Group Comprehensive Accident Insurance
Thank you for using our Online Application Process. Coverage for yourself,
or eligible spouse, will become effective as soon as the application is approved/processed and first premium is paid.
Fields marked with * are required
Please complete so you can easily save and come back to this application. Once you click “Next”, we’ll send you an email with your information for future reference.
(If you’re not working with an agent, leave the field blank.)
IMPORTANT: If you are working with an agent, you have
been provided with an agent number to use on this application. Please enter the number
in the field above.
Please note: This coverage is guaranteed acceptance for eligible USBA Members and their spouses ages 18-59
who are working at least 20 hours per week and not on active duty.