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USBA Group Life Insurance plans are underwritten by New York Life Insurance Company
 
 
Questions? Call (800) 821-7912
or Contact Us
 

USBA Member Forms: Name/Address Change, Account Permission, Pay Method, Scholarship

 
Some of our most commonly requested forms are now available online. Just click on the link to the form you need, print it, fill in the requested information, and mail the completed form to us at:

USBA
P.O. Box 25956
Overland Park, KS 66225-0956
 
 
Request for Change of Name
If you’ve changed your name and need us to update our records,  click here.

Request for Change of Address
If you want to notify USBA of an address change, click here. (Or go back to the Member Contact form and notify us by e-mail. Be sure to include your current address and phone, your new address, and the effective date you’ll be at the new address.)

Permission to Receive Account Information
If you want to give your spouse or someone else permission to get information about your USBA coverage, click here. (NOTE: We are not allowed to disclose this information unless we have signed permission from the owner of the coverage.)

Member Pay Forms
Automatic Payment Options

For your convenience, USBA monthly payments can be made through military allotment or USBA EZ PAY. To start or change an automatic pay method, click on the appropriate link below.

USBA EZ PAY (Automatic Bank Draft)
Using this convenient pay method, your insurance premium is automatically deducted from your bank account each month. Simply deduct your insurance premium amount from your bank balance on the first of every month. USBA does the rest.
Convenient Online USBA EZ PAY form – you must sign in to the Member Service Center to use this secure form.
Print and Mail-in USBA EZ PAY Form
Bank Change Form – Use only if you are currently paying your USBA premiums by USBA EZ PAY (formerly known as Checkmatic) and need to make a bank change.
Military Allotment
Premium payment by allotment is available to those drawing Active Duty or Retired military pay (except retired PHS). It offers the convenience of having your insurance premium deducted from your pay and sent directly to USBA. The allotment will be sent to USBA each month—no hassle of writing a check, plus your premium is always paid on time.

Just call us at (800) 821-7912 if you have questions or need assistance in completing the allotment form.

Start a New Allotment Deduction
To start a NEW allotment, select your duty status and branch of service. Then print the form. Once completed, file it with your Finance Center or Finance Officer. Filing instructions are provided on each form.
Active Duty Army
Active Duty Air Force or Navy
Active Duty Coast Guard
Active Duty Marine Corps
Active Duty NOAA
Retired Air Force, Army, Marine Corps, or Navy
Retired Coast Guard

Change an Existing Allotment Deduction
To CHANGE an existing USBA allotment, select your branch of service and duty status. Then print the form. Be sure to complete all information needed. Your current USBA allotment amount can be found on your LES statement. Filing instructions are provided on each form.
Active Duty Air Force or Navy
Active Duty Army
Active Duty Coast Guard
Active Duty Marine Corps
Active Duty NOAA
Retired Air Force, Army, Marine Corps, or Navy
Retired Coast Guard
 
Request for Dietrich Scholarship Application
Click here for information about USBA’s William A. Dietrich Memorial Scholarship. It’s offered to graduating high school seniors each school year. Applications must be received at USBA by March 31 prior to graduation.
     

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