Fill out and electronically submit the enrollment form below or
download the printable version and mail to:
HealthGap - Administration, 3830 N 167th Ct, Omaha NE 68116. DO NOT SEND MONEY AT THIS TIME.
You will be billed for your first month's payment.
*HealthGap is not an insurance plan. It is a discounted membership plan. Range of discounts for medical or ancillary services provided
under the plan will vary depending on type of provider, medical or ancillary service received. The plan does not make payments to
providers for the medical or ancillary services received under the discount medical membership plan. Contracted providers will accept
$10.00 at time of visit as payment for all services provided in the urgent care setting. Membership fees must be paid current. All providers
working for Urgent Care of Omaha are contracted under this membership plan.