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United Security Health and Casualty currently does business in Arizona, Arkansas, Illinois, Indiana, Missouri and Nebraska!


State is required.

Please Select an effective date greater than Dec, 31, 2009
Effective Date:

Applicant
First Name:	Middle Initial:	Last Name:
Gender:	Birth Date: MM/DD/YYYY	Tobacco Use:
Healthy Discount


Spouse
First Name:	Middle Initial:	Last Name:
Gender:	Birth Date: MM/DD/YYYY	Tobacco Use:
Healthy Discount


Zip Code:	Dependents:




* Required Fields

* 70/30 Coinsurance is reflected in major medical premium

Accident Benefit

Prescription Drug Card

Network Physician Copay

Coinsurance Option

Dental

Term Life:

Applicant:
Spouse:

Maternity

Applied Behavioral Analysis, Chemical Dependency and Mental Illness Offer

Prosthetic Devices Offer

TMJ

Drug Dependency Benefit

Mental Disorder Benefit

Smoking Cessation Offer

Mental Disorders

Hospice

Morbid Obesity

First Benefit Cancer Plan:

Dental Plus

STMM Add On:

Accident Hospital

Disability Income Plan (Applicant Only)

Network Provider Selection

Benefit:	6 Months	12 Months	24 Months	60 Months
Elimination:	7 Days	14 Days	30 Days	60 Days	90 Days
Occupation/Duties:	P -- White Collar	B -- Accidental	A -- Hazardous
Benefit Amount:
Explanation Of Occupation Codes

Critical Illness:

Exclude Contraceptives

Benefit:
Plan:

If you choose Optional Benefits, you must Select "Update Protector Plus" before applying for coverage.

Maternity

Term Life:

Dental

Applicant:

Prescription Drug Card:

Spouse:

Accidental Death & Dismemberment

Chemical Dependency And Mental Illness

TMJ

Drug Dependency Benefit

Mental Disorders

Hospice

Mental Disorder Benefit

Smoking Cessation Offer

Morbid Obesity

First Benefit Cancer Plan:

Dental Plus

STMM Add On:

Accident Hospital

Disability Income Plan (Applicant Only)

Network Provider Selection

Benefit:	6 Months	12 Months	24 Months	60 Months
Elimination:	7 Days	14 Days	30 Days	60 Days	90 Days
Occupation/Duties:	P -- White Collar	B -- Accidental	A -- Hazardous
Benefit Amount:
Explanation Of Occupation Codes

Critical Illness:

Benefit:
Plan:

If you choose Optional Benefits, you must select "Update Unlimited Access" before applying for coverage.

* 70/30 Coinsurance is reflected in major medical premium

Maternity

Term Life:

Dental

Applicant:

Prescription Drug Card:

Spouse:

Coinsurance Option

Chemical Dependency And Mental Illness

TMJ

Mental Disorder Benefit

Morbid Obesity

Mental Disorders

Smoking Cessation Offer

Drug Dependency Benefit

Hospice

First Benefit Cancer Plan:

Dental Plus

STMM Add On:

Accident Hospital

Disability Income Plan (Applicant Only)

Network Provider Selection

Benefit:	6 Months	12 Months	24 Months	60 Months
Elimination:	7 Days	14 Days	30 Days	60 Days	90 Days
Occupation/Duties:	P -- White Collar	B -- Accidental	A -- Hazardous
Benefit Amount:
Explanation Of Occupation Codes

Critical Illness:

Benefit:
Plan:

If you choose Optional Benefits, you must select "Update HealthSelect PPO" before applying for coverage.

* 70/30 Coinsurance is reflected in major medical premium

Prescription Drug Card:

Chemical Dependency And Mental Illness

Coinsurance Option

TMJ

Drug Dependency Benefit

Mental Disorders

Hospice

Mental Disorder Benefit

Smoking Cessation Offer

Morbid Obesity

First Benefit Cancer Plan:

Dental Plus

STMM Add On:

Accident Hospital

Disability Income Plan (Applicant Only)

Network Provider Selection

Benefit:	6 Months	12 Months	24 Months	60 Months
Elimination:	7 Days	14 Days	30 Days	60 Days	90 Days
Occupation/Duties:	P -- White Collar	B -- Accidental	A -- Hazardous
Benefit Amount:
Explanation Of Occupation Codes

Critical Illness:

Benefit:
Plan:

If you choose Optional Benefits, you must select "Update Preferred Value" before applying for coverage.

Maternity

Term Life:

80/20 Coinsurance Option

Applicant:

Applied Behavioral Analysis

TMJ

Mental Disorder Benefit

Morbid Obesity

Spouse:

Smoking Cessation Offer

Drug Dependency Benefit

Mental Disorders

Hospice

First Benefit Cancer Plan:

Dental Plus

STMM Add On:

Accident Hospital

Disability Income Plan (Applicant Only)

Network Provider Selection

Benefit:	6 Months	12 Months	24 Months	60 Months
Elimination:	7 Days	14 Days	30 Days	60 Days	90 Days
Occupation/Duties:	P -- White Collar	B -- Accidental	A -- Hazardous
Benefit Amount:
Explanation Of Occupation Codes

Critical Illness:

Benefit:
Plan:

If you choose Optional Benefits, you must select "Update Healthy Savings" before applying for coverage.

