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Gap Plus Plan - www.gapplusplan.com - Member Driven Value.
Super Gap Plan - www.ubamembers.com - Member Driven Value.

Super Gap Plan

Select here to Apply Now to UBA Membership & Super Gap Plan

Plan Costs*

Individual - $55 per month
Individual+1 - $105 per month
Family - $120 per month  

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Select here to view Super Gap Plan Sample Member Guide for details on plan

Group Accidental Death & Dismemberment & Group Accident Medical Expense Insurance helps with out-of-pocket costs due to an accident. Hospital Fixed Indemnity Insurance helps with out-of-pocket costs due to accident or sickness for emergency room visits and daily hospital confinement. Group Critical Illness Insurance helps with out-of-pocket costs due to the first diagnosis of life-threatening cancer, heart-attack or stroke. Group Term Life Insurance provides valuable protection for your family in case of loss. The Super Gap Plan is a great fit for families, people who tend to be accident prone or with a family history of cancer, heart-attack or stroke, or those that just want that extra layer of protection for some of their out-of-pocket costs (like health plan deductibles, coinsurance maximums, and out of network costs if you choose to go to a doctor or provider not in your network) due to an accident, emergency room visit or being diagnosed with a Critical Illness. Super Gap Plan is designed to supplement your comprehensive health insurance plan for additional protection.

Gap Your Major Medical with Strong,
Affordable Coverage. The Gap Way. 


Group Accident Insurance Tab - Super Gap Plan

GROUP ACCIDENT INSURANCE



View Accident (AME & AD&D) Exclusions and Limitations - Gap AME Plan


Group Accidental Death & Dismemberment Insurance

If, within 1-year from the date of an Accident, covered by the Policy and the Certificate, Injury from such Accident, results in Loss listed below, We will pay the percentage of the Principal Sum set opposite the Loss in the table below. If the Covered Person sustains more than one such Loss as the result of one Accident, We will pay only one amount, the largest to which the Covered Person is entitled. This amount will not exceed the Principal Sum which applies for the Covered Person.

Maximum Benefits+

Member Principal Sum $5,000.00
Spouse Principal Sum $5,000.00
Dependent Child(ren) Principal Sum $5,000.00

+Available to all active members of the United Business Association, age 18-79, who have chosen to enroll themselves in the Super Gap Plan option and their enrolled Spouse up to age 70 as well as their enrolled dependent Children.


LOSS & PERCENTAGE OF PRINCIPAL SUM

Loss of Life 100%
Loss of two or more Hands or Feet 100%
Loss of Speech and 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%
Loss of Thumb and Index Finger (same hand)   25%


Group Accident Medical Expense Insurance

Accident Medical Expense benefits may be available on an allocated or unallocated basis shown, that is to say there may be specific limits or out-of-pocket expenses on certain Covered Expenses (allocated) or all Covered Expenses may be subject to the same maximum limit and out-of-pocket expenses (unallocated). Any Deductibles, Coinsurance, Co-payments, Benefit Periods, and Benefit Maximums apply on a Covered Person, per Covered Accident basis. If an injury to the Covered Person results in Covered Person incurring Eligible Expenses for any of the services in the schedule of benefits, We will pay the Eligible Expenses incurred, subject to any applicable Deductible Amount, Benefit Period, that are in excess of Expenses payable by any other Health Care Plan, regardless of any Coordination of Benefits provision contained in such Health Care Plan.

Maximum Benefits+

Member Annual Maximum Benefit Amount $25,000.00
Spouse Annual Maximum Benefit Amount $25,000.00
Dependent Child(ren) Annual Maximum Benefit Amount $25,000.00

+Available to all active members of the United Business Association, age 18-79, who have chosen to enroll themselves in the Super Gap Plan option and their enrolled Spouse up to age 70 as well as their enrolled dependent Children.


Loss Period

(First Covered Expenses)

90 days after the Covered Accident or Injury


Benefit Period

1 year from the date of the Covered Accident or Injury, provided the injury occurs prior to the Expiration Date and care is Medically Necessary.


Deductible

$100.00


The Covered Person must be under the care of a Physician when the Eligible Expenses are incurred. The Expense must be incurred solely for the treatment of a covered injury while the person is insured under the Certificate or during the Benefit Period stated on the schedule of benefits. The total of all medical benefits payable under the Certificate is shown in the schedule of benefits and is subject to the specific maximums shown above.



