Check on your ID card or your Member Guide. Does your ID card or Member guide have one of these 3 logos? Use the claim forms that correspond to the appropriate logo located on your ID Card. Your ID card also has type of insurance on the back along with the Claims administrator & phone number.
If your Logo is (see below) and the back of your ID card has the claim's administrator as CBP, select for the correct CLAIM FORM HERE.
The Claims Administrator for United States Fire Insurance Company's Group Accident Insurance is:
Co-ordinated Benefit Plans (CBP)
Po Box 23802 | Tampa, FL 33623 | Phone: 877.442.7029 | Email: email@example.com
Online Claims Look-up: CBPConnect.com
If your Logo is (see below) and the back of your ID card has the Claim's Administrator as GTL, select for the correct Claim Forms below:
The Claims Administrator for Guarantee Trust Life Insurance Company's Group Accident Only Insurance is:
Guarantee Trust Life Insurance Company
Po Box 1148 | Glenview, IL 60025-8148 | Phone: 800.622.1993 | Fax: 847.803.1835
If your logo is (see below) and the back of your ID card has the Claim's Administrator as HSR, select for the correct Claim Forms Below:
The Claims Administrator for Sirius America Insurance Company's Blanket Group Accident Insurance is:
Health Special Risk (HSR)
HSR Plaza II 4100 Medical Parkway, Suite 200 | Carrollton, Texas 75007 | Phone (972) 512-5600 | Fax: (972) 512-5820 | Toll Free (866) 523-3452
Important: Healthy America and United Business Association (UBA) are not authorized to pay claims or be involved in the claims decision process. All claim decisions are made by the TPA claims administrator and the insurance carrier.
If you need help, contact us at 866.438.4274 and we will be happy to try and assist you.