Welcome to USBA!
Military Life Insurance, TRICARE, CHAMPVA
Supplements for Armed Forces & Services:
Active Duty, Transitioning Military,
Veterans, Retired Military, Reserve &
National Guard, Federal Employees

QUESTIONS? Contact Us
877-297-9235 Sales
800-821-7912 Member Support

8/18/2018

Life Insurance Application for Individuals Joint Life Insurance Application for Spouses

Member Service Center Term Renewal Options Forms BRIEFING Newsletter Member Exclusive Offers Member Contact

Overview Board Members eCard Gallery Polls Press Room Scholarship & Recipients Testimonials Privacy Policy

Home > Contact Us

Contact Us / Free USBA Military Life Insurance Information Packet

Welcome USBA Members!

Questions? Want a FREE Information packet? Just complete this form or call us from 8am to 4:30pm CST, Monday through Friday, at (800) 821-7912.

*Required fields.

1. Member ID#: Please supply your member # to expedite your request. For your privacy, this is a secure form.

2. Select the plans in which you are most interested:

Life Insurance Plans
Smart Value 10 Year Group Level Term
Smart & Lean 15 Year Group Level Term
Long Term 20℠ Year Group Level Term
Double Value TWO for ONE^® Family Group Level Term
Basic Value Group Level Term
Life-Time Value Group Whole Life
50+ Group Whole Life
First Steps℠ Children’s Group Whole Life

Other Insurance Plans
Hospital Indemnity
TRICARE Select Supplement*
TRICARE Reserve Select Supplement*
TRICARE Retired Reserve Supplement*
CHAMPVA Supplement*
Long Term Care Insurance

*Not available in all states

**Monumental Life Insurance Company, a Transamerica company, Cedar Rapids IA

3. What is your mailing address?

*First Name:
Middle Initial:
*Last Name:
*Gender:
*Address 1:
Address 2:
Apt. #:
*City:
*State:
*Zip Code:
Date of Birth:		/ /
Tobacco Use:
Qualification Status:

4. How do you want to be contacted? Enter either a phone # or email address if you want us to contact you.
Contact Method:
Best Time to Contact:
Phone Number:		- - Ext.
Email Address:
Confirm Email Address:

5. Spouse Information: if interested in spousal coverage:
Spouse First Name:
Spouse Middle Initial:
Spouse Last Name:
Spouse Birthdate:		/ /
Spouse Tobacco Use:

6. Message:

If you wish to contact us by mail, please send to:

USBA
P.O. Box 25956
Overland Park, KS 66225-5956