Thank you for submitting your COBRA election form. We cannot report your eligibility until we have received your premium payment.
You do not have to make this payment now. We will be sending you an invoice for the premium.
Please use this form to make your first payment for your COBRA coverage if you would like us to report your eligibility as soon as possible.
This is a TWO step process.
We will process your request for a credit card payment and send you an invoice via email to make your payment directly on the PayPal website.
Once you receive the email invoice and complete the payment using the link on the email, we will post the premium payment to your account.
You do not have to be a PayPal member to make a payment.
To cover the cost of processing the credit card payment we will add a 3.5% fee (minimum fee is $2.00) to your premium amount due. The fee will be shown as 'shipping'.
This payment will not be processed immediately.