National Benefit Plan

Our Packages

Download Application

FILL IN THE INFORMATION REQUESTED:

Date :

First Name : Last Name :

Address 1:

Address 2:

City: State : Zip :

Daytime Phone :

Evening Phone :

E-Mail :

Date of Birth (Must be under the age of 70):

DEPENDENTS (required for family memberships):

Name:      DOB      Relationship:

Name:      DOB      Relationship:

Name:      DOB      Relationship:

Name:      DOB      Relationship:

SELECT ONE OF THE FOLLOWING PLANS:

Bronze - Single Membership: $29.50

Bronze - With Family Membership: $39.50

added seperate benefits at no additional charge

$2,500 Accident Medical with $2,000 Accidental Death & Dismemberment

*One time enrollment fee of $15.00 applied to all plans

Silver - Single Membership: $43.50

Silver - With Family Membership: $53.50

added seperate benefits at no additional charge

$5,000 Accident Medical with $2,000 Accidental Death & Dismemberment

*One time enrollment fee of $15.00 applied to all plans

Gold - Single Membership: $50.50

Gold - With Family Membership: $60.50

added seperate benefits at no additional charge

$7,500 Accident Medical with $2,000 Accidental Death & Dismemberment

*One time enrollment fee of $15.00 applied to all plans

Platinum - Single Membership: $56.50

Platinum - With Family Membership: $66.50

added seperate benefits at no additional charge

$10,000 Accident Medical with $2,000 Accidental Death & Dismemberment

*One time enrollment fee of $15.00 applied to all plans PAYMENT OPTIONS BANK OR CC:

BANK DRAFT: I HEREBY AUTHORIZE NIA Asset Protection Group to initiate funds transfers from the depository financial institution account indicated below and authorize my depository financial institution to honor those transfers. I understand that the initial funds transfer will be for the cost of the plan that I have chosen plus a one time $15 membership
fee.

Please choose one of the four convenient draft dates that you wish the account at your depository financial institution to be debited for the

National Benefit Plan:

Draft Date:
1st 15th

NAME OF ACCOUNT HOLDER:

ACCOUNT TYPE: CHECKING SAVINGS

NAME OF BANK:

CITY: STATE: ZIP:

BRANCH:

ABA # (#s at bottom of check)

ACCT#

Credit Card Info:
Credit Card Type:
Credit Card Number:
Expiration Date: MM YY

SIGN HERE (Type Your Name) :
( signature required )

I have read and agree to the Terms & Conditions Listed below: :

TERMS AND CONDITIONS

CBA Membership includes both insured and non-insured benefits and services. CBA or NIA Asset Protection Group [are not insurance companies]. CBA is an association enrolls members. The insurance is provided by Guarantee Trust Life Insurance Company under group policy form GP1200 issued to National [Association] of Consumers Direct.
NIA Asset Protection Group throuogh membership in CBA provides savings to its members on services with a number of sources. The current list of benefits may be modified through additions deletions at its discretion. Healthcare professionals providing healthcare services reimbursement from NIA Asset Protection Group or CBA.
Membership in CBA will automatically terminate if a member's dues are not paid on a timley basis.
Membership is effective on the first day of the first month immediately following date that the application is accepted by CBA. following enrollment acceptance Membership is renewable at the Member's option. Non-payment will result in cancellation membership. A member may cancel at any time by written notice to: Asset Protection Group.
Membership dues may be changed for all members, but not individually, upon notice. The benefit information contained herein is a brief summary only and subject provisions, limitations and exceptions set forth in the membership packet. Please your membership packet for the exceptions and limitations.
The IP address from the computer/interface you are using will be saved for security and validation purposes.
"These insurance benefits are underwritten by Guarantee Trust Life Insurance Company. These benefits are under policy Form MP-1300 issued to Consumer Benefits of America. Coverage becomes effective on the date provided in your membership material."

This website provides summary information. For a complete listing of benefits, exclusions and limitations, please refer to the certificate of insurance. In the event there are discrepancies with the information on this website, the terms and conditions of the coverage documents will govern.

The National Benefit Plan is not available to residents of NY, OR, MD, NH, OK or TX.

Credit Card Info: