Monthly Automatic Withdrawal (Pay-O-Matic) is Convenient! You won?t need to write a single check or buy a stamp. And there?s no extra cost to you! Once a month, on your billing date, we?ll deduct.
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How to fill out the Bcbs Mn Payomatic Fax Number Form online
The Bcbs Mn Payomatic Fax Number Form is designed to facilitate automatic monthly payments. This guide provides a clear, step-by-step approach to help you complete the form accurately and efficiently.
Follow the steps to complete the Bcbs Mn Payomatic Fax Number Form online
- Press the ‘Get Form’ button to access the form. Ensure you have the required information ready before proceeding.
- Complete the Monthly Automatic Withdrawal (Pay-O-Matic) authorization form. Include your name on the bank account, the bank's name, and account number.
- If using a checking account, attach a void check to the form. If using a savings account, attach a savings deposit slip. Ensure the attachment is secured with tape, avoiding staples.
- Fill in the branch office address, city, state, and zip code associated with your bank account.
- If you are a new customer, enclose a check for one month’s payment with your application. Existing members should not send any money.
- Sign the form in the designated areas, confirming your authorization for Blue Cross to deduct payments from your account. Include any joint account holder’s signature if applicable.
- Review the completed form for accuracy before submission. Once satisfied, send it to the indicated mailing address for Blue Cross and Blue Shield of Minnesota.
- Upon submission, retain a copy of the form for your records. You can choose to stop automatic withdrawals by notifying Blue Cross at least 15 days before your next payment.
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