Payment Information

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

Success You successfully made a payment of $332.00 on Month Day, Year. Your payment will be processed in 2 - 3 days.

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 successfully made a payment of $332.00 on Month Day, Year. Your payment will be processed in 3 - 5 days.

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 You must pay your past due amount of $125.00 by January 14, 2020, or you may lose coverage.

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

Add Auto-Pay

Payment Method

Account Type

Bank routing number:

Institution Name:

Account number:

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

Edit Auto-Pay

Payment Method

Account Type

Bank routing number:

Institution Name:

Bank Name

Account number:

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

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: The convenience fee of $10 will appear separately on your credit card statement.

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.

Cancel

Bank Account (one-time or recurring) - transfer funds from bank account

Account Type:

Bank Routing Number:

Institution Name:

Account Number:

Frequency:

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

Cancel 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 OK

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
For coverage period	–
Amount Due	$0.00

Description	Benefit	Amount
Charge	Medical Plan	$212.00
Charge	Dental Plan	$50.00
Charge	Medical Plan - Medicare	$70.00
Payment		($332.00)

Received
Amount	$332.00
Method	Direct Debit

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