Get the free PERACare Automatic Payment Authorization - copera

This form is used to authorize Colorado PERA to automatically withdraw PERACare premiums from the individual's checking or savings account.

How to fill out peracare automatic payment authorization

How to fill out PERACare Automatic Payment Authorization

1. Obtain the PERACare Automatic Payment Authorization form from the official PERACare website or your benefits provider.
2. Fill in your personal information, including your name, address, and contact details.
3. Provide your PERACare membership number or any required identification number.
4. Specify the bank account details from which payments will be deducted, including the bank name, account number, and routing number.
5. Indicate the frequency of payments (e.g., monthly, quarterly).
6. Sign and date the authorization form to confirm your agreement to the automatic payment plan.
7. Submit the completed form to the designated PERACare office or your payment processing department.

Who needs PERACare Automatic Payment Authorization?

1. Individuals enrolled in the PERACare health benefits program who prefer automatic deduction for their premium payments.

People Also Ask about

Is PERACare any good?

PERACare plans offer generous benefits and broad networks of providers across the United States. The plans also cover only retirees, who tend to have more medical needs and use more services than the general population, resulting in higher plan costs.

How do I revoke an automatic payment authorization?

You can do this over the phone, or you can write the company stating clearly that you are revoking authorization. Then, you'll need to contact the bank or credit union that's associated with the payment and let them know that you've revoked authorization from the company.

Is PERACare a medicare advantage plan?

PERACare offers three Medicare Advantage plans that combine all of the benefits of Medicare Parts A and B with Part D prescription coverage into one comprehensive plan with easy to understand out-of-pocket costs.

How do I revoke authorization for automatic payments?

Call and write your bank or credit union Next, call your bank or credit union and say you have revoked authorization for the company to take automatic payments from your account. Customer service should be able to help you, and your bank or credit union might have a form for this online.

What is electronic payment authorization form?

An ACH authorization form, also known as an ACH payment form, is an essential component of electronic transactions used to grant permission to a financial institution to debit or credit an individual or business account, allowing for the transfer of funds between bank accounts.

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What is PERACare Automatic Payment Authorization?

PERACare Automatic Payment Authorization is a form that allows participants in the PERACare health insurance program to authorize automatic withdrawals from their bank accounts for premium payments.

Who is required to file PERACare Automatic Payment Authorization?

Participants who wish to set up automatic payments for their PERACare health insurance premiums are required to file the PERACare Automatic Payment Authorization.

How to fill out PERACare Automatic Payment Authorization?

To fill out the PERACare Automatic Payment Authorization, participants must provide their personal information, bank account details, and indicate the preferred payment schedule. It's important to review the form for accuracy before submission.

What is the purpose of PERACare Automatic Payment Authorization?

The purpose of the PERACare Automatic Payment Authorization is to simplify the premium payment process for participants by allowing automatic deductions, thus ensuring timely payments and reducing the risk of lapse in coverage.

What information must be reported on PERACare Automatic Payment Authorization?

The information that must be reported includes the participant's full name, address, PERACare account number, bank account details (account number and routing number), and authorization for the automatic payment to be debited from the account.