Request Automatic Bank Account Deduction
To have premiums automatically deducted from a bank account,
complete and submit the form below. If you are not the person we insure,
include your information in the section provided.
Questions? Please call 1-800-523-9100. NY
Residents call 1-800-323-4542.
Your request will be processed within the next few
business days.
Note: For Medicare Supplement plans issued in 2010 or later,
please call 1-800-800-2254 for customer service for your
policy.
(*) Means required field
If you are not the insured, please complete the following:
Please provide the following:
Enter Policy Number(s)
To pay for more than one policy click the Add link.
Add
Banking Information
(choose from the 3rd to the 28th day of the month)
