Secure Premium Payment
Please use this secure form for sending personal or confidential information. You may use this form to:
- Send personal credit card or bank account information.
- Provide updates on your health condition or changes in conditions.
- Make change requests to your current plan or account information.
- Submit claim forms and/or confidential medical records.
All information will be stored in an encrypted and secured database until it is ready to be accessed by a support representative. You will also receive a confirmation email along with a unique reference ID which can be used to track your message.