This plan is not available in New York.

All applications are in PDF format readable with Acrobat Reader. Select the Minnesota Only application if you live in Minnesota. All other states except New York and Utah use the 47 States application.

USBA Members: If you want to change your existing coverage, please tell us exactly what you want to cancel, replace, or reduce in a statement you sign and date. Then enclose the statement with your application to help us process your request more quickly. All requests for a change in coverage are subject to approval by the insurance company.

Please tell us how you came to our Web site: Select One Search Engine Website Ad Print Ad Email Friends or Family TV Ad Direct Mail Called USBA Insurance Agent Other Job Fair Alabama State Employee Association Download 49 States Application Attention Puerto Rico Residents Please contact USBA regarding your application for this product. 1-800-368-7021 Select One Yahoo! Google MSN Other Select One Yahoo! AOL Military.com Hampton Roads/PilotOnline Knight-Ridder TA Online GI Jobs Other Corporate Gray FayettevilleNC.com Military Exits MSN SignOnSanDiego.com Select One GI Jobs Military Times Association Journal Other Select One Destiny Job Site Other Channel Name: Agent Name: Please Name: Select One 1/24/07 Virginia Beach, VA Other