  • Wyoming
  
  

Benefit Boost Services

Non-Insurance Services included in this plan.

This plan includes the highly-regarded Benefit Boost Subscription Services which are:

• Virtual Urgent Care & Virtual Talk Therapy Visits with telehealth services provided by Walmart Health Virtual Care
• Free gummy multi-vitamins;
• Retail prescription & pet prescription discounts powered by Paramount RX^®;
• Dental Discounts powered by Aetna Dental Access^® network;
• and Identity theft protection with LifeLock^®.

All Benefit Boost Services are not Insurance and are separate services from the insurance as part of this optional membership product. Benefit Boost services are subject to change when needed.

Dental Discounts powered by Aetna Dental Discount network are not available in AK, CT, IA, MA, RI, UT, VT, WA and this benefit is not available for the residents of Vermont.

As part of your overall Gap 5000+ Plan cost, the non-insurance Benefit Boost Subscription services retail at $25 (Individual), $40 (Ind+1), $60 (Family).

If you purchased the Virtual PCP Solution Subscription Membership with the Benefit Boost Subscription Membership, the Walmart Health Virtual Care Visits telehealth services will be based on the Virtual PCP Solution Subscription telehealth services provided by Walmart Health Virtual Care.

Sirius America Insurance Company does not offer and is not affiliated with the additional non-insurance Benefit Boost services and discount programs offered in connection with membership in the United Business Association (UBA).

The $0 cost Virtual Urgent Care & Virtual Talk Therapy Visits - visits are paid by HealtyAmerica and not the member.

Read the guide carefully. This is a brief description of a virtual urgent care and talk therapy telehealth service provided by Walmart Health Virtual Care; dental discount program powered by the Aetna Dental Access® Network; a prescription discount program through Paramount RX®; free multi-vitamin service; and an identity theft discount program through LifeLock®; and is not an insurance contract. This is not a qualified health plan under the Affordable Care Act (ACA). Some services may be covered by a qualified health plan under the ACA. This plan does not meet the minimum creditable coverage requirements under M.G.L.c. 111M and 956 CMR 5.00. This is not a Medicare prescription drug plan. The product provides discounts at participating providers for services. The plan does not make payments directly to providers. The plan member is obligated to pay for all services but will receive a discount from participating providers. The range of discounts will vary depending on the type of provider and services. Not all services are available in all states.

Walmart Health Virtual Care, Aetna Dental Access^®, Paramount RX^®, LifeLock^®, United Business Association, and HealthyAmerica are separate legal entities and have sole financial responsiblity for their own products.

GAP EDGE+

Gain the edge on
out-of-pocket expenses.

Blanket Group Accident Insurance

Blanket Group Accident Medical Expense Insurance

$25,000 Group Accident Medical Expense Insurance Annual Maximum Benefit.

$100 Deductible per accident.

Blanket Group Accidental Death & Dismemberment Insurance

$5,000 Group Accidental Death & Dismemberment Insurance Maximum Principal Sum.

Blanket Group Accident Insurance Policy is underwritten by Sirius America Insurance Company.

Group Critical Illness Insurance

Critical Illness Insurance Benefit

$25,000 Critical Illness Benefit Lifetime Maximum Benefit Amount

Maximum Lifetime Benefit Amount is $2500 if first diagnosis of a Covered Critical Illness occurs within the first year from the effective date. Invasive Cancer benefit will not be paid if Proof of Loss occurs prior to 45 days from the effective date. Benefit ends at age 65 and Critical Illness Insurance Benefit is only available for Covered Member and their Eligible Spouse.

Group Critical Illness Insurance Policy is underwritten by Sirius America Insurance Company.

Group Hospital Indemnity Insurance

Physician Visit and Urgent Care Visit Benefit

$125 per visit up to 4 visits per Covered Person per Coverage Year.

A daily benefit will be paid for each visit made by a Covered Person to a Physician's Office or a licensed Urgent Care Facility to receive care or treatment of a Sickness, an Accident or an Injury.

Member and Dependent coverage ends when the Member is age 65.

Emergency Room Visit Benefit

$500 per visit up to 2 visits per Covered Person per Coverage Year.

