Payment Information

Success You have successfully added automatic payments from your checking account.

Success You have successfully made a payment using your Credit/Debit Card. Your payment will be processed in .

Success You have successfully deleted automatic payments. Your insurance bill will no longer be paid automatically. You will be required to pay your bill manually.

Success You have successfully made a payment using your . Your payment will be processed in

Success You have chosen to submit your payment via mail. Don't forget to mail your statement along with your check. Your Payment History and associated statement will reflect your payment once we receive and process your check. This typically takes from 5 – 10 business days.

Statement	Due Date	Past Due	Current Balance	Total Due		Auto-Pay
		$0.00	$332.00	$332.00		Auto-Pay: OFF

Past Due Amount Past due amounts must be paid immediately or you risk losing your coverage.

Payment Required First automatic payment will occur on May 1, 2018. Ensure that you make a payment for the statement due on April 1, 2018.

Add Auto-Pay

Payment Method

Account Type

Bank routing number:

Institution Name:

Account number:

Note: First automatic payment will occur on May 1, 2018. Ensure that you make a payment for the statement due on April 1, 2018.

Edit Auto-Pay

Payment Method

Account Type

Bank routing number:

Institution Name:

Bank Name

Account number:

Note: First automatic payment will occur on May 1, . Ensure that you make a payment for the statement due on April 1, 2018.

Select a Payment Option

Total Due: $332.00 / Due Date:

How would you like to pay your bill?

Credit / Debit Card (one-time)

Fees Apply

I Agree to the $10 convenience fee that will be added to the total due.

Note: A refund or reversal will result in an additional $10.00 fee.

Credit Card / Debit Card Information

Name on the Card

Card number

Expiration

Security Code

Billing Address

Address 1

Address 2(optional)

City

State

ZIP Code

You're paying your total due of $332.00 plus the $10.00 convenience fee.

Bank Account (one-time Direct) -transfer funds from my bank account one time.

Account Type:

Bank Routing Number:

Institution Name:

Account Number:

Note: Payment typically takes 3 – 5 business days to process after your payment is submitted.

Pay Bill

Mail a check or money order

To make a payment by check or money order, select and print the appropriate statement and mail it along with your payment. It typically takes from 5 – 10 business days for us to receive and process this type of payment.

Cancel

Account Number	123456789
Payment Due Date	05/01/
For coverage period	05/01/ – 05/31/
Amount Due	$332.00
Total Enclosed	$

Post Date	Description	Benefit	Amount
04/15/	Charge	Medical Plan	$212.00
04/15/	Charge	Dental Plan	$50.00
04/15/	Charge	Medical Plan - Medicare	$70.00

Account Number	123456789
Payment Due Date	04/01/
For coverage period	04/01/ – 04/30/
Amount Due	$0.00

Post Date	Description	Benefit	Amount
03/15/	Charge	Medical Plan	$212.00
03/15/	Charge	Dental Plan	$50.00
03/15/	Charge	Medical Plan - Medicare	$70.00
03/31/	Payment		($332.00)

Coverage	Coverage Dates
Medical Plan	-
Dental Plan	-
Medical Plan - Medicare	-

Health & Insurance

Payment Information

Add Auto-Pay

Edit Auto-Pay

Select a Payment Option

Recent Activity

Coverage Dates	Amount Due	Payment Received
-	$332.00	$332.00	Receipt
-	$332.00	$332.00	Receipt
-	$332.00	$332.00	Receipt