Online Document Delivery Agreement (agreement to go paperless).
Thank you for choosing to receive your Membership Premium Payment information online. Membership Premium Payment includes the following list of documents:
- Account Inquiry/IRS Information
- Billing Address Change - Outside the USA
- Cashed Refund Check(s)
- COBRA Important Information
- COBRA Payment Delinquency
- COBRA Rates
- Consolidated Billing – Denied
- Consolidated Billing - Information Needed
- Direct Pay Account - Change to payment method from credit card to monthly invoice
- Direct Pay Account - Change to payment method from Electronic Funds Transfer (EFT) to monthly invoice
- Direct Pay Account - Change to payment method from monthly invoice to credit card
- Direct Pay Account - Change to payment method from monthly invoice to Electronic Funds Transfer (EFT)
- Direct Pay Account - Credit card deduction change
- Direct Pay Account - Electronic Funds Transfer (EFT) deduction change
- Direct Pay Account - Rate increase
- EFT Amount to Debit
- EFT Discontinued
- EFT Failed
- EFT Set Up Confirmation
- Electronic Funds Transfer Failed
- Finance Fee
- Finance Status
- Individual Insufficient Funds - Payment Remittance Did Not Clear
- Individual Medi-Cal Delinquency - Termination
- Individual Premium Payment Delinquency
- KPIF - Active Account with Balance Due
- KPIF - Electronic Funds Transfer Return
- KPIF - Rate Change Notice
- KPIF - Receipt of Payment
- Payment Correction
- Payment Not Honored
- Payment Past Due Notice
- Payment Research Information Needed
- Payment(s) Due
- Premium Information/Options
- Rate/Premium Change
- Refund - Letter Of Indemnification
- Renewal Premium Update /Options
- SHOP - Individual Delinquency - Termination Notification
- Status of Account Letter
- Stopping Payment on a Third Party's Account
- Unable to Process - More Information Needed
Viewing your Membership Premium Payment documents online, instead of receiving printed materials by mail, is environmentally friendlier and secure.
Your preference selection tells us how you would like to receive your documents during our normal distribution process. Your preference to receive electronic documents online will be processed within 30 days of your request.
Your electronic Membership Premium Payment documents will be posted in a format that you can easily open, view, and print using industry standard software at any time.
If you change your mind, you may come back to this site to update your preference at any time. Simply opt back in to the paper process by choosing "U.S. Mail". Your preference will be processed within 30 days of your request.
If you would like to request a paper copy, have any questions about your Membership Premium Payment, or need help with the online feature, please call Member Services.