Get Group Echeck Submission Form - Capital Blue Cross

Filling out the Group ECheck Submission Form is a straightforward process designed to facilitate automatic payment of your first month’s premium directly from your bank account. This guide provides step-by-step instructions to ensure your completion of the form is seamless.

Follow the steps to successfully complete the Group ECheck Submission Form.

1. Press the ‘Get Form’ button to access the Group ECheck Submission Form and open it for editing.
2. In the Group Information section, enter the group name, the name of the group policymaker, and the complete address, including street, city, state, and zip code. Fill in the group policymaker’s telephone number and title accurately.
3. Have the group policymaker sign and date the form in the designated fields to authorize the deduction.
4. Proceed to the Financial Institution Information section. Enter the name of the financial institution and its ABA/Routing Number. Provide the complete address of the financial institution.
5. Fill in the name on the bank account, the bank account number, and the amount of the first month’s premium to be withdrawn.
6. Document the voided check number and ensure that all fields are completed to prevent any delays in processing.
7. After reviewing the form for accuracy, save any changes and either download, print, or share the completed form. Make sure to return it to Capital Blue Cross along with any required new group paperwork.

Complete your Group ECheck Submission Form online today for a hassle-free payment experience.