USBA Military Life Insurance Logo
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
New York Life Insurance Logo
USBA Group Life Insurance plans are underwritten by New York Life Insurance Company
QUESTIONS? Contact Us
877-297-9235 Sales
800-821-7912 Member Support
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 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 Standard/Extra Supplement*
TRICARE Reserve Select Supplement*
TRICARE Retired Reserve Supplement*
CHAMPVA Supplement*
Cancer Care Insurance**
Long Term Care Insurance

*Coverage is currently not available in Maine, Montana, Nevada, New Hampshire and Washington.

**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:
 
 

Before submitting this form, please type the characters displayed above:

     
  

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

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


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