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Please! Add all the information to complete your payment.
Payment Form Health
Policy Number
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Payment Frequency
Annual (1 Single Payment)
Semi-Annual (2 Payments)
Quarterly (4 Payments)
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Important info regarding payment frequencies:
•
Annual:
No additional fee (1 single payment) | •
Semi-Annual:
10% additional fee (2 installments)
•
Quarterly:
12% additional fee (4 installments) | •
Monthly:
20% additional fee (12 installments)
•
Policy Fee:
charged once, included only in your first payment (not added to each installment).
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• American Express transactions incur an additional 4% charge.
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