Did You Know Accident Statistic - Gap AME Plan

Non-Fatal Injuries affect millions of Americans. In 2015, 40.6 million people - about 1 in 8 - sought medical attention.1

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

1 National Safety Council. (2017). Injury Facts®. 2017 Edition. Itasca, IL: Author. Library of Congress Catalog Number: 99-74142. Statistics taken from Page 2 and 144. http://viewer.zmags.com/publication/20020222#/20020222/1



THIS IS A LIMITED POLICY. THIS IS NOT COMPREHENSIVE MAJOR MEDICAL INSURANCE.
THIS IS AN ACCIDENT ONLY POLICY.

This is a brief description of coverage provided under the Policy Certificate and is subject to the terms, conditions, limitations and exclusions of the policy. Please see the policy and certificate for complete details. Coverage may vary or may not be available in all states. Plans are underwritten by United States Fire Insurance Company, Eatontown, NJ. The insurance described in this document provides limited benefits. Limited benefit plans are insurance products with reduced benefits intended to supplement comprehensive health insurance plans. This insurance 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, this insurance is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act.



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Super Gap Plan State Availability

State Availability for Super Gap Plan

AL, AR, AZ, CA, DC, DE, FL, GA, ID, IL, IN, IA, KS, KY, LA, MI, MO, MS, NE, NM, NJ, NC, ND, OH, OK, PA, RI, SC, TN, TX, VA, WV, WI & WY

HOW TO FILE CLAIMS FOR ACCIDENT & ER
CRITICAL ILLNESS OR TERM LIFE  

Group Accident Claims - Super Gap Plan
GROUP ACCIDENT
CLAIMS 

United Business Association Claims Unit
Co-ordinated Benefit Plans
Po Box 23802
Tampa, FL 33623
Phone: 877.442.7029
Email: team2@cbpinsure.com
Online Claims Look-up:
CBPConnect.com       

hospital Fixed Indemnity & ER Claims - Super Gap Plan
HOSPITAL FIXED
INDEMINTY & ER CLAIMS 

United Business Association Claims Unit
Co-ordinated Benefit Plans
Po Box 23802
Tampa, FL 33623
Phone: 877.442.7029
Email: team2@cbpinsure.com
Online Claims Look-up:
CBPConnect.com       

Select here to view and download Group Accident Claim form for Super Gap Plan
Select here to view and download Hospital Indeminty & ER Claim Form for Super Gap Plan
Group Critical Illness Claims - Super Gap Plan
GROUP CRITICAL
ILLNESS CLAIMS 

United Business Association Claims Unit
Windsor Life Insurance Company
1345 River Bend Drive Suite 100
Dallas, TX 75247
Phone: 877.368.3927
Fax: 214.528.2777     

Group term Life Claims - Super Gap Plan
GROUP TERM
LIFE CLAIMS 

United Business Association Claims Unit
Investors Heritage Life Insurance Company
200 Capital Ave, Po Bo x717
Frankfort, KY 40602-0717
Phone: 800.422.2011
Fax: 502.223.6575     

Select here to view and download critical illness claim form for super gap plan
Select here to view and download term life claim form for super gap plan
Accident & Hospital Indemnity (ER) Claims:

To Connect to CBPConnect for Accident Claims online claims look-up, you need your Member ID Number. You can locate your Member ID number on your welcome letter in the kit you received in the mail with your membership ID card. If you can't locate your Member ID number, please contact your Personal Member Concierge at 866.438.4274.

Critical Illness Claims:

Claims for benefits shall be administered based on the Policy Certificate. A copy of the Policy Certificate is available upon request. Benefits are subject to the definitions, limitations, exclusions and other provisions within the Policy Certificate. For more information and complete details of the terms, conditions, limitations, definitions of covered critical illnesses and exclusions of coverage, please refer to the Policy Certificate. 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.

Term Life Claims:

To change beneficiaries, use the Change Beneficiary Change Form below.

Select here to download Term Life Change of Beneficiary Form - Super Gap Plan
Important Note:

These claim forms above are for Super Gap Plans purchased on or after 04.05.18 or all Super Gap Plans on or after 06.01.18. If you purchased a Super Gap Plan prior to 04.05.18 and claim occurs before 06.01.18, please locate your claim form on the Members Link at www.ubamembers.com.

United Business Association

The United Business Association (UBA) is a nationwide membership of small business owners and employees. UBA leverages our purchasing power to secure benefits and discounts that may not be otherwise available on an individual basis. With association group insurance programs, shared business knowledge, business and lifestyle benefits and services and opportunities to network, We are Better Together. Your membership in the United Business Association allows you to access and enroll in association group insurance programs and apply for association short term medical insurance. Various insurance companies have issued group limited benefit insurance policies to the United Business Association as the group master policyholder. Product features, additional plans and availability may vary by state. View UBA's Refund / Cancellation Policy.

*Plan Costs listed at the top of the page do not include the separate $10 UBA Membership dues. You must be a member of the United Business Association to access and enroll in this Gap Plan.

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