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Direct Payment Authorization Format to:Mail to:Phone support:Email support:(608) 8314790 Employee Benefits Corporation, PO Box 44347, Madison WI 537444347 (800) 3462126 | (608) 8318445 employerservices@ebcflex.comGetting

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How to fill out cobrasecure direct payment authorization

01

Step 1: Obtain the direct payment authorization form from CobraSecure.

02

Step 2: Fill in all required information such as your name, address, payment amount, and payment frequency.

03

Step 3: Provide your bank account details including account number and routing number.

04

Step 4: Sign and date the form to authorize CobraSecure to make direct payments from your bank account.

05

Step 5: Submit the completed form to CobraSecure for processing.

Who needs cobrasecure direct payment authorization?

01

Individuals who want to authorize CobraSecure to make direct payments from their bank account.

02

Companies or organizations that have an agreement with CobraSecure for direct payments.

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What is cobrasecure direct payment authorization?

Cobrasecure direct payment authorization is a secure method of authorizing payments directly to Cobra Insurance providers without the need for manual approval or processing.

Who is required to file cobrasecure direct payment authorization?

Employers or individuals who are enrolled in Cobra Insurance are required to file cobrasecure direct payment authorization.

How to fill out cobrasecure direct payment authorization?

To fill out cobrasecure direct payment authorization, you need to provide relevant personal and payment information online through the secure portal.

What is the purpose of cobrasecure direct payment authorization?

The purpose of cobrasecure direct payment authorization is to streamline the payment process for Cobra Insurance premiums and ensure timely payments to providers.

What information must be reported on cobrasecure direct payment authorization?

Information such as personal details, payment method, insurance plan details, and payment frequency must be reported on cobrasecure direct payment authorization.

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