Online Application

$2500 FAMILY
AccidentSHIELD
PLUS, ENHANCED & PREMIUM Plans


For Single Plans or other Family Plans, return to the APPLY NOW Page

Dues as low as:
$46.00 PER MONTH
There is a one-time, registration fee of $10 for the Plan.


Please complete the application TODAY so that we may process your request immediately. Plan benefits will begin on the 1st day of the month following receipt of your application. If today is the 1st of the month, your benefits will start TODAY.
If you have any type of medical emergency, DO NOT delay treatment. Such a delay could result serious harm or illness, and might result in expenses that exceed any savings realized by waiting for the plan to go into effect.

Once you have completed the application below, we will send you an email message as your confirmation of receipt of your application. The confirmation will contain instructions and telephone numbers that will allow you to make a claim if you need to before your membership packet arrives (usually in 1-2 weeks).

WBA uses a true Secure Application system powered by Plug'n Pay Technologies to assure the confidentiality of your personal information.

Please Select Your Plan Design
$2500 FAMILY AccidentSHIELD PLUS Plans
+ Accidental Total Temporary Disability (TTD) $53 per month
+ TTD                                                     $636 per year
+ Accidental Total Temporary Disability & Spouse TTD (TTD&STTD) $71 per month
+ TTD&STTD                                            $852 per year
+ Consult-A-Dr Premium (CaDr) $46 per month
+ CaDr                                               $552 per year
+ $100,000 AD&D ($100K AD&D) $53 per month
+ $100K AD&D                                   $636 per year
+ $250,000 AD&D ($250K AD&D) $72 per month
+ $250K AD&D                                   $864 per year
$2500 FAMILY AccidentSHIELD ENHANCED Plans/F>
+ TTD + CaDr $64 per month
+ TTD + CaDr                                      $768 per year
+ TTD&STTD + CaDr $82 per month
+ TTD&STTD + CaDr                             $984 per year
+ TTD + $100K AD&D $71 per month
+ TTD + $100K AD&D                          $852 per year
+ TTD&STTD + $100K AD&D $89 per month
+ TTD&STTD + $100K AD&D                 $1068 per year
+ TTD + $250K AD&D $90 per month
+ TTD + $250K AD&D                          $1080 per year
+ TTD&STTD + $250K AD&D $108 per month
+ TTD&STTD + $250K AD&D                 $1296 per year
+ CaDr + $100K AD&D $64 per month
+ CaDr + $100K AD&D                    $768 per year
+ CaDr + $250K AD&D $83 per month
+ CaDr + $250K AD&D                    $996 per year
$2500 FAMILY AccidentSHIELD PREMIUM Plans
+ TTD + CaDr + $100K AD&D $82 per month
+ TTD + CaDr + $100K AD&D           $984 per year
+ TTD&STTD + CaDr + $100K AD&D $100 per month
+ TTD&STTD + CaDr + $100K AD&D  $1200 per year
+ TTD + CaDr + $250K AD&D $101 per month
+ TTD + CaDr + $250K AD&D           $1212 per year
+ TTD&STTD + CaDr + $250K AD&D $119 per month
+ TTD&STTD + CaDr + $250K AD&D  $1428 per year

DUES SHOWN DO NOT INCLUDE $10 ONE TIME ENROLLMENT FEE

WE ACCEPT THE FOLLOWING PAYMENT METHODS.
Credit Card Types
CHECKS
ONLINE
Please tell us how you found our web site
Please give us the name of the source
Search engine name, magazine, link site, etc.


 
READ CAREFULLY BEFORE YOU APPLY

Member Information Guide and Membership Identification Card(s) will be supplied via U.S. Postal service. Your request authorizes Comprehensive Insurance Agency, LLC, on the behalf of WBA, to charge your credit card or debit your checking account for the initial and subsequent payments to start and continue your WBA membership. Comprehensive Insurance Agency, LLC will charge your credit card or debit your checking account as each modal dues payment comes due. You must provide Comprehensive Insurance Agency, LLC 30 days written notice if you wish to cancel your WBA membership.

After the initial guarantee period has passed, refunds will be based on the following 1st day of the month 30 days AFTER your written request to cancel your membership. Cancellation requests must be in writing or via email. The member will be refunded the unused portion, if any, of dues paid in advance.

ENROLLMENT FEE


A one time, non-recurring enrollment fee of $10.00 will be added to the
first modal dues charge that appears on your credit card or bank statement.
TOTAL INITIAL PAYMENT CHARGE
will be your chosen plan dues PLUS $10.00.
All dues thereafter will be the chosen modal dues.

I understand that my coverage will not become effective, active and available until the 1st day of the 1st month following submission of my application unless the "Earliest Available" option was chosen on the application.


AGREEMENT AND AUTHORIZATION

I have read, understand and agree to the terms and conditions above. I authorize Comprehensive Insurance Agency, LLC to sign and charge my credit card or debit my checking account according to the plan and payment frequency I have chosen.

I authorize Comprehensive Insurance Agency, LLC the authority to charge my credit card or debit my checking account for all future modal renewal dues as they come due. I will notify Comprehensive Insurance Agency, LLC in writing of my wish to cancel my WBA membership at least 30 days in advance.

Please Select Your Payment Method:

All text, images and other content of this web site are protected by copyright law and shall not be used or reproduced in any medium without the express, specific written consent of the site owner.
Comprehensive Insurance Agency, LLC - All rights reserved.