If you purchased an optional supplemental UBA Gap Membership plan that included group insurance programs, you can find more information about how to access the insurance claim forms here. Did you have an accident, emergency room visit, doctor visit, first diagnosis critical illness (invasive cancer, heart attack or stroke), dental, vision, term life or short term medical claim? You can also locate the phone number to the claim's administrator(s) on the back of the ID card.
There are multiple ways that you can access your plan specific claims forms for your state. The first and best way to access your specific plan insurance claim form(s) is to log in to the Member Portal. Each type of group insurance that you have purchased in your UBA Gap Membership plan will be highlighted along with the correct claim forms. Instructions on how to access your Member Portal are below. We provided a screenshot of the login & register page of the Member Portal and instructions on what to do to get registered. Second, you can always Call us, and we will be happy to assist you getting the correct form for your plan and state.
You must fill out an accident claim form and send to the appropriate claim's administrator located on the form along with all other necessary documentation including itemized bills, explanation of benefits from all other insurance and anything else the claim's administrator requests. Call for help to learn how to file an accident claim.
You must fill out a critical illness claim form when you have a first diagnosis of a covered Critical Illness and send to the appropriate claim's administrator located on the form. The claim's administrator will confirm the first diagnosis & check for pre-existing conditions. Call for help to learn how to file a Critical Illness Claim.
You must fill out a term claim form upon death of a covered member and send to the appropriate claim's administrator located on the form. The claim's administrator pays claims to the beneficiary on file. Don't forget this insurance coverage ends when the covered member turns 65. Call for help to learn how to file a Term Life Claim.
You must fill out an accident claim form (Hospital Fixed Indemnity uses the same claim form as the accident claim form) and send to the appropriate claim's administrator located on the form along with all other necessary documentation including itemized bills, explanation of benefits from all other insurance and all other claim's administrator requests. Call for help to learn how to file a hospital fixed indemnity claim (These Group Hospital Fixed Indemnity Claims can include: ER Visits / Physician Visit / Daily Hospital Confinement / Outpatient Labs & X-rays).
This is for members that purchased the Gap HCI plan only. You must fill out the Gap HCI claim form for the Group Accident and Sickness Hospital Cash Indemnity Insurance underwritten by Federal Insurance Company and send to the appropriate claim's administrator located on the form along with all other necessary documentation including itemized bills, explanation of benefits and all other claim's administrator requests. Call for help to learn how to file a Group Accident & Sickness Hospital Cash Insurance claim for the Gap HCI plan.
This is only for members that purchased the individual Short Term Medical Insurance STM plan underwritten by United States Fire Insurance Company. You must fill out the short term medical claim form and send it to the claim's administrator, Health Special Risk (HSR) - info is located on the form along with all other necessary documentation. For Short Term Medical Claims, the first time you see a provider, you must file a claim. Once the claim is established with the provider, you will not have to file a claim for that same provider again. Call for help to learn about how to file a Short Term Medical Insurance claims.
If you are using a participating dental provider then a claim form does not need to be filed. Only if you are not using a participating provider do you need to send in the claim form to the dental claim's administrator. Call for help to learn about how to file a Dental Claim.
If you are using a participating vision provider, VSP then a claim form does not need to be filed. Only if you are not using the participating provider VSP do you need to send in the claim form to the vision claim's administrator. Call for help to learn about how to file a Vision Claim.
Important: HealthyAmerica and United Business Association (UBA) are not authorized to pay claims or be involved in the claim decision process. All claim decisions are made by the TPA claim's administrator and the insurance carrier.
If you need help, contact us at 866-438-4274, and we will be happy to try and assist you.