A daily benefit will be paid for a Physician's treatment of a Covered Person during an Emergency Room visit during which Emergency Care is provided for Sickness, Accident or Injury.

Member and Dependent coverage ends when the Member is age 65.

Pre-existing Condition Limitation

The Policy will not cover any loss due to a Pre-existing Condition if the loss begins within 12 months after the Covered Person's effective date of insurance. However, the Policy may pay benefits for a loss due to a Pre-existing Condition of a Covered Person who was covered:

1. by a Replaced Policy; and
2. by the Policy, issued by Us to the Policyholder on the Policy Effective Date, and the Certificate.

The claim will be reviewed. If the Pre-Existing Condition Limitation in the Certificate does not apply, the benefits provided by the Policy and the Certificate will be paid.

If the Covered Person does not satisfy the Certificate's Pre-existing Condition Limitation, but can satisfy the Replaced Policy's pre-existing condition limitation giving credit for all time insured under both policies; then the benefit payable will be the lesser of:

1. the benefits provided by the Policy and the Certificate without applying the Pre-existing Condition Exclusion; or
2. the benefits provided by the Replaced Policy.

If the Covered Person does not satisfy the Certificate's Pre-existing Condition Limitation or that of the Replaced Policy, no Benefit will be paid.

Definition of Pre-existing Condition:

Pre-existing condition means a condition for which a Physician has treated or for which a Physician has advised treatment of the Covered Person within 12 months before the Covered person's effective date of insurance.

Coverage Year:

Means a period beginning on the Primary Covered Person's Certificate Effective Date and ending 12 months after that date. Successive Coverage Years will begin after the first Coverage Year, each extending for 12-Month periods, provided that the Primary Covered Person does not terminate His coverage within the same Coverage Year. If the Primary Covered Person terminates His coverage during a Coverage Year and re-enrolls for coverage under a new certificate within the same Coverage Year, all benefits, benefit limits and benefit maximums will be those that applied to Him under the previously terminated certificate. In this case, a new Coverage Year will begin for the Primary Covered Person after He has been insured under the new certificate of a period of 12 months.

Group Hospital Indemnity Insurance Policy is underwritten by Sirius America Insurance Company.

ASSOCIATION BENEFITS
PROVIDED BY:

BLANKET GROUP ACCIDENT INSURANCE
& GROUP CRITICAL ILLNESS INSURANCE
& GROUP HOSPITAL INDEMNITY INSURANCE
POLICIES UNDERWRITTEN BY:
Sirius America Insurance Company

BILLING, FULFILLMENT &
CUSTOMER SERVICE PROVIDED BY:

^{*Billing is administered through the Third Party Administrator
of H A Partners, Inc. or HealthyAmerica (depending on state).}

THE INSURANCE PORTIONS OF THIS MEMBERSHIP PRODUCT PROVIDE LIMITED COVERAGE. THEY DO NOT PROVIDE COMPREHENSIVE MAJOR MEDICAL INSURANCE. COVERAGE IS PROVIDED UNDER BLANKET ACCIDENT, GROUP CRITICAL ILLNESS & GROUP HOSPITAL INDEMNITY INSURANCE ONLY POLICIES.

The following monthly insurance rates apply to coverage underwritten by Sirius America Insurance Company¹. Your overall total association membership dues for the optional supplemental Gap Edge+ Plan also include these monthly insurance rates:

¹Blanket Group Accident Insurance:
$8.54 (Member), $17.07 (Member+1), $32.18 (Family)

¹Group Critical Illness Insurance:
$15.45 (Member) & $30.90 (Member+Spouse)

¹Group Hospital Indemnity Insurance:
$10.85 (Member), $23.44 (Member+1), $36.73 (Family)