Short Term Medical

Optional Riders (Additional Premium Required)

Chemical Dependency and Mental Illness
Child Health
TMJ
Alcohol & Drug Dependency
Mental Disorders
Mental Disorder Benefit

PRINT QUOTE

PLEASE PARDON OUR DUST ...

The online application for is currently unavailable.

We apologize for the inconvenience. For now you can print a blank application, fill it in and fax to USH&C at (708) 475-6128.

All online applications will be available soon.

USH&C appreciates your business. Please contact us if you need assistance.

Plan Options

Face Amount:
* Face Amount must be in an increment of $100.00
* Bill Type:	MonthlyQuarterlySemi-AnnualAnnualPre-Authorized Checking
Accelerated Death Benefit Option

Plan Options

Face Amount:
* Bill Type:	MonthlyQuarterlySemi-AnnualAnnualPre-Authorized Checking

Plan Options

Term:
Primary Rate Class:
Primary Face Amount:
	Primary Face Amount must be in an increment of $1,000.
	Primary Face Amount must be $100,000 - $250,000 to qualify for the Preferred Rate Class.
Spouse Face Amount:
	Spouse Face Amount must be in an increment of $1,000.
Dependent(s) Face Amount:
	Dependent(s) Face Amount must be in an increment of $1,000.
* Bill Type:	MonthlyQuarterlySemi-AnnualAnnualPre-Authorized Check/Credit Card
	* The quoted rate will include the billing fee

Plan Options

* Premium includes a $10 annual policy fee and $30 annual administrative fee. Underwritten by United Security Health and Casualty Insurance Company 6640 S. Cicero Ave., Bedford Park, IL 60638

Primary Benefit:
Spouse Benefit:
* Bill Type:	Monthly Quarterly Semi-Annual Annual Pre-Authorized Check/Credit Card

Applicants ages 18 to 59 can get $10,000 or $20,000. Applicants ages 60 to 64 $5,000 or $10,000. Applicants ages 65 to 69 $2,500 or $5,000. Applicants ages 65 to 74 $1,500 or $3,000.

Critical Illness

Basic Plan

Covers cancer, heart attack, kidney failure, stroke & organ transplant
Face amounts available from $5,000 - $50,000
Lump sum benefit paid upon diagnosis
Guaranteed renewability

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Critical Illness

Extended Plan

Covers cancer, heart attack, kidney failure, stroke & organ transplant, severe paralysis & loss of sight/speech/hearing
Face amounts available from $5,000 - $50,000
Lump sum benefit paid upon diagnosis
Guaranteed renewability

PRINT QUOTE

Critical Illness

Basic Plan with Return of Premium

Covers cancer, heart attack, kidney failure, stroke & organ transplant
Face amounts available from $5,000 - $50,000
Lump sum benefit paid upon diagnosis
Guaranteed renewability
Return of Premium Option available

PRINT QUOTE

Critical Illness

Extended Plan with Return of Premium

Covers cancer, heart attack, kidney failure, stroke & organ transplant, severe paralysis & loss of sight/speech/hearing
Face amounts available from $5,000 - $50,000
Lump sum benefit paid upon diagnosis
Guaranteed renewability
Return of Premium Option available

PRINT QUOTE

Security Access Plan

An affordable option for everyday health care needs

Immediate Benefit
No deductible or copay to meet
Preventative care and immunizations
Doctor office visits and presription drugs

Choose Your Optional Benefits

If you have any questions, please call the Marketing Department @ 800-875-4422, option 1.

Accident Hospital

Dental Plus

Critical Illness:

Benefit:
Plan:

If you choose Optional Benefits, you must select "Update Security Access" before applying for coverage.

PRINT QUOTE

Contact Me

If you like our rates and would like a policy please call us at (800) 875-4422 or input your contact information below.

Contact Information will be used solely by USH&C personnel and will not be sold or distributed.

Name:

Phone Number:

Email Address:

Payment Options / Fees

Annual	Direct Bill	Credit Card	PAC/Bank Draft
$0.00	$10.00	$10.00	$2.00

All payment types available in monthly, quarterly, semi-annual or annual options.
A one time, *non-refundable $25.00 application fee must be included with the initial payment for all major medical applications.
* subject to state regulation
Do not cancel current coverage until approved by United Security Health and Casualty.

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FREE QUOTE

Online Rater

Effective Date:

Applicant

Spouse

Short Term Medical

Optional Riders (Additional Premium Required)

PLEASE PARDON OUR DUST ...

Plan Options

Plan Options

Plan Options

Plan Options

Critical Illness

Critical Illness

Critical Illness

Critical Illness

Security Access Plan

Choose Your Optional Benefits

Contact Me

Payment Options / Fees