Read the Certificate(s) of Insurance carefully. This is a brief description of various group association insurance membership products and is not an insurance contract, nor part of the Certificate of Insurance and is subject to the terms, conditions, limitations, and exclusions of the Blanket Group Policy and Certificate(s) of Insurance. Coverage may vary or may not be available in all states. You’ll find complete coverage details in the Certificate(s) of Insurance. Blanket Group Accident Insurance, Group Critical Illness Insurance, and Group Hospital Indemnity Insurance Policies are underwritten by Sirius America Insurance Company, New York, NY. The insurance described in this document provides limited benefits. Limited benefit plans are insurance products with reduced benefits intended to help supplement comprehensive health insurance plans. The insurance coverage is not an alternative to comprehensive coverage. It does not provide major medical or comprehensive medical coverage and is not designed to replace major medical insurance. Further, the insurance coverage is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act. Coverage for Critical Illness is for Member and eligible Spouse between the ages of 18-64. Benefit for Group Critical Illness Insurance ends at age 65. Group Critical Illness Insurance Benefit Maximum is reduced if the first diagnosis occurs in the first year from the effective date. Membership Product cost for the Gap Edge+ Plan does not include the separate $10 UBA Membership dues. You must be a member of the United Business Association in order to purchase this plan.

United Business Association, Sirius America Insurance Company, and HealthyAmerica are separate legal entities and have sole financial responsibility for their own products.

HASA-1000 | HASA-BAM-1000 | HASA-HI-1000

• CHOOSE STATE TO VIEW CERTIFICATE OF INSURANCE
  
  (Limitations & Exclusions)
  • Alabama
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Illinois
  • Indiana
  • Kentucky
  • Louisiana
  • Michigan
  • Missouri
  • Mississippi
  • Nebraska
  • Nevada
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Rhode Island
  • Tennessee
  • Texas
  • Virginia
  • West Virginia
  • Wisconsin
  • Wyoming
  
  

Benefit Boost Services

Non-Insurance Services included in this plan.

This plan includes the highly-regarded Benefit Boost Subscription Services which are:

• Virtual Urgent Care & Virtual Talk Therapy Visits with telehealth services provided by Walmart Health Virtual Care
• Free gummy multi-vitamins;
• Retail prescription & pet prescription discounts powered by Paramount RX^®;
• Dental Discounts powered by Aetna Dental Access^® network;
• and Identity theft protection with LifeLock^®.

All Benefit Boost Services are not Insurance and are separate services from the insurance as part of this optional membership product. Benefit Boost services are subject to change when needed.

Dental Discounts powered by Aetna Dental Discount network are not available in AK, CT, IA, MA, RI, UT, VT, WA and this benefit is not available for the residents of Vermont.

As part of your overall GAP EDGE+ Plan cost, the non-insurance Benefit Boost Subscription services retail at $25 (Individual), $40 (Ind+1), $60 (Family).

If you purchased the Virtual PCP Solution Subscription Membership with the Benefit Boost Subscription Membership, the Walmart Health Virtual Care Visits telehealth services will be based on the Virtual PCP Solution Subscription telehealth services provided by Walmart Health Virtual Care.

Sirius America Insurance Company does not offer and is not affiliated with the additional non-insurance Benefit Boost services and discount programs offered in connection with membership in the United Business Association (UBA).

The $0 cost Virtual Urgent Care & Virtual Talk Therapy Visits - visits are paid by HealtyAmerica and not the member.

Read the guide carefully. This is a brief description of a virtual urgent care and talk therapy telehealth service provided by Walmart Health Virtual Care; dental discount program powered by the Aetna Dental Access® Network; a prescription discount program through Paramount RX®; free multi-vitamin service; and an identity theft discount program through LifeLock®; and is not an insurance contract. This is not a qualified health plan under the Affordable Care Act (ACA). Some services may be covered by a qualified health plan under the ACA. This plan does not meet the minimum creditable coverage requirements under M.G.L.c. 111M and 956 CMR 5.00. This is not a Medicare prescription drug plan. The product provides discounts at participating providers for services. The plan does not make payments directly to providers. The plan member is obligated to pay for all services but will receive a discount from participating providers. The range of discounts will vary depending on the type of provider and services. Not all services are available in all states.

Walmart Health Virtual Care, Aetna Dental Access^®, Paramount RX^®, LifeLock^®, United Business Association, and HealthyAmerica are separate legal entities and have sole financial responsiblity for their own